左心功能变化对脑小血管病及其认知障碍的影响

Effects of left heart function changes on cerebral small vessel diseases and its cognitive impairment

目的探讨左心功能变化对脑小血管病(CSVD)及其认知障碍的影响。方法收集2012年2月至2018年6月于安徽医科大学第一附属医院神经内科就诊的CSVD患者199例(CSVD组),选取同期认知功能正常的健康老年人103例(NC组)。按照血管性认知障碍诊断标准将199例CSVD患者分为CSVD伴血管性认知障碍患者112例(CSVD-VCI组)与CSVD无认知障碍患者87例(CSVD-NCI组)。依据受试者头颅MRI表现对脑白质高信号进行评分,并统计腔隙性脑梗死数目;采用简易精神状态检查量表(MMSE)、剑桥老年认知测试量表-中文版(CAMCOG-C)等评估整体认知功能及其亚认知域功能;应用心脏超声技术监测左室射血分数(LVEF)、左房内径(LAD)等左心功能指标。结果CSVD组LVEF值[(63±6)%]显著低于NC组[(65±5)%](P=0.007),而LAD值显著高于NC组(P=0.024);CSVD-VCI患者LVEF值[(62±6)%]显著低于CSVD-NCI患者[(64±5)%](P=0.02)。CSVD组MMSE、CAMCOG-C评分与LVEF值呈显著正相关(r=0.210,P=0.003;r=0.238,P=0.001)。Logistic回归分析结果显示,LVEF值减低为CSVD、CSVD-VCI发生的独立危险因素(OR=0.937,95%CI 0.890~0.986;OR=0.900,95%CI 0.829~0.977)。结论左心功能变化影响CSVD发生及其认知障碍程度,LVEF值降低可能为CSVD及其认知障碍发生的独立危险因素。

Objective To explore the correlation of left heart function changes with cognitive impairment in patients with cerebral small vessel diseases (CSVD). Methods From February 2012 to June 2018, 199 CSVD patients admitted to the Department of Neurology of the First Affiliated Hospital of Anhui Medical University were enrolled as CSVD group. A total of 103 healthy elderly persons without cognition disorders were included as normal control group (NC group). According to the diagnostic criteria, CSVD patients were divided into 112 CSVD patients with vascular cognitive impairment (CSVD-VCI group) and 87 CSVD patients without cognitive impairment (CSVD-NCI group). Neuroimaging markers of CSVD (including lacunar infarction and white matter hyperintensity) were assessed through brain MRI. Cognitive function was evaluated by The Mini-Mental State Examination (MMSE), the Cambridge Cognitive Examination-Chinese Version (CAMCOG-C), etc. Routine echocardiography was performed to evaluate left ventricular ejection fraction (LVEF), left atrial diameter (LAD) and other parameters. Results Compared with NC group, the LVEF level was significantly decreased in CSVD group [(65±5)% and (63±6)%, respectively](P=0.007), while LAD level was significantly increased in CSVD group (P=0.024). The LVEF level of CSVD-VCI group [(62±6)%] was significantly lower than that of CSVD-NCI group [(64±5)%](P=0.02). Correlation analysis revealed MMSE and CAMCOG-C scores in CSVD group were positively correlated with LVEF level (r=0.210, P=0.003;r=0.238, P=0.001). Logistic regression analysis revealed that declined LVEF was an independent risk factor associated with CSVD (OR=0.937, 95%CI 0.890-0.986) and CSVD-VCI (OR=0.900, 95%CI 0.829-0.977). Conclusions Left heart function changes play important roles in the occurrence of CSVD and severity of its cognitive impairment. The declined LVEF may represent an independent risk factor for CSVD and its cognitive impairment.