高血压病患者脑白质高信号体积与认知功能的相关性分析

The association between white matter hyperintensities volume and cognitive function in patients with hypertension

目的探讨高血压病患者脑白质高信号体积与认知功能的相关性。方法连续性收集2017年1—12月在南京大学医学院附属鼓楼医院神经内科住院及门诊就诊的高血压病患者82例,年龄50~80岁,采用全自动白质定量技术计算受试者个体脑白质高信号总体积、室周脑白质高信号体积及深部脑白质高信号体积,通过神经心理量表检测受试者整体认知水平及记忆能力、语言能力、执行能力、处理速度水平,采用线性回归统计方法分析两者之间相关性。以受试者高血压病病程中位数为界,通过分层分析探索白质高信号体积与认知功能的相关性是否受高血压病病程的影响。结果校正年龄、性别、教育年限、腔隙性脑梗死及脑萎缩分级后,反映执行能力的连线测试(2-1)得分与脑白质高信号总体积(标准化β值=0.268,P=0.019)、室周脑白质高信号体积(标准化β值=0.243,P=0.037)及深部脑白质高信号体积(标准化β值=0.243,P=0.021)呈显著线性关系,反映处理速度的斯特鲁色词测验-2得分与室周脑白质高信号体积有显著相关性(标准化β值=0.270,P=0.023),进一步校正高血压病病程后,连线测试(2-1)得分仍与白质高信号总体积(标准化β值=0.277,P=0.016)、室周白质高信号体积(标准化β值=0.251,P=0.032)、深部白质高信号体积(标准化β值=0.248,P=0.019)呈显著线性关系,斯特鲁色词测验-2得分与白质高信号总体积(标准化β值=0.237,P=0.041)及室周白质高信号体积(标准化β值=0.290,P=0.013)呈显著线性关系。对高血压病病程的分层分析显示白质高信号体积与认知功能的相关性不受高血压病病程的影响。结论高血压病患者脑白质高信号总体积,室周脑白质高信号体积与深部脑白质高信号体积均与执行功能有关,室周脑白质高信号体积还可影响处理速度,高血压病患者脑白质高信号体积与各认知域的相关性不受高血压病病程的影响。

ObjectiveTo explore the association between white matter hyperintensities volume and cognitive function in patients with hypertension.MethodsEighty-two patients with hypertension enrolled from the Department of Neurology of Nanjing Drum Tower Hospital from January 2017 to December 2017 were recruited in this study sequentially,who aged between 50 and 80 years.All subjects used automatic white matter quantitative technique to get their personal whole white matter hyperintensities volume,periventricular white matter hyperintensities volume and deep white matter hyperintensities volume.Neuropsychological scales were used to evaluate their global cognitive function,memory function,fluency,executive function and processing speed.The association between white matter hyperintensities volume and cognitive function via linear regression analysis was assessed.To explore whether the association between white matter hyperintensities volume and cognitive function be affected by the duration of hypertension,stratification analyses were conducted using the median of the duration of hypertension as separation.ResultsAfter adjusting for age,sex,education,lacunar infarctions and global cortical atrophy grade,the Trail Marking Test(2-1)score which reflects executive function was found to be related to whole white matter hyperintensities volume(standardized beta-value=0.268,P=0.019),periventricular white matter hyperintensities volume(standardized beta-value=0.243,P=0.037)and deep white matter hyperintensities volume(standardized beta-value=0.243,P=0.021).Victorial Stroop Test-2 score which reflects processing speed was found to be related to periventricular white matter hyperintensities volume(standardized beta-value=0.270,P=0.023).After additional adjusting for the duration of hypertension,the Trail Marking Test(2-1)score was still found to be related to whole white matter hyperintensities volume(standardized beta-value=0.277,P=0.016),periventricular white matter hyperintensities volume(standardized beta-value=0.251,P=0.032)and deep white matter hyperintensities volume(standardized beta-value=0.248,P=0.019).The Victorial Stroop Test-2 score was found to be related to whole white matter hyperintensities volume(standardized beta-value=0.237,P=0.041)and periventricular white matter hyperintensities volume(standardized beta-value=0.290,P=0.013).ConclusionWhole white matter hyperintensities volume,periventricular white matter hyperintensities volume and deep white matter hyperintensities volume are related to executive function,periventricular white matter hyperintensities volume is also related to processing speed in patients with hypertension,and the association between white matter hyperintensities volume and cognitive domain is not influenced by the duration of hypertension.