颈动脉斑块易损性评分较斑块积分更能准确预测脑白质病变及认知损害

Carotid plaque vulnerability score is more accurate than Crouse score to predict white matter lesions and cognitive impairment

目的对比颈动脉斑块易损性评分和斑块积分与脑白质病变(WML)及认知损害的相关性,明确易损性评分是否能更敏感地评估WML及认知损害。方法以2016年4月至2019年5月苏州大学附属第一医院老年医学科住院患者为研究对象,收集经颈动脉超声证实的201例颈动脉斑块患者的基本资料、实验室资料、颈动脉超声及头颅磁共振等影像学数据。将所有研究对象根据斑块易损性分为稳定组和易损组,计算两组对象的颈动脉斑块易损性评分及Crouse积分,所有对象均采用Fazekas量表和蒙特利尔认知评价量表(MoCA)分别进行WML视觉评分及认知功能评价,以上数据进行组间统计学分析。结果稳定组与易损组之间高血压、Fazekas评分、脑室旁白质病变(PVWML)、深部白质病变(DWML)、MoCA总分、斑块总数、斑块形态、回声特征、均质性及血管狭窄程度有统计学差异(P<0.05),易损组高血压比例、斑块总数及斑块各特征评分均高于稳定组,而认知功能评分低于稳定组,且全脑WML、PVWML及DWML均更严重。易损性评分和Crouse积分与Fazekas评分正相关(r=0.23和r=0.26,P<0.05),与MoCA总分显著负相关(r=-0.39和r=-0.34,P<0.001)。Logistic回归分析结果显示,易损性评分分别是PVWML、Fazekas评分及MoCA总分的独立危险因子(P<0.05)。结论对比颈动脉斑块积分,易损性评分可作为评价WML及认知损害严重程度的敏感指标。

Aim Comparing the correlation between carotid plaque vulnerability score and Crouse score and white matter lesions(WML) and cognitive impairment, to determine whether the vulnerability score can more sensitively assess WML and cognitive impairment. Methods From April 2016 to May 2019, 201 patients in Geriatrics Department of the First Affiliated Hospital of Soochow University were selected as subjects. All the subjects were divided into stable group and vulnerable group according to plaque vulnerability. The carotid plaque vulnerability score and Crouse score of the two groups were calculated. All the subjects were evaluated by Fazekas scale and Montreal cognitive assessment(MoCA) for visual score of WML and evaluation of cognitive function. The above data were statistically analyzed between groups. Results There were statistically significant differences in hypertension, Fazekas score, paraventricular white matter lesions(PVWML), deep white matter lesions(DWML), MoCA score, plaque counts, plaque morphology, echo characteristics, homogeneity and vascular stenosis between stable group and vulnerable group(P<0.05). The scores of hypertension, plaque counts and plaque characteristics in vulnerable group were higher than those in stable group, while cognitive function score was lower than that in stable group, and the global WML, PVWML and DWML were more serious. The vulnerability score and Crouse score were positively correlated with the Fazekas score, and negatively correlated with the MoCA score. The results of Logistic regression analysis showed that the vulnerability score was an independent risk factor(P<0.05) for PVWML, Fazekas score and MoCA score. Conclusion Compared with carotid plaque score, vulnerability score can be used as a sensitive index to assess the severity of WML and cognitive impairment.