不同影像学类型脑小血管病与认知障碍的关系及影响因素
摘要
目的:探讨不同影像学类型的脑小血管病与认知障碍的关系,并分析认知障碍的影响因素。方法:脑小血管病患者82例(观察组),根据核磁影像学表现分为腔隙性病灶型28例,脑白质疏松型33例,微出血型8例以及血管周围间隙扩大型13例。选取同期门诊无脑血管病者30例为对照组。收集两组年龄,性别,受教育年限,吸烟史,高血压史,糖尿病史以及相关实验室检查结果,以简易智力状态评定量表(MMSE)及蒙特利尔认知量表(MoCA)评定认知障碍,比较各组间认知水平,采用Logistic回归分析认知障碍的危险因素。结果:观察组患者MMSE评分及MoCA评分分别为26.79±2.37分、25.66±3.07分,均低于对照组的27.83±1.88分、26.93±2.59分,差异均有统计学意义(P<0.05)。腔隙性病灶组MMSE评分26.46±2.20分和MoCA评分25.10±2.64分,脑白质疏松组MMSE评分26.33±2.47分和MoCA评分25.30±3.09分,均低于对照组的MMSE评分和MoCA评分,差异均有统计学意义(P<0.05);而其他各组间两两比较,认知水平差异均无统计学意义(P>0.05)。多因素分析显示,高龄、吸烟、高血压史、高糖化血红蛋白、高LDL-C血症是认知障碍的危险因素,而高HDL-C水平及受教育年限是保护性因素。结论:脑小血管病可以导致认知水平的下降,尤其以影像学表现为腔隙性病灶及白质疏松的患者更易合并认知障碍。针对危险因素采取针对性干预措施,有可能改变疾病的进程及预后。
引文
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[5]Marstrand JR, Garde E, Rostrop E, et al. Cerebral perfusion and cerebrovascular reactivity are reduced in white matter hyperintensities[J]. Stroke, 2002, 33(4):972-976.
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