老年脑小血管病患者认知障碍发生率及影响因素分析

Analysis of incidence and influencing factors of cognitive impairment in elderly patients with cerebral small vessel disease

目的探究老年脑小血管病(CSVD)患者认知障碍的发生率及影响因素。方法回顾性收集作者医院收治的CSVD患者201例,以是否伴有认知障碍分为伴认知障碍组(n=101)和未伴认知障碍组(n=100),比较两组患者临床资料的差异,并采用多因素Logistics回归分析影响CSVD患者发生认知障碍的影响因素,采用Pearson相关性分析患者血清同型半胱氨酸(Hcy)、D-二聚体水平与蒙特利尔认知评估量表(MoCA)评分的相关性。结果CSVD患者认知障碍的发生率为50.25%;与未伴认知障碍组比较,伴认知障碍组年龄及血清Hcy、D-二聚体水平均高(P<0.05或P<0.01),有痴呆家族史、直立性低血压、高血压、颈动脉粥样硬化、阻塞性睡眠呼吸暂停低通气综合征(OSAHS)、高尿酸血症占比均高(P<0.05或P<0.01),MoCA评分低(P<0.01);CSVD患者血清Hcy、D-二聚体水平与MoCA评分呈负相关(r=-0.513,r=-0.503;P<0.05);痴呆家族史、直立性低血压、高血压、颈动脉粥样硬化、OSAHS、高尿酸血症、高血清Hcy水平、高血清D-二聚体水平均为CSVD患者发生认知障碍的独立危险因素(P<0.05)。结论老年CSVD患者认知障碍的发生率较高,其发生受高血压、颈动脉粥样硬化、高尿酸血症等多种因素影响,临床加强对患者影响因素的控制可能会降低认知障碍的发生。

Objective To investigate the incidence of cognitive impairment and influencing factors in elderly patients with cerebral small vessel disease(CSVD).Methods We restrospectively collected 201 CSVD patients who admitted to the authors'hospital.All patients were divided into cognitive impairment group(n=101)and non-cognitive impairment group(n=100)The differences in clinical data of the two groups were compared.Multivariate logistic regression was used to analyze the influencing factors of cognitive impairment in CSVD patients,and pearson correlation was used to analyze the correlation between serum homocysteine(Hcy)and D-dimer levels and Montreal Cognitive Assessment(MoCA)scores.Results The incidence of cognitive impairment in CSVD patients was 50.25%.Compared with non-cognitive impairment group,the cognitive impairment group had older age,higher serum Hcy and D-D levels(P<0.05 or P<0.01),htgher proportion of family history of dementia,orthostatic hypotension(OH),hypertension,carotid atherosclerosis,obstructive sleep apnea hypopnea syndrome(OSAHS),and hyperuricemia(P<0.05 or P<0.01),and lower MoCA scores(P<0.01).Serum Hcy and D-D levels in CSVD patients were negatively correlated with MoCA score(r=-0.513,r=-0.503;P<0.05);Family history of dementia,OH,hypertension,carotid atherosclerosis,OSAHS,hyperuricemia,high serum Hcy level,and high serum D-dimer level were independent risk factors for cognitive impairment in patients with CSVD(P<0.05).Conclusions The incidence of cognitive impairment in elderly CSVD patients is high,and was associated with various factors,such as hypertension,carotid atherosclerosis,and hyperuricemia.our study supported that controling the influencing factors of patients with CSVD may reduce the occurrence of cognitive impairment.