非痴呆性血管性认知功能障碍脑梗死患者进展为血管性痴呆的危险因素分析

Risk Factors for Progression to Vascular Dementia in Patients With Non Dementia Vascular Cognitive Impairment and Cerebral Infarction

目的分析非痴呆性血管性认知功能障碍(VCIND)脑梗死患者进展为血管性痴呆(VD)的危险因素。方法 2015年1月—2017年6月,收集99例脑梗死VCIND患者的临床资料,进行6~24个月的随访,根据末次随访结果将其分为VCIND组(71例)和VD组(28例),对VCIND脑梗死患者发生认知障碍的危险因素进行单因素和多因素Cox分析。结果脑白质评分与大脑各区域梗死灶数量均是VD的独立危险因素,脑白质评分每增加1分,患者进展为VD的风险就增加50.3%,额区、丘脑、基底节梗死灶数量每增加1个,患者进展为VD的风险将分别增加68.0%、69.9%、42.3%。结论脑白质评分与各脑区梗死灶数量分布特点对于VD风险预测具有重要意义,对VCIND患者应当加强动脉自旋标记灌注成像检查随访。

Objective To analyze the risk factors for progression to vascular dementia （VD） in patients with non-dementia vascular cognitive impairment （VCIND） and cerebral infarction. Methods From January 2015 to June 2017, 99 cases of VCIND patients with cerebral infarction were collected and followed up for 6 to 24 months. According to the results of the last follow-up, they were divided into VCIND group （71 cases） and VD group 28 cases）, the risk factors of cognitive impairment in patients with VCIND cerebral infarction were analyzed by single factor and multivariate Cox. Results The white matter score and the number of infarcts in all regions of the brain were independent risk factors for VD. The risk of progression to VD was increased by 50.3% for each additional 1 point in white matter score. The number of infarcts in the frontal area, the thalamus and the basal ganglia increased by 1, the number of patients with VD increased by 68.0%, 69.9% and 42.3% respectively. Conclusion The white matter score and the quantitative distribution of infarct size in each brain region are important for the prediction of VD risk. Arterial spin-labeling perfusion imaging should be followed up in VCIND patients.