小动脉硬化性脑小血管病患者认知功能及影像学总负荷的相关因素研究

Relative factors of cognitive function and total imaging burden in patients with arteriolosclerotic cerebral small vessel disease

目的 探讨小动脉硬化性脑小血管病(CSVD)患者认知功能和影像学总负荷的相关因素。方法 选择2014年1月至2022年8月江苏大学附属武进医院神经内科首次住院确诊的小动脉硬化性CSVD患者146例,根据简易智能状态检查量表(MMSE)评分分为认知障碍组108例,非认知障碍组38例。收集人口学信息、临床表现、认知功能评分、Barthel指数、实验室检查及随访结果,采用头颅MRI评估脑白质高信号(WMH)Fazekas评分、CSVD影像学总负荷及脑萎缩评分。采用二分类logistic回归分析与CSVD认知功能的相关因素,有序多分类logistic回归分析与CSVD影像学总负荷的相关因素。结果 认知障碍组年龄、日常生活能力中重度依赖、脑深部WMH评分、浅表脑萎缩评分和深部脑萎缩评分显著高于非认知障碍组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,深部脑萎缩与CSVD认知障碍独立相关(OR=1.491,95%CI:1.054~2.109,P=0.024)。有79例患者完成中位数随访3年,随访后认知障碍和CSVD影像学总负荷评分高的人数显著增加(P<0.01)。单因素分析中,CSVD影像学总负荷与吸烟(OR=2.192,95%CI:1.010~4.754,P=0.047)、高血压(OR=4.904,95%CI:1.547~15.549,P=0.007)相关。多因素分析中,CSVD影像学总负荷与高血压独立相关(OR=7.338,95%CI:2.175~24.730,P=0.001)。结论 小动脉硬化性CVSD的病程可能与认知功能和影像学总负荷相关。深部脑萎缩是CSVD认知障碍的独立相关因素,高血压是CSVD影像学总负荷的独立相关因素。

Objective To explore the relative factors of cognitive function and total imaging burden in patients with arteriolosclerotic cerebral small vessel disease(CSVD).Methods A total of 146 patients with firstly-confirmed arteriolosclerotic CSVD treated in our department from January 2014 to August 2022 were enrolled,and then divided into cognitive impairment group(n=108)and non-cognitive impairment group(n=38)according to their mini-mental state examination(MMSE)score.Demographic information,clinical manifestations,cognitive function score,Barthel index,results of laboratory examinations and follow-up results were collected.Brain MRI was performed for white matter hyperintensity(WMH)Fazekas score,total imaging burden of CSVD and cerebral atrophy grade.Binary logistic regression analysis was used to analyze the factors related to cognitive function in CSVD patients.Ordered multiple logistic regression analysis was employed the correlative factors to the total imaging burden of CSVD.Results Older age,moderate to severe dependence on activities of daily living,higher deep brain WMH score and superficial and deep cerebral atrophy grade were observed in the cognitive impairment group than the non-cognitive impairment group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that cerebral atrophy was independently associated with cognitive impairment of CSVD(OR=1.491,95%CI:1.054-2.109,P=0.024).Among the 79 patients with a median follow-up period of 3 years,the numbers of patients with cognitive impairment and high scores of total imaging burden of CSVD were increased significantly after follow-up(P<0.01).Univariate analysis revealed that smoking(OR=2.192,95%CI:1.010-4.754,P=0.047)and hypertension(OR=4.904,95%CI:1.547-15.549,P=0.007)were correlated with total imaging burden of CSVD.While multivariate analysis found that hypertension was independently associated with total imaging burden of CSVD(OR=7.338,95%CI:2.175-24.730,P=0.001).Conclusion The disease course of arteriolosclerotic CVSD may be related to cognitive function and total imaging burden.Deep cerebral atrophy is an independent risk factor for cognitive dysfunction of CSVD,and hypertension is an independent risk factor for total imaging burden of CSVD.