急性基底节区梗死的脑小血管病总负荷与认知功能损害相关性分析

Correlation analysis of total cerebrovascular disease burden and cognitive impairment in patients with acute basal ganglia infarction

目的探讨急性基底节区梗死患者脑小血管病(cerebral small vessel disease,CSVD)总负荷与认知功能损害的相关性。方法纳入首次发生的急性基底节区梗死患者,收集入组患者的一般资料,行蒙特利尔认知量表(Montreal cognitive assessment,MoCA)评定,根据MoCA评分结果分为认知功能损害组(cognitive impairment,CI)组和非认知功能损害组(non cognitive impairment,NCI)组。两组患者分别行CSVD总负荷评分,分析不同程度的脑小血管病总负荷与认知功能损害的相关性。结果本研究共入组178例患者,CI组135例,NCI组43例,两组患者的年龄(t=4.11,P=0.04)比较,差异具有统计学意义。两组患者的高密度脂蛋白(t=2.92,P=0.09)和糖化血红蛋白C(t=3.02,P=0.08)比较,差异不具有统计学意义。CI组患者梗死体积更大[CI组(424.72±36.55)mm^(3),NCI组(227.02±34.62)mm^(3),t=4.022,P=0.046];两组患者在单个豆状核(χ^(2)=19.08,P<0.01)、尾状核(χ^(2)=9.97,P<0.01)、内囊部位(χ^(2)=3.85,P=0.05)梗死、梗死部位同时累及豆状核、内囊及尾状核(χ^(2)=4.30,P=0.04)、合并颈内动脉中重度狭窄(χ^(2)=4.14,P=0.04)及合并中重度颅内动脉狭窄(χ^(2)=4.19,P=0.04)的比较,差异均具有统计学意义。CI组与NCI组患者的CSVD总负荷[(2.12±1.22)vs.(1.41±0.79),t=3.62,P<0.01]、深部脑白质高信号(32.1%vs.9.1%,t=9.02,P<0.01)、脑微出血(52.2%vs.31.8%,t=5.54,P=0.02)的比较,差异具有统计学意义。两组患者在MoCA评分、视空间与执行、注意、语言、概括抽象、记忆和定向的比较,差异具有统计学意义(P<0.05),命名上的比较,差异无统计学意义(P>0.05)。logistic回归方程结果显示,CSVD总负荷(OR=0.316,95%CI:0.185~0.541,P<0.001)、年龄(OR=0.924,95%CI:0.884~0.967,P=0.001)及梗死体积(OR=1.002,95%CI:1.000~1.003,P=0.047)与急性基底节区梗死患者认知功能损害显著相关。结论CSVD总负荷评分高、年龄大和梗死体积大可能是急性基底节区梗死患者出现认知功能损害的危险因素。

Objective To investigate the correlation between total burden of cerebral small vessel disease(CSVD)and cognitive impairment in patients with acute basal ganglia infarction.Methods Patients with acute basal ganglia infarction for the first time were enrolled,and the general data of the enrolled patients were collected.Patients were assessed by Montreal cognitive assessment(MoCA).Based on MoCA assessment,patients were then divided into cognitive impairment(CI)group and non-cognitive impairment(NCI)group.CSVD total load scores were conducted afterwards in order to analyze the correlation between the total load of different degrees of cerebral small vessel disease and cognitive impairment.Results A total of 178 patients were enrolled in this study:135 in the CI group and 43 in the NCI group.There were significant differences in age(t=4.11,P=0.04)but not in high-density lipoprotein(t=2.92,P=0.09),and glycosylated hemoglobin C(t=3.02,P=0.08)between the two groups.The infarct volume was larger in the CI group(CI group:424.72±36.55,NCI group:227.02±34.62,t=4.022,P=0.046).There were significant differences in a single lentiform nucleus(χ^(2)=19.08,P<0.01),caudal Nucleus(χ^(2)=9.97,P<0.01),infarction at the site of internal capsule(χ^(2)=3.85,P=0.05),the infarct site involved lentiform nucleus,internal capsule and caudate nucleus at(χ^(2)=4.30,P=0.04),and numbers of patients with moderate-to-severe internal carotid artery stenosis(χ^(2)=4.14,P=0.04)as well as numbers of patients with moderate to-severe intracranial artery stenosis(χ^(2)=4.19,P=0.04).Similarly,there were significant differences in CSVD total burden(t=3.62,P<0.01),deep white matter hyperintensity(t=9.02,P<0.01),and cerebral microbleeds(t=5.54,P=0.02)between CI group and NCI group.The comparisons on MoCA score,visuospatial and execution,attention,language,generalization and abstraction,memory and orientation but not naming were statistically significant between the two groups.The logistic regression equation showed that CSVD total burden(OR=0.316,95%CI:0.185~0.541,P<0.001),age(OR=0.924,95%CI:0.884~0.967,P=0.001)and infarct volume(OR=0.924,95%CI:0.884~0.967,P=0.001),(95%CI:1.000~1.003,P=0.047)was significantly associated with cognitive impairment in patients with acute basal ganglia infarction.Conclusion High CSVD total load score,older age and larger infarct volume may be risk factors for cognitive impairment in patients with acute basal ganglia infarction.