脑小血管病磁共振总负担对认知功能的影响

Effect of total magnetic resonance imaging burden on the cognitive functionin patients with cerebral small vessel diseases

目的探索脑小血管病患者脑磁共振总负担与认知功能的相关性。方法选择2021年9月至2022年10月入住我院神经内科并经脑磁共振成像(magnetic resonance imaging,MRI)确诊的227例脑小血管病患者,收集相应的临床资料、脑影像资料、血液学指标,使用蒙特利尔认知评估量表(MoCA)评估认知状态,探索磁共振影像学标志物与认知功能障碍的相关性。结果①经多因素分析,年龄、高血压病、同型半胱氨酸、尿酸、腔隙性梗死评分和脑小血管病总负荷均与MoCA分数存在相关性,差异有统计学意义(P<0.05)。②其他变量保持不变的情况下,脑小血管病总负荷每增加1分,MoCA分数下降2.27分;腔隙评分每增加1分,MoCA分数下降0.74分;同无高血压病的患者相比,合并高血压病者MoCA分数下降0.94分;尿酸和同型半胱氨酸水平每升高1个单位,MoCA分数分别下降0.01分和0.07分;年龄每长1岁,MoCA分数下降0.07分。总体来看,所有的预测变量解释了MoCA分数下降55.1%的变化。结论脑小血管病患者的认知功能受多种因素影响,脑MRI表现在一定程度上代表了脑小血管病脑内的病理状态,提示脑MRI总负担对认知功能下降有预警意义。

Objective To explore the correlation between total cerebral magnetic resonance imaging(MRI)burden and cognitive function in patients with cerebral small vessel diseases(CSVDs).Methods A total of 227 CSVD patients diagnosed by the brain MRI and hospitalized in the Department of Neurology from September 2021 to October 2022 were recruited.Their clinical data,brain imaging data,and hematological indicators were collected.Cognitive function was evaluated using the Montreal Cognitive Assessment(MoCA)scale.The correlation between MRI markers and cognitive dysfunction was explored.Results The multivariate analysis showed that age,hypertension,homocysteine(HCY),uric acid(UA),lacunar stroke score(Lac)and total burden of CSVDs were all significantly correlated with the MoCA score(P<0.05).When other variables remained unchanged,the MoCA score decreased by 2.27 points for each point increase in the total burden of CSVD.The MoCA score decreased by 0.74 points for each point increase in the Lac score.The MoCA score decreased by 0.94 points for patients with a history of hypertension compared with those lacking the history of hypertension.The MoCA score decreased by 0.01 points and 0.07 points for each unit increase in UA and HCY levels,respectively.The MoCA score decreased by 0.07 points for one year older.Overall,all predictors explained the 55.1%decrease in MoCA scores.Conclusion The cognitive function of CSVD patients is affected by many factors,and the brain MRI visualizes the intracranial pathological state.It is suggested that the total burden of brain MRI has an early warning significance for cognitive decline.