小血管病性认知功能障碍的影响因素及其与血浆超敏C反应蛋白水平的相关性

Influential factors of vascular cognitive impairment due to small vessel disease and its correlation with serum high-sensitivity C-reactive protein

目的研究小血管病性认知功能障碍(VCI-SVD)的影响因素及其与血浆超敏C反应蛋白(hsCRP)水平的相关性。方法给256例SVD患者进行蒙特利尔认知评估(MoCA)量表评分,以及临床资料收集和血糖化血红蛋白、血脂、hs-CRP水平检测。分为VCI-SVD组(MoCA量表评分≤26分)和无VCI-SVD组(MoCA量表评分>26分),对结果进行比较分析。结果 VCI-SVD组患者135例,无VCI-SVD组患者121例。VCl-SVD组的血浆hs-CRP水平显著高于无VCI-SVD组(P<0.01),血糖化血红蛋白水平、收缩压,有房颤、吸烟、饮酒的比率显著高于无VCI-SVD组,受教育年限显著低于无VCI-SVD组(P<0.05~0.01)。多因素Logistic回归分析显示,在校正了年龄、收缩压、教育年限、房颤、吸烟、饮酒因素后,糖化血红蛋白、高hs-CRP血症是VCI-SVD的独立危险因素(OR=1.447,95%CI:1.25~5.54,OR=1.587,95%CI:1.87~5.67,均P<0.05)。相关分析显示,血浆hs-CRP水平与MoCA量表总分及视空间与执行能力、语言、延迟回忆各亚项评分呈负相关(r=-0.621^-0.430,均P<0.05);与命名、抽象力、定向力和注意力亚项评分无相关性。结论糖尿病、高血压、房颤和吸烟、饮酒、受教育年限低及高hs-CRP血症是VCI-SVD的影响因素;而糖尿病、高hsCRP血症是VCI-SVD的独立危险因素。

Objective To investigate the influential factors of vascular cognitive impairment due to small vessel disease（VCI-SVD） and its correlation with serum high-sensitivity C-reactive protein （ hs-CRP）.Methods Totally 256 patients with cerebral SVD were scored by Montreal Cognitive Assessment （ MoCA ） table and the level of glycosylated hemoglobin ,blood lipid and hs-CRP were measured respectively .They were divided into VCI-SVD group （MoCA≤26） and no VCI-SVD group（MoCA〉26） , and the results were compared and analyzed .Results One hundred and thirty-five patients were classfied as VCI-SVD group, 121 patients were classfied as no VCI-SVD group. The serum levels of hs-CRP were higher significantly in VCI-SVD group compared with no VCI-SVD group （ P〈0.01）.Glycosylated hemoglobin levels , systolic blood pressure, atrial fibrillation, smoking, alcohol consumption were significantly higher than those in no VCI-SVD group, while years of education were significantly lower than that that in no VCI-SVD group（P〈0.05~0.01）.Multivariate logistic regression analysis showed , after controlling for correlation confounding risk factors , glycosylated hemoglobin levels and high serum hs-CRP were independent risk factors for VCI-SVD（ OR=1.447,95%CI：1.25 -5.54,OR=1.587,95%CI：1.87 -5.67,all P〈0.05）.The correlation analysis showed that serum hs-CRP levels were negatively correlated with MoCA total score and visual-spatial and executive function,language,and short-term memory impairment（r=-0.621--0.430,all P〈0.05）, and had no correlation with name , abstract, orientation and attention items score .Conclusions Diabetes, hypertension, atrial fibrillation and smoking , drinking, years of education and the level of hs-CRP are the affecting factors of VCI-SVD, and diabetes and high serum hs-CRP are independent risk factors for VCI-SVD.