脑小血管病患者近期皮质下小梗死与认知功能的相关性研究

Relationship between cognitive function and recent small subcortical infarcts in patients with cerebral small vessel disease

目的 探讨脑小血管病(CSVD)患者近期皮质下小梗死与认知功能的相关性。方法 回顾性连续纳入2018年2月―2022年9月就诊于北京大学第一医院神经内科经头部MRI诊断的CSVD患者,收集一般人口学资料和临床资料,使用简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估认知功能,根据磁共振DWI分为近期皮质下小梗死(RSSI)组和非RSSI组,统计RSSI的部位和数目。比较两组患者的一般人口学资料、临床资料、认知功能,分析RSSI影像学特征与认知功能的关系。结果 共纳入CSVD患者181例,RSSI组91例,非RSSI组90例。RSSI组与非RSSI组相比,BMI高[(25.43±3.53)kg/m^(2) vs(24.27±3.33)kg/m^(2),t=2.228, P=0.027],收缩压高[(145.3±16.2)mmHg vs(139.6±20.2)mmHg,t=2.013,P=0.046],MoCA总分较低[22(18.8,26) vs 24(21,27),Z=-1.980,P=0.048],视空间与执行能力[3(2,4) vs 4(3,5),Z=-2.756,P=0.006]、语言[2(2,3) vs 2(1,2), Z=-2.020,P=0.043]、抽象[2(1,2) vs 2(1,2)分,Z=-2.052,P=0.04]得分均较低,差异均具有显著性统计学意义(P<0.05)。RSSI基底节梗死组与非RSSI组相比,MoCA总分较低[21(17,23) vs 24(21,27),Z=-2.018,P=0.044],视空间与执行[3(1.5,3.5) vs 4(3,5),Z=-2.601,P=0.009]得分较低,RSSI脑干梗死组与非RSSI组相比,视空间与执行[3(2,4) vs 4(3,5),Z=-2.325,P=0.020]、语言[2(1,2) vs 2(2,3),Z=-2.338,P=0.019]得分较低,差异具有显著性统计学意义。结论 CSVD患者中RSSI可导致认知功能障碍,与RSSI梗死部位相关,RSSI不同梗死部位导致不同的认知损害模式。预防RSSI发生,对于预防CSVD相关认知功能障碍具有重要意义。

Objective To investigate the relationship between cognitive function and recent small subcortical in⁃farcts(RSSI)in patients with cerebral small vessel disease(CSVD).Methods We retrospectively consecutively in⁃cluded patients with CSVD confirmed by brain magnetic resonance imaging in the Department of Neurology,Peking Uni⁃versity First Hospital from February 2018 to September 2022.General demographic data and clinical data were collected.Cognitive function was assessed using the Mini-Mental State Examination(MMSE)and the Montreal Cognitive Assessment(MoCA).According to diffusion-weighted imaging findings,the patients were divided into RSSI group and non-RSSI group.The number and location of RSSI were recorded.The general demographic data,clinical data,and cognitive func⁃tion of the two groups were compared,and the relationship between RSSI imaging features and cognitive function was ana⁃lyzed.Results A total of 181 patients with CSVD were included,with 91 in the RSSI group and 90 in the non-RSSI group.Compared with the non-RSSI group,the RSSI group had a significantly higher body mass index(24.27±3.33 vs 25.43±3.33 kg/m^(2),t=2.228,P=0.027),a significantly higher systolic pressure(139.6±20.2 vs 145.3±20.2 mmHg,t=2.013,P=0.046),a significantly lower total MoCA score[24(21,27)vs 22(18.8,26),Z=-1.980,P=0.048],a significantly lower score in visuospatial and executive function[4(3,5)vs 3(2,4),Z=-2.756,P=0.006],a signifi⁃cantly lower score in language[2(2,3)vs 2(1,2),Z=-2.020,P=0.043],and a significantly lower score in abstrac⁃tion[2(1,2)vs 2(1,2),Z=-2.052,P=0.04].Compared with the non-RSSI group,patients with RSSI in the basal ganglia had a significantly lower total MoCA score[24(21,27)vs 21(17,23),Z=-2.018,P=0.044]and a signifi⁃cantly lower score in visuospatial and executive function[4(3,5)]vs 3(1.5,3.5),Z=-2.601,P=0.009];and pa⁃tients with RSSI in the brainstem had significantly lower scores in visuospatial and executive function[4(3,5)vs 3(2,4),Z=-2.325,P=0.020]and language[2(2,3)vs 2(1,2),Z=-2.338,P=0.019].Conclusion In patients with CSVD,RSSI can result in cognitive impairment,and the location of RSSI can affect the pattern of cognitive impairment.Preventing the occurrence of RSSI is important for pre⁃venting CSVD-related cognitive impairment.