脑小血管病患者认知功能障碍与H型高血压及脑血流动力学相关性分析

Correlation Analysis of Cognitive Impairment of Cerebral Small Vessel Disease and H-Type Hypertension and Cerebral Hemodynamics

目的:探讨脑小血管病(CSVD)患者认知功能障碍与H型高血压及脑血流动力学相关性。方法:选取CSVD合并原发性高血压患者96例,均进行蒙特利尔认知评估量表(MoCA)评定,经颅多普勒超声(TCD)进行血流动力学检查。根据同型半胱氨酸(Hcy)水平分为非H型高血压组和H型高血压组,根据认知功能分为认知功能正常组(NCI)及认知功能障碍非痴呆组(VCIND)组。比较2组临床数据。结果:H型高血压组蒙特利尔认知评估量表(MoCA)评分低于单纯高血压组(P<0.05),大脑中动脉-搏动指数(MCA-PI)和大脑前动脉(ACA)-PI高于单纯高血压病组(P<0.05),2组的MCA-平均血流速度(Vm)和ACA-Vm差异无统计学意义(P>0.05)。VCIND组的Hcy水平、MCA-PI和ACA-PI均高于NCI组(P<0.05),2组的MCA-Vm和ACA-Vm差异无统计学意义(P>0.05)。经多元线性回归分析可知,Hcy与MoCA评分呈负相关(P<0.05),Hcy与MCA-PI(P<0.05)、ACA-PI(P<0.05)呈正相关;MCA-PI与MoCA评分(P<0.05)呈负相关;而ACA-PI与MoCA评分无相关性。结论:H型高血压患者的血浆高Hcy水平可能是促进和加重认知功能障碍的重要因素,PI值可考虑作为反映深部小血管病变及认知障碍的参考指标。

Objective:To explore the correlation between cognitive dysfunction and H-type hypertension and cerebral hemodynamics in patients with cerebral small vessel disease(CSVD).Methods:Ninety-six patients with CSVD and essential hypertension were selected.The Montreal Cognitive Assessment Scale(MoCA)was used to assess cognitive function,and transcranial Doppler ultrasound(TCD)was used to examine cerebral hemodynamics.Patients were divided into the non-H-type hypertension group and H-type hypertension group according to homocysteine(Hcy)level.Patients were also divided based on cognitive function into the no cognitive impairment(NCI)group and vascular cognitive impairment no dementia(VCIND)group.Clinical data of two groups were compared.Results:Compared with the non-H-type hypertension group,the H-type hypertension group had a lower MoCA score(P<0.05)and higher middle cerebral artery pulsatility index(MCA-PI)and anterior cerebral artery pulsatility index(ACA-PI)values(P<0.05).There was no significant difference between the two groups in mean flow velocity(Vm)of the MCA and ACA(P>0.05).The Hcy level and MCA-PI and ACA-PI values of the VCIND group were higher than those of the NCI group(P<0.05);the MCA-Vm and ACA-Vm were not significantly different between the two groups(P>0.05).Multiple linear regression analysis showed that Hcy level was negatively correlated with MoCA score(P<0.05)and positively correlated with MCA-PI(P<0.05)and ACA-PI(P<0.05).MCA-PI was negatively correlated with MoCA score(P<0.05),while ACA-PI showed no correlation with MoCA score.Conclusion:In H-type hypertension,elevated plasma Hcy levels may be a key factor in promoting and aggravating cognitive impairment.The PI value may be an important parameter when evaluating deep vascular lesions and cognitive impairment.