维生素D水平与老年脑小血管病患者认知功能障碍的相关性研究

Correlation between vitamin D level and cognitive dysfunction in elderly patients with cerebral small vessel disease

目的分析老年脑小血管病(CSVD)患者的血清25-羟基维生素D[25(OH)D]水平与认知功能障碍之间的关系。方法选择2019年12月至2020年12月于连云港市第二人民医院就诊的老年CSVD患者共97例,其中男56例、女41例,年龄65~85岁,依据蒙特利尔认知评估量表(MoCA)评分结果,分为CSVD认知正常组(50例)、CSVD认知障碍组(47例),另选取同期健康老年人群作为对照组(30例),收集3组受试者的临床资料和测定血清25(OH)D水平。计量资料组间比较采用单因素方差分析,计数资料组间比较采用χ^(2)检验,多因素logistic回归分析分析CSVD患者出现认知功能障碍的危险因素,Pearson相关性分析分析认知障碍组MoCA评分与25(OH)D水平的关系。结果CSVD认知正常组[(23.36±2.10)μg/L]、CSVD认知障碍组[(15.66±1.47)μg/L]25(OH)D水平较对照组[(34.03±2.17)μg/L]降低(F=13.764,P<0.05),且CSVD认知障碍组的25(OH)D水平明显低于CSVD认知正常组水平(P<0.05);此外,CSVD认知障碍组在视空间与执行、注意力及计算力、抽象、延迟回忆、定向力评分和MoCA总分方面较CSVD认知正常组、对照组下降(均P<0.05)。多因素logistic回归分析结果示25(OH)D水平是老年CSVD患者认知功能障碍的保护因素(OR=0.491,P=0.005)。CSVD认知障碍组患者中25(OH)D水平与MoCA总分及视空间与执行、注意力及计算力、延迟回忆、定向力评分呈正相关(r=0.74、0.63、0.59、0.74、0.53,均P<0.05)。结论血清25(OH)D水平降低是老年CSVD患者出现认知功能障碍的危险因素,低25(OH)D水平者认知障碍更明显。

Objective To investigate the correlation between serum 25-hydroxyvitaminD[25(OH)D]level and cognitive dysfunction in elderly patients with cerebral small vessel disease(CSVD).Methods From December 2019 to December 2020,97 patients with CSVD in The Second People's Hospital of Lianyungang City including 56 males and 41 females,aged 65-85 years were selected and were divided into a CSVD with normal cognition group(50 cases)and a CSVD with cognitive dysfunction group(47 cases)according to the Montreal Cognitive Assessment Scale(MoCA)score,and other 30 elderly healthy people were selected as a control group.The clinical data and serum 25(OH)D levels of the three groups were collected.One way ANOVA was used for comparison of the measurement data between groups,χ^(2) test was used for comparison of the count data between groups.Multivariate logistic regression analysis was used to analyze the risk factors for cognitive dysfunction in CSVD patients,and Pearson correlation analysis was used to explore the relationship between the MoCA score and 25(OH)D level in the cognitive dysfunction group.Results The 25(OH)D levels of the CSVD with normal cognition group[(23.36±2.10)μg/L]and the CSVD with cognitive dysfunction group[(15.66±1.47)μg/L]were lower than that of the control group[(34.03±2.17)μg/L](F=13.764,P<0.05),and the level of 25(OH)D in the CSVD with cognitive dysfunction group was significantly lower than that in the CSVD with normal cognition group(P<0.05).Compared with those in the CSVD with normal cognition group and the control group,the scores of visual space and execution,attention and computation,abstraction,delayed recall,and orientation and the total score of MoCA were decreased in the CSVD with cognitive dysfunction group(all P<0.05).Multivariate logistic regression analysis showed that 25(OH)D level was a protective factor for cognitive dysfunction in elderly patients with CSVD(OR=0.491,P=0.005).In the CSVD with cognitive dysfunction group,the level of 25(OH)D was positively correlated with the total score of MoCA and the scores of visual space and execution,attention and computation,delayed recall,and orientation(r=0.74,0.63,0.59,0.74,0.53;all P<0.05).Conclusion The decline of serum 25(OH)D level is a risk factor for cognitive dysfunction in elderly patients with CSVD,and patients with low serum 25(OH)D level have more obvious cognitive dysfunction.