影响老年脑小血管病患者发生认知功能障碍的危险因素分析

Risk factors affecting cognitive impairmentin patients with cerebral small vessel disease

目的分析影响老年脑小血管病(cerebral small vessel disease,CSVD)患者发生认知功能障碍(cognition impairment,CI)的危险因素。方法回顾性分析2016年8月到2019年9月我院收治102例老年CSVD患者资料,患者采用蒙特利尔认知评估(MoCA)量表进行评分,以26分为界线评价患者有无认知功能障碍,53例患者(<26分)纳入CI组(存在认知功能障碍),49例(≥26分)患者纳入对照组(不存在认知功能障碍)。比较两组患者认知功能评分,痴呆症发生情况,影响CSVD患者发生CI单因素和多因素分析。结果CI组患者注意、记忆、空间及执行功能、抽象思维、语言、定向、命名、计算等各项认知功能评分显著低于对照组(P<0.05);CI组患者痴呆症发生率(39.62%)高于对照组(6.12%),差异有统计学意义(P<0.05);单因素分析显示CI组患者年龄(>65岁)、学历、既往脑梗死人数、高血压人数、高血脂、吸烟史(超过5年)人数、总胆固醇和尿酸水平显著高于对照组患者(P<0.05),多因素分析结果显示脑梗死、高血压、高血脂和吸烟史为影响CSVD患者发生CI危险因素。结论CSVD患者发生CI后容易出现痴呆,脑梗死、高血压、高血脂和吸烟史为CSVD患者发生CI危险因素。

Objective To analyze risk factors affecting cognitive impairment(CI)in patients with cerebral small vessel disease(CSVD).Methods A retrospective analysis was performed on the data from 102 patients with CSVD who were admitted to the hospital from April 2016 to April 2018.The patients were scored by the Montreal cognitive assessment(MoCA).Taking 26 points as the boundary to judge the presence or absence of CI in the patients.53 patients(less than 26 points)were included in the CI group(with CI).And 49 patients(equaling to or greater than 26 points)were included in the control group(without CI).The cognitive function scores and the incidence of dementia were compared between the two groups.Univariate and multivariate analysis were performed to analyze the factors affecting CI in patients with CSVD.Results The scores of cognitive function such as attention,memory,spatial and executive function,abstract thinking,language,orientation,naming and calculation in the CI groupwere significantly lower than those in the control group(P<0.05).The incidence of dementia in the CI groupwas higher than that in the control group(39.62%vs 6.12%)(P<0.05).Univariate analysis showed that the age(older than 60 years old),education,number of people with cerebral infarction,number of people withhypertension,hyperlipidemia,number of people with smoking history(over 5 years),total cholesterol and uric acid levels in the CI groupwere significantly higher than those in the control group(P<0.05).Multivariate analysis showed that cerebral infarction,hypertension,hyperlipidemia and smoking history were risk factors affecting CI in patients with CSVD.Conclusion Patients with CSVD are prone to dementia after CI.And cerebral infarction,hypertension,hyperlipidemia and smoking history are risk factors for CI in patients with CSVD.