腔隙性梗死和脑白质病变患者的认知损害

Cognitive impairment in patient with lacunar infarct and white matter lesion

目的探讨腔隙性梗死（1acLInarinfarct，LI）和脑白质病变（whitematterlesion，WML）患者认知损害的特征及其危险因素。方法纳入年龄65～75岁的LI和WML住院患者，收集其人口统计学和临床资料。LI和WML通过MRI确诊。采用蒙特利尔认知评估量表（MontrealCognitiveAssessment，MoCA）评价认知功能。采用抑郁自评量表和汉密尔顿焦虑量表排除抑郁和焦虑患者。根据MoCA总分将患者分为认知损害组和认知功能正常组，比较两组人口统计学和临床资料。采用多变量logistic回归分析确定认知损害的独立危险因素。对LI和WIVlL的认知损害特征进行比较。结果共纳入130例LI或WML患者。其中，92例存在认知损害，38例认知功能正常；85例存在LI，45例存在WML；男性53例，女性77例。单变量分析显示，认知损害组受教育年限[（7．54±4．65）年对（11．29±3．17）年；t=4．286，P=0．001]显著性低于认知正常组，而高血压（54．6％对16．2％；X2=4．477，P=0．018）、高脂血症（53．1％对16．2％；X2=5．263，P=0．044）、糖尿病（46．9％对10．8％；，=3．827，P=0．017）以及LI（43．8％对21．5％；X2=3．928，P=0．015）和WML（26．9％对7．7％；X2=4．072，P=0．009）的构成比显著性高于认知正常组。多变量logistic回归分析显示，受教育年限[优势比（oddsratio，OR）1．305，95％可信区间（Confidenceinterval，CI）1．104～7．975；P=0．001]、糖尿病（OR1．328，95％C／1．292～3．422；P=0．015）、高血压（OR1．978，95％叫1．034～5．443；P=0．028）、LI（OR1．224，95％C11．004～2．007；P=0．013）和WML（OR1．489，95％C／1．202～3．778；P=0．010）是认知损害的独立危险因素。WML组MoCA总分[（21．61±5．33）分对（19．19±7．07）分；t=1．841，P=0．038]以及立方体复制[（0．43±0．50）分对（0．31±0．47）分；t=1．104，P=0．010]、画钟实验[（2．53±0．89）分对（2．04±1．22）分；t=2．229，P=0．008]、字母辨别[（0．85±0．36）分对（0．62±0．50）分；t=2．585P=0．000]和100连续减7[（2．62±0．79）分对（2．19±1．17）分；t=2．113；P=0．001]得分均显著性低于LI组。结论LI和WML患者均常伴有认知损害，而且WML患者的认知损害较重。受教育年限、高血压病和糖尿病是LI和WML患者发生认知损害的独立危险因素。WML患者的视空间执行功能和注意力损害较LI患者更明显。

Objective To investigate the features and its risk factors for cognitive impairment in patients with lacunar infarct （LI） and white matter lesion （WML）.Methods The inpatients with LI and WML aged 65 to 75 years old were enrolled. Their demographic and clinical data were collected. LI and WML were diagnosed by magnetic resonance imaging （MRI）. Montreal Cognitive Assessment Scale （MoCA） was used to evaluate cognitive function. Self-Rating Depression Scale and Hamilton Anxiety Scale were used to exclude patients with depression and anxiety. The patients were divided into either a cognitive impairment group or a normal cognitive function group. The demographic and clinical data of both groups were compared. Multivariate logistic regression analysis was used to analyze and determine the indenendent riskfactors for cognitive impairment. The characteristics of cognitive impairment of LI and WML were compared. Results A total of 130 patients with LI or WML were enrolled, 92 of them had cognitive impairment, and 38 had normal cognitive function; 85 had LI, and 45 had WML; 53 were males and 77 were females. Univariate analysis showed that years of education in the cognitive impairment group （7.54 ±4. 65 years vs. 11.29 ±3.17 years; t =4. 286, P =0. 001） was significantly lower than that of the normal cognitive function group, while the constituent ratios of hypertension （54. 6% vs. 16.2% ;X2 =4. 477, P = 0. 018）, hyperlipidemia （53. 1% vs. 16.2% ;X2 =5. 263; P =0. 044）, diabetes mellitus （46. 9% vs. 10.8% ; X2 =3. 827, P =0. 017）, as well as LI （43.8% vs. 21.5% ;X2 =3. 928, P =0. 015） and WML （26. 9% vs. 7.7% ;X2 =4. 072, P =0. 009） were significantly higher than those of the normal cognitive function group. Multivariate logistic regression analysis showed that years of education （odds ratio [ OR], 1. 305, 95% confidence interval [ CI] 1. 104 -7. 975; P =0. 001）, diabetes mellitus （OR 1. 328, 95% CI 1. 292 -3. 422; P =0. 015）, hypertension （OR 1. 978, 95% CI 1. 034 -5. 443; P =0. 028, LI （OR 1. 224, 95% CI 1. 004 - 2. 007; P=0. 013）, and WML （OR 1. 489, 95% CI 1. 202 -3. 778; P=0. 010） were the independent risk factors for cognitive impairment. The total MoCA score （21.61 ± 5.33 vs. 19. 19 ± 7.07; t = 1. 841, P = 0. 038） and cube copy （0.43 ± 0. 50 vs. O. 31 ± 0. 47; t = 1. 104, P = 0. 010）, clock drawing test （2.53 -± 0. 89 vs. 2.04 ± 1.22; t =2. 229, P =0. 008）, letters identification （0. 85 ±0. 36 vs. O. 62 ±0. 50; t =2. 585, P = =0. 000）, and 100 minus 7 consecutively （2. 62 ±0. 79 vs. 2. 19 ±1.17; t =2. 113; P =0. 001） of the WML group were significantly lower than those of the LI group. Conclusions The patients with LI and WML often had cognitive impairment, and the cognitive impairment in patients with WML was more serious. Years of education, hypertension and diabetes were the independent risk factors for cognitive impairment in patients with LI and WML. Visuospatial executive function and attention damage in patients with WML were severer than those of the patients with LI.