老年脑动脉粥样硬化患者继发血管性认知功能障碍的风险预测因子研究

Risk predictors of vascular cognitive impairment in elderly patients with cerebral atherosclerosis

目的研究老年脑动脉粥样硬化患者继发血管性认知功能障碍(VCI)的风险预测因子。方法回顾性分析2016年1月~2020年12月在青岛市市立医院接受治疗的160例脑动脉粥样硬化患者,按照其有无继发VCI将其分为VCI组(64例)和非VCI组(96例),比较两组性别、年龄、身体质量指数(BMI)、合并症、不良嗜好、脑白质病变情况及血清内皮素-1(ET-1)、血管内皮生长因子水平(VEGF)水平,利用受试者工作特征曲线(ROC)分析ET-1、VEGF预测患者继发VCI的价值,将两组有差异信息纳入logistic回归分析模型,进行量化赋值明确脑动脉粥样硬化患者继发VCI的危险因素。结果VCI组年龄≥70岁、合并糖尿病、合并高脂血症、吸烟、脑白质病变患者比例及ET-1水平显著高于非VCI组,VEGF水平显著低于非VCI组,差异有统计学意义(P<0.05)。ET-1、VEGF预测患者继发VCI的ROC曲线下面积分别为0.823、0.784。经logistic回归分析证实,年龄≥70岁、合并糖尿病、合并高脂血症、吸烟、脑白质病变、ET-1≥79.245 pg/ml、VEGF<202.240 pg/ml是脑动脉粥样硬化患者继发VCI的危险因素。结论高龄、糖尿病、高脂血症、吸烟、脑白质病变、ET-1水平升高、VEGF水平降低均有可能引起脑动脉粥样硬化患者发生VCI。

Objective To study the risk predictors of vascular cognitive impairment(VCI)in elderly patients with cerebral atherosclerosis.Methods 160 patients with cerebral atherosclerosis who were treated in our hospital from January 2016 to December 2020 were retrospectively analyzed.They were divided into VCI group(n=64)and non VCI group(n=96)according to whether they had secondary VCI,The gender,age,body mass index(BMI),complications,adverse habits,white matter lesions,serum endothelin-1(ET-1),vascular endothelial growth factor(VEGF)levels were compared between the two groups.The value of ET-1 and VEGF in predicting secondary VCI was analyzed by ROC curve.The difference information between the two groups was included in logistic regression analysis model,and quantitative evaluation was performed to identify cerebral artery Risk factors of secondary VCI in patients with atherosclerosis.Results The proportion of patients with age≥70 years,diabetes mellitus,hyperlipidemia,smoking,white matter lesions and ET-1 level in VCI group were significantly higher than those in non VCI group,and the VEGF level was significantly lower than that in non VCI group(P<0.05).The area under ROC curve of ET-1 and VEGF predicting VCI was 0.823 and 0.784,respectively.Logistic regression analysis confirmed that age≥70 years old,diabetes,hyperlipidemia,smoking,white matter lesions,ET-1≥79.245 pg/ml,VEGF<202.240 pg/ml are secondary to cerebral atherosclerosis Risk factors for VCI.Conclusion Old age,diabetes,hyperlipidemia,smoking,white matter lesions,elevated ET-1 levels,and decreased VEGF levels may all cause VCI in patients with cerebral atherosclerosis.