首次脑梗死伴脑小血管病患者认知功能障碍相关危险因素的研究分析

Analysis of risk factors of cognitive dysfunction in first attack cerebral infarction patients with cerebral small vascular disease

目的分析伴有脑小血管病(CSVD)的首次脑梗死患者在认知功能障碍方面的相关危险因素。方法选取2012年8月至2014年1月因急性脑梗死入住南通市第一人民医院神经内科的患者105例,并根据MRI筛选出存在CSVD的患者41例,不伴有CSVD的患者64例,并对患者的年龄、性别、受教育程度、危险因素等人口统计学指标及临床特征进行评估,寻找CSVD的危险因素,将入选的所有患者采用蒙特利尔认知评估量表(MoCA)筛选出存在血管性认知功能障碍(VCI)的患者49例,其余56例无认知功能障碍,并比较两组的人口统计学特征,分析认知功能障碍的相关危险因素。采用Logistic回归分析,Spearman等级相关分析等方法研究CSVD与认知功能障碍的相关性。结果在CSVD组与无CSVD组的比较中,高血压患者分别为34例(82.9%)和29例(45.3%,χ2=14.732,P=0.000),高脂血症患者为36例(87.8%)和25例(39.1%,χ2=24.834,P=0.000),冠心病患者为37例(90.2%)和28例(43.8%,χ2=24.920,P=0.000),差异均有统计学意义;CSVD组年龄[(73.13±4.96)岁]大于无CSVD组[(68.45±7.05)岁,t=4.374,P=0.015];CSVD组和无CSVD组的MoCA评分分别为(23.50±2.102)分和(27.46±1.823)分,差异有统计学意义(t=7.207,P=0.000);CSVD组在注意力评分[(3.09±0.916)分]、视空间和执行能力评分[(3.46±0.163)分]低于无CSVD组(t=5.384、11.546,P均<0.05)。糖尿病患者分别为20例(48.7%)和34例(53.1%),差异无统计学意义(χ2=0.003,P=0.960)。认知功能障碍组年龄[(70.86±6.43)岁]大于无认知功能障碍组[(65.03±5.29)岁,t=7.651,P=0.010];认知功能障碍组平均受教育年限[(4.32±1.326)年]小于认知功能障碍组[(6.19±2.478)年,t=7.850,P=0.000];认知功能障碍组及无认知功能障碍组皮质下关键部位受累分别为33例(71.7%)与26例(46.4%,χ2=4.645,P=0.048)。认知功能障碍组脑梗死体积为(6.461±1.385)mm3,无认知功能障碍组脑梗死体积为(6.280±1.472)mm3,两组差异无统计学意义(t=0.635,P=0.587)。结论高血压、高脂血症、冠心病、年龄等是CSVD的危险因素。伴有CSVD的脑梗死患者更易出现认知功能障碍。CSVD所累及的部位与认知功能障碍的程度密切相关。伴有CSVD的血管性认知损害以注意和执行功能障碍为其主要特征。

Objective To analyze the related risk factors in terms of cognitive dysfunction for the patients with cerebral infarction associated with cerebral small vessel disease .Methods One hundred and five patients in Neurology Department of Nantong First Peoples′Hospital with acute cerebral infarction from August 2012 to January 2014 were selected .According to MRI , 41 patients were associated with cerebral small vessel disease （ CSVD ） , and the other 64 patients were not associated with CSVD .The demographic indicators,such as the patient′s age,gender,education level,existing risk factors and clinical features were evaluated,looking for risk factors for CSVD.By using Montreal cognitive assessment （MoCA）,49 patients were screened out with vascular cognitive impairment （VCI）from all the selected patients,the remaining 56＆amp;nbsp;patients without cognitive dysfunction .The demographic characteristics of the two groups were compared to analyzerelated risk factors of cognitive dysfunction .The correlation between CSVD and cognitive dysfunction were studied by using the logistic regression and Spearman rank correlation analysis .Resulst Compared the group with CSVD and the group without CSVD ,the proportion of hypertension was34 cases （82.9%） and 29 cases（45.3%,χ2=14.732 ,P=0.000）,the proportion of high cholesterol was 36 cases（87.8%） and 25 cases （39.1%,χ2 =24.834,P=0.000）,the proportion of coronary heart disease was 37cases（90.2%）and 28 cases（43.8%,χ2=24.920,P=0.000）;The age of CSVD group [（73.13 ＆#177;4.96）years] is greater than that of group without CSVD [ （ 68.45 ＆#177;7.05 ） years ,t=4.374,P=0.015 ];MoCA scores of groups with and without CSVD were （ 23.50 ＆#177;2.102 ） scores and（ 27.46 ＆#177;1.823 ） scores;The attention function score [（3.09 ＆#177;0.916 ）scores]and the visual spatial and executive ability score [（3.46 ＆#177;0.163）scores ]of the group with CSVD were less than the group without CSVD （t=5.384 ,11.546 ,all P＆lt;0.05 ） .The proportion of diabetes was20 cases （ 48.7%） and 34 cases （ 53.1%,χ2 =0.003 , P =0.960 ） .The age of cognitive dysfunction group [ （ 70.86 ＆#177;6.43 ） years ] was greater than the group without cognitive dysfunction [（65.03 ＆#177;5.29）years,t =7.651,P=0.010];The average years of education of group without cognitive dysfunction group [（4.32 ＆#177;1.326）years] were less than the cognitive dysfunction group [（6.19 ＆#177;2.478） years,t=7.850,P=0.000];The proportion of involvement of subcortical key parts of cognitive dysfunction group and the group without cognitive dysfunction was 33 cases（71.7%）and 26 cases（46.4%,χ2 =4.645, P=0.048 ） .The difference between the infarct volume of cognitive dysfunction group [ （ 6.461 ＆#177;1.385 ） mm3]and that of group without cognitive dysfunction [（6.280 ＆#177;1.472）mm3,t=0.635,P=0.587 ]had no statistical significance.Conclusions Hypertension ,high cholesterol ,coronary heart disease,and age are risk factors of CSVD .The cerebral infarction patients associated with CSVD are more likely to show cognitive dysfunction .The parts involved by CSVD are closely related to the extent of cognitive dysfunction .The attention and executive dysfunctionin is the main feature of vascular cognitive impairment associated with CSVD.