高血压合并脑小血管病患者情感淡漠危险因素及其与认知功能的相关性

Risk factors of apathy and correlations with cognitive function in patients with hypertension combined with cerebral small vessel disease

目的观察高血压合并脑小血管病(CSVD)患者情感淡漠危险因素及其与认知功能的相关性。方法前瞻性纳入141例高血压合并CSVD患者,根据神经精神问卷-淡漠量表(NPI-Apathy)将其分为淡漠组(n=43)与非淡漠组(n=98)。比较组间一般资料、影像学标志物评分及影像学总负荷评分;以多因素logistic回归分析观察高血压合并CSVD患者情感淡漠的独立危险因素,以Spearman相关分析观察其情感淡漠与认知功能的相关性。结果淡漠组患者年龄、高密度脂蛋白胆固醇(HDL-C)、侧脑室旁脑白质高信号(WMH)Fazekas评分、深部/幕下脑微出血及总负荷评分均高于非淡漠组(P均<0.05);其简易精神状态检查(MMSE)及蒙特利尔认知评估(MoCA)评分均低于非淡漠组(P均<0.05)。HDL-C及侧脑室旁WMH Fazekas评分均为高血压合并CSVD患者情感淡漠的独立危险因素(P均<0.05),且其NPI-Apathy评分与MMSE评分及MoCA评分均呈中度负相关(r=-0.543、-0.484,P均<0.001)。结论HDL-C及侧脑室旁WMH Fazekas评分均为高血压合并CSVD患者情感淡漠的独立危险因素;情感淡漠越严重,认知功能越低。

Objective To explore the risk factors of apathy and correlations with cognitive function in patients with hypertension combined with cerebral small vessel disease(CSVD).Methods Totally 141 patients with hypertension combined with CSVD were prospectively enrolled and were divided into apathy group(n=43)and non-apathy group(n=98)according to neuropsychiatric inventory-apathy scale(NPI-Apathy)scores.The general data,imaging marker scores and total imaging burden scores were compared between groups.In hypertension combined with CSVD patients,multivariate logistic regression analysis was performed to screen the independent risk factors of apathy,and Spearman correlation analysis was also performed to observe the correlation of apathy and cognitive function.Results The patients’age,high density lipoprotein cholesterol(HDL-C),Fazekas scores of lateral periventricular white matter hyper-intensity(WMH),cerebral microbleed of depth/infratentorial and total imaging burden scores of apathy group were all higher,while mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)scores were both lower than those of non-apathy group(all P<0.05).HDL-C and Fazekas scores of lateral periventricular WMH were both independent risk factors for apathy(both P<0.05),while NPI-Apathy scores were moderately negatively correlated with cognitive function in patients with hypertension combined with CSVD(r=-0.543,-0.484,both P<0.001).Conclusion HDL-C and Fazekas scores of lateral periventricular WMH were both independent risk factors for apathy in patients with hypertension combined with CSVD.The more severe the apathy,the lower the cognitive function.