老年脑白质病变患者认知功能障碍与高胆固醇血症的关系

Relationship between cognitive impairment and hypercholesterolemia in elderly patients with white matter lesions

目的探讨老年脑白质病变(WML)患者认知功能障碍与高胆固醇血症的关系及相关危险因素。方法连续收集于大坪医院住院的WML患者347例,根据神经心理学评估分为认知功能正常组(n=86)及认知功能障碍组(n=261)。比较两组的一般情况,并分析高胆固醇血症与WML严重程度及认知功能的相关性,行logistics回归分析WML患者认知功能障碍的危险因素。结果与认知功能正常者相比,认知功能障碍患者的年龄偏大,其中男性、低教育水平、高血压及高胆固醇血症所占比例较高,血浆低密度脂蛋白(LDL)水平较高,而简易精神状态量表(MMSE)分值及有他汀类药物使用史的患者比例较低(P<0.05)。随着WML严重程度由轻度到重度逐渐增加,认知功能障碍患者所占比例明显增高(P=0.001),高胆固醇血症的发生率逐渐增高(P=0.000)。高胆固醇血症患者蒙特利尔量表(Mo CA)总分及视空间与执行功能、注意力及计算力、语言、抽象能力、延迟回忆等领域分值均明显低于无高胆固醇血症患者(P<0.05)。Logistics回归分析显示,低教育水平、高血压、高胆固醇血症及LDL水平增高为WML患者认知功能障碍的独立危险因素(P<0.05),而他汀类药物使用史为保护因素(P<0.05)。结论高胆固醇血症可显著增加WML患者认知功能障碍的风险,伴高胆固醇血症的WML患者应作为认知功能障碍的高危人群进行关注,控制各种危险因素的同时,应加强早期干预。

Objective To study the relationship between cognitive impairment and hypercholesterolemia as well as the risk factors thereof in elderly patients with white matter lesions （WML）. Methods A total of 347 WML patients were divided into normal cognitive group （n=86） and cognitive impairment group （n=261） according to their mini-mental state examination （MMSE） score. The general situation of the two groups was compared and the correlation of hypercholesterolemia with WML severity and cognitive function was analyzed; the risk factors of cognitive impairment in WML patients were analyzed by logistic regression analysis. Results Compared with those in normal cognitive group, the patients in cognitive impairment group were older, the plasma low-density lipoprotein （LDL） level and the proportion of male, low education level, hypertension and hypercholesterolemia were significantly higher （P〈0.05）, while MMSE score and the proportion of patients with a history of statins were significantly lower （P〈0.05）. The proportion of patients with cognitive impairment significantly increased （P=0.001 ）, and the incidence of hypercholesterolemia also increased significantly （P=0.000） with the increasing of WML severity. The Montreal Congnitive Assessment （MoCA） score, visuospatial and executive function, attention and computing power, language and abstract ability, and delayed recall scores of patients with hypercholesterolemia were significantly lower than that of patients without hypercholesterolemia （/9〈0.05）. Logistic regression analysis showed that low education level, hypertension, hypercholesterolemia and the higher level of plasma LDL were independent risk factors of cognitive impairment in patients with WML （P〈0.05）, while the history of statins use was a protective factor （P〈0.05）. Conclusion Hypercholesterolemia can significantly increase the risk of cognitive impairment in patients with WMLj thus the WML patients with hypercholesterolemia should be focused, and various risk factors should be controlled, at the same time the fortified early intervention is necessary.