老年人脑白质高信号的影响因素及与认知功能障碍的关系

Risk factors for white matter hyperintensity and its effect on cognitive function in elderly patients

目的观察老年人脑白质高信号(white matter hyperintensity,WMH)的影响因素及其与认知功能之间的关系。方法收集2015年6月至2017年9月作者医院老年神经科住院治疗的212例非卒中患者的临床资料,根据患者头颅MR对WMH进行Fazekas量表评分,并根据Fazekas量表评分将患者分为WMH 0~1分组和WMH 2~3分组。比较不同程度WMH组间病史、生化检查结果、脑萎缩评分及蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分之间的差异,并采用二元Logistic回归分析WMH和认知功能障碍的关系。结果WMH 0~1分组高血压、冠心病比例、尿酸(uric acid,UA)水平及a/b(额叶比,比值越高表示脑萎缩越严重)均明显低于WMH 2~3分组(P<0.05),其25羟-维生素D水平、MoCA总评分、视空间与执行功能、连线、复制立方体、画钟、记忆、注意、语言、抽象、延迟回忆、定向子项评分均显著高于WMH 2~3分组(P<0.05)。Logistic回归分析表明高血压、冠心病和高UA是WMH严重程度的独立危险因素(P<0.05),WMH严重程度对认知功能有明显影响(P<0.05)。高血压分级与WMH之间无相关性,但患者24 h平均收缩压、白天平均收缩压与WMH呈正相关(P<0.05)。结论高血压(尤其是收缩压增高)、冠心病和高UA是WMH的独立危险因素,老年人WMH与认知功能障碍相关。

Objective To study the risk factors for white matter hyperintensity(WMH)and its effect on cognition.Methods Clinical data were collected from 212 non-stroke patients admitted to the geriatric neurology department of the author’s hospital from June 2015 to September 2017.Based on the cranial MR results,patients were graded from 0 to 3 on the Fazekas scale score according to WMH severity,whereas 0-1 was classified as one group and 2-3 as another group.Differences in medical history,biochemical findings,brain atrophy scores,and Montreal cognitive assessment(MoCA)scores between the two groups with different degrees of WMH were compared,and the relationship between WMH and cognitive impairment was analyzed using binary logistic regression.Results The proportion of hypertension and coronary heart disease,uric acid level and a/b(frontal lobe ratio,higher ratio indicates more severe brain atrophy)were significantly lower in the WMH 0-1 group than those in the WMH 2-3 group(P<0.05).25-(OH)-D level,total MoCA score,visuospatial and executive function,trail making,cube copying,clock drawing,memory,attention,language,abstraction,delayed recall and orientation sub-score were significantly higher in the WMH 0-1 group than those in the WMH 2-3 group(P<0.05).Logistic regression analysis showed that hypertension,coronary heart disease and high UA were independent risk factors for WMH severity(P<0.05),and WMH severity had a significant effect on cognitive function(P<0.05).There was no significant correlation between hypertension grading and WMH,but the 24 h mSBP and DmSBP were positively correlated with WMH(P<0.05). Conclusions Hypertension(especially increased systolic blood pressure),coronary heart disease and high UA are independent risk factors for WMH and WMH in the elderly is associated with cognitive impairment.