不同类型脑小血管病患者认知功能损害特征及危险因素分析

发布时间：2018-03-23 07:48

本文选题：脑小血管疾病　切入点：中风　出处：《中国全科医学》2017年05期 　论文类型：期刊论文

【摘要】：目的比较不同类型脑小血管病(CSVD)患者认知功能损害的特征,并分析其危险因素。方法选取2012—2013年河北医科大学第一医院神经内科住院治疗的CSVD患者118例,根据影像学表现,分为脑白质病变(WML)组40例,腔隙性脑梗死(LI)组38例,WML+LI组40例。另选取同期门诊就诊影像学无异常者39例为对照组。记录受试者性别、年龄、受教育年限、吸烟史、饮酒史,是否合并高血压、糖尿病、高脂血症,有无脑卒中病史,以及超敏C反应蛋白(hs-CRP)水平。采用简易智力状态检查量表(MMSE)及蒙特利尔认知评估量表(Mo CA)评估受试者认知能力,采用临床痴呆评定量表(CDR)评估受试者痴呆严重程度。应用多因素Logistic回归分析CSVD患者发生认知功能损害的危险因素。结果各组MMSE总分及记忆力、回忆能力、注意和计算力评分比较,差异有统计学意义(P0.05);其中,WML组MMSE总分及记忆力、回忆能力评分低于对照组,LI组MMSE总分及回忆能力评分低于对照组,WML+LI组MMSE总分及记忆力、回忆能力、注意和计算力评分低于对照组、WML组、LI组(P0.05)。各组Mo CA总分、视空间及执行功能、记忆、语言、计算评分比较,差异有统计学意义(P0.05);其中,WML组Mo CA总分、视空间及执行功能、记忆、语言评分低于对照组,LI组Mo CA总分、视空间及执行功能、语言评分低于对照组,WML+LI组Mo CA总分、视空间及执行功能、语言、计算评分低于对照组、WML组、LI组,记忆评分低于对照组、LI组(P0.05)。WML组、LI组痴呆程度较对照组严重,WML+LI组痴呆程度较对照组、WML组、LI组严重(P0.05)。多因素Logistic回归分析显示,较高的受教育年限〔OR=0.684,95%CI(0.561,0.835)〕是CSVD患者认知功能损害的保护因素,高龄〔OR=1.092,95%CI(1.022,1.168)〕、吸烟史〔OR=3.732,95%CI(1.058,13.164)〕、饮酒史〔OR=4.615,95%CI(1.094,19.465)〕、糖尿病〔OR=2.937,95%CI(1.016,8.491)〕、高脂血症〔OR=3.207,95%CI(1.024,10.045)〕及hs-CRP水平升高〔OR=1.245,95%CI(1.040,1.492)〕是CSVD患者认知功能损害的危险因素(P0.05)。结论不同类型CSVD患者均可产生认知功能损害,WML合并LI患者认知功能损害更为严重,主要表现为视空间及执行功能、记忆、语言、计算4个认知域损害,且WML合并LI可加重痴呆的发生;高龄、吸烟史、饮酒史、糖尿病、高脂血症及hs-CRP水平升高是CSVD患者发生认知功能损害的危险因素。
[Abstract]:Objective to compare the characteristics of cognitive impairment in patients with different types of small cerebral vascular disease (CSVD) and to analyze the risk factors. Methods 118 CSVD patients who were hospitalized in Department of Neurology, first Hospital of Hebei Medical University from 2012 to 2013 were selected. The patients were divided into white matter lesion group (WML) group (n = 40) and lacunar infarction (Li) group (n = 38), WML Li group (n = 40). Another 39 cases were selected as control group. Sex, age, years of education, smoking history, drinking history were recorded. To evaluate the cognitive ability of subjects with hypertension, diabetes, hyperlipidemia, history of stroke, and the level of hypersensitive C-reactive protein (hs-CRP). The subjects' cognitive ability was assessed by MMSE (simple Mental State Checklist) and Mo CA (Montreal Cognitive Assessment scale). The severity of dementia was evaluated by clinical dementia rating scale (CDR). The risk factors of cognitive impairment in patients with CSVD were analyzed by multivariate Logistic regression analysis. Results the total scores of MMSE, memory, memory and recall were measured in each group. The scores of MMSE and memory in WML group were lower than those in control group (P < 0.05). The total MMSE score and recall ability score in WML group were lower than those in control group (P < 0.05), and the total MMSE score, memory ability and memory ability in WML Li group were lower than those in control group (P < 0.05), and the scores of recall ability were lower than those in control group (P < 0.05). The total score of Mo CA, visual space and executive function, memory, language and calculation score in WML group were significantly lower than those in control group WML group (P 0.05), the total score of Mo CA, visual space and executive function, memory, memory in WML group were significantly lower than those in control group, and the scores of Mo CA, visual space, executive function and memory in WML group were significantly lower than those in control group (P < 0.05). The total score of Mo CA, visual space and executive function, the total score of Mo CA, visual space and executive function, the score of language and the score of language calculation were lower than those of the control group and WML group, and the scores of language and language were lower than those of the control group and WML group. The memory score was lower than that in the control group (P 0.05). The degree of dementia in the Li group was more severe than that in the control group. Multivariate Logistic regression analysis showed that the dementia degree of the Li group was more severe than that of the control group. The higher number of years of education (0.684 / 95) is the protective factor of cognitive impairment in patients with CSVD. In the elderly, OR1.092 / 95 CIQ 1.022 / 1.168C, the history of smoking 1.03.73295 CI1.0588 / 13.164, the history of drinking 1.0994 (19.465C), the diabetes mellitus OR2.9395CI1.0168.491a, the hyperlipidemia OR3.20795CI1.02.20795CI1.01.020795CI1.01.20795CI1.010.045) and the elevated hs-CRP level / OR1.24595CI1.040401.492a are the risk factors for cognitive impairment in CSVD patients (P 0.05). Conclusion different types of CSVD patients may have cognitive impairment or cognitive impairment in patients with CSVD. The damage to function is more serious. The main manifestations were visual space and executive function, memory, language, calculation of four cognitive domain damage, and WML combined with Li can aggravate the occurrence of dementia, old age, smoking history, drinking history, diabetes mellitus, Hyperlipidemia and elevated hs-CRP level are risk factors for cognitive impairment in CSVD patients.
【作者单位】：河北医科大学第一医院神经内科;
【分类号】：R743.3

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