优势半球无症状颈动脉粥样硬化斑块与认知功能障碍的关系

Relationship between asymptomatic carotid plaque of dominant hemisphere side and cognitive impairment

目的本研究评价基于社区筛查的40岁及以上无症状颈动脉粥样硬化斑块与认知功能障碍的关系,重点研究优势半球斑块对认知功能的影响。方法根据入排标准,共有861例40岁及以上既往无脑血管病、能配合完成颈动脉超声和认知测评、且数据齐全的对象纳入本研究。研究对象来自北京市昌平区北七家社区卫生服务中心和北京市顺义区空港医院筛查点的非城镇居民,在2015年9月至2017年9月期间参与中国国家卒中高危人群筛查和干预(China National Stroke Screen Survey,CNSSS)项目。采用多因素Logistic回归分析优势半球无症状颈动脉粥样硬化斑块与认知功能障碍的关系。结果本研究中无症状颈动脉粥样硬化斑块患病率为59.2%(510例),认知障碍患病率为60.3%(519例),右利手占92.0%(792例),左利手占8.0%(69例)。对右利手人群分析发现,多因素调整后,无症状左侧(优势半球)颈动脉粥样硬化性斑块与低Mo CA评分有关(2个及以上斑块的OR值为1.60,95%CI:1.01~2.53,P=0.044)。结论本研究发现,在40岁及以上非城镇人群中,优势半球的无症状颈动脉粥样硬化斑块与认知功能减退相关。加强对无症状颈动脉粥样硬化斑块的筛查及管理,对预防及延缓认知功能减退有重要意义。

Objective This study is aim to evaluate the relationship between asymptomatic carotid atherosclerotic plaque of dominant hemisphere side and cognitive impairment in community population aged over 40 years old.Method According to the inclusion criteria,a total of 861 participants over 40 years old without cerebrovascular disease who completed carotid ultrasound,cognitive assessment were enrolled in this study.The participants were rural residents from Beiqijia community in Changping District of Beijing and Beijing Konggang community in Shunyi District of Beijing who participated the China National Stroke Screen Survey(CNSSS)project from September 2015 to September 2017.Multivariate logistic regression was used to analyze the relationship between asymptomatic carotid atherosclerotic plaque of dominant side and cognitive impairment.Result In this study,the prevalence of asymptomatic carotid plaque was 59.2%(510 cases),the prevalence of cognitive impairment was 60.3%(519 cases).The ratio of right dominant hand was 92.0%(792 cases),and left dominant hand was 8.0%(69 cases).The analysis found that left asymptomatic carotid atherosclerotic plaque was associated with low MOCA score in right-dominant hand population after multivariate adjustment(OR of more than two plaques was 1.60,95%CI:1.01-2.53,P=0.044).Conclusion Asymptomatic carotid plaque of dominant hemisphere side was associated with cognitive decline in rural community population aged over 40 years old.Screening and management of asymptomatic carotid plaque may be important to prevent and delay cognitive decline.