新发皮质下小梗死患者基底节区扩大的血管周围间隙与执行功能的相关性

Correlation between basal ganglia-enlarged perivascular space and executive function in patients with recent small subcortical infarct

目的明确新发皮质下小梗死(RSSI)伴认知障碍的影响因素,探讨RSSI伴认知障碍患者扩大的血管周围间隙(EPVS)与执行功能的关系。方法选择南京医科大学附属常州市第二人民医院神经内科自2021年2月至12月收治的RSSI患者115例,按照蒙特利尔认知评估量表(MoCA)评分将其分为认知功能正常组(MoCA评分≥26分,45例)及认知功能障碍组(MoCA评分<26分,70例)。采用单因素分析比较2组患者一般临床资料及EPVS体积等的差异,采用多因素Logistic回归分析明确RSSI伴认知障碍的独立影响因素。同时进一步根据EPVS视觉分级将患者分为EPVS无-轻度组及中重度2组,比较2组患者不同认知功能域评分的差异,采用Spearman相关分析检验EPVS分级及体积与执行功能的关系。结果RSSI伴认知功能障碍组患者的年龄、血肌酐水平、基底节区EPVS(BG-EPVS)中重度患者比例、BG-EPVS体积均明显高于认知功能正常组患者,受教育年限明显低于认知功能正常组患者,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,BG-EPVS体积是RSSI伴认知功能障碍的独立危险因素(OR=1.421,95%CI:1.028~1.965,P=0.034)。在RSSI伴认知功能障碍的患者中,BG-EPVS中重度组患者的MoCA总分及视空间与执行功能域评分明显低于无-轻度组患者,Stroop色词测验(SCWT)和连线测试(TMT)复合Z分及执行功能总复合Z分明显高于无-轻度组患者,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,RSSI伴认知功能障碍患者BG-EPVS分级及BG-EPVS体积均与执行功能总复合Z分呈正相关关系(r=0.439,P=0.001;r=0.410,P=0.001)。结论BG-EPVS体积是RSSI患者认知功能障碍的独立危险因素,BG-EPVS分级及BG-EPVS体积均与认知功能中的执行功能损伤程度相关。

Objective To identify the influencing factors for cognitive impairment in patients with recent small subcortical infarct(RSSI),and explore the relationship between enlarged perivascular space(EPVS)and executive function in patients with RSSI.Methods From February to December 2021,115 patients with RSSI accepted treatment in Department of Neurology,Changzhou Second People's Hospital Affiliated to Nanjing Medical University were enrolled.According to Montreal cognitive assessment(MoCA)scores,these patients were divided into normal cognitive function group(MoCA scores≥26,n=45)and cognitive impairment group(MoCA scores<26,n=70);univariate analysis was used to analyze the differences of general clinical data and EPVS volume between the two groups;multivariate Logistic regression analysis was used to identify the independent influencing factors for RSSI combined with cognitive impairment.Patients were further divided into EPVS non-mild group and EPVS moderate-severe group according to EPVS visual assessment;the differences of scores of different executive function domains were compared between the two groups;Spearman correlation analysis was used to observe the relationships of EPVS grading and volume with executive function.Results Patients in the cognitive impairment group had significantly older age,significantly higher serum creatinine level,proportion of patients with moderate-severe basal ganglia EPVS(BG-EPVS)and BG-EPVS volume,and significantly lower years of education as compared with those in the normal cognitive function group(P<0.05).Multivariate Logistic regression analysis showed that BG-EPVS volume(OR=1.421,95%CI:1.028-1.965,P=0.034)was an independent risk factor for RSSI combined with cognitive impairment.MoCA total scores,scores of visual space and executive function domains in patients of the BG-EPVS moderate-severe group were significantly lower than those in patients of the BG-EPVS non-mild group,while Z-scores of Stroop color word test(SCWT)and trail making test(TMT),and total Z-scores of executive function were significantly higher than those in patients of the BG-EPVS non-mild group(P<0.05).Spearman correlation analysis showed that BG-EPVS grading and volume were positively correlated with total Z-scores of executive function in RSSI patients with cognitive impairment(r=0.439,P=0.001;r=0.410,P=0.001).Conclusion BG-EPVS volume is an independent risk factor for cognitive impairment,and both BG-EPVS grading and volume are correlated with impairment degrees of executive function in cognitive function in RSSI patients.