脑小血管病磁共振总负担对认知功能的影响

doi:10.3969/j.issn.1004-583X.2023.11.004

摘要/Abstract

摘要：

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。

关键词: 脑小血管病, MRI总负担, 认知, MoCA量表

Abstract:

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.

Key words: cerebral small vessel disease, total MRI burden, cognitive function, MoCA scale

中图分类号:

R743

朱方方, 魏学志, 冯敏. 脑小血管病磁共振总负担对认知功能的影响[J]. 临床荟萃, 2023, 38(11): 984-990.

Zhu Fangfang, Wei Xuezhi, Feng Min. Effect of total magnetic resonance imaging burden on the cognitive function in patients with cerebral small vessel diseases[J]. Clinical Focus, 2023, 38(11): 984-990.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2023.11.004

https://lchc.magtechjournal.com/CN/Y2023/V38/I11/984

图/表 7

表1 两组临床资料及影像学指标比较

Tab.1 Comparison of clinical data and imaging indicators between the two groups

项目	认知障碍组 ( $n$ =100)	认知正常组 ( $n$ =127)	χ²/ $t$ / $F$ 值	$P$ 值
性别[例(%)]
男女	69(69.0) 31(31.0)	87(68.5) 40(31.5)	0.011	1.000
年龄( $x -$ ±s)	69.00±6.73	64.80±6.66	0.619	<0.01
教育年限( $x -$ ±s)	9.39±3.35	9.35±3.05	0.014	0.919
吸烟[例(%)]
无有	45(45.0) 55(55.0)	77(60.6) 50(39.4)	0.317	0.023
饮酒[例(%)]
无有	62(62.0) 38(38.0)	75(59.1) 52(40.9)	0.060	0.683
高血压病[例(%)]
无有	43(43.0) 57(57.0)	79(62.2) 48(37.8)	0.392	0.005
冠心病[例(%)]
无有	57(57.0) 43(43.0)	81(63.8) 46(36.2)	0.139	0.339
糖尿病[例(%)]
无有	63(63.0) 37(37.0)	76(59.8) 51(40.2)	0.065	0.681
卒中史[例(%)]
无有	53(53.0) 47(47.0)	76(59.8) 51(40.2)	0.138	0.345
TG(mmol/L)	2.17±0.71	2.04±0.67	0.198	0.140
CHOL(mmol/L)	4.85±1.07	4.57±1.12	0.258	0.055
HDL(mmol/L)	1.93±0.51	1.89±0.52	0.081	0.544
LDL(mmol/L)	2.49±1.12	2.44±1.02	0.051	0.702
HCY(mmol/L)	17.20±6.16	14.00±5.84	0.533	<0.01
UA(mmol/L)	396.00±65.50	378.00±69.20	0.262	0.050
FBG(mmol/L)	6.01±1.12	5.89±0.97	0.110	0.407
Lac评分(分)	0.70±0.46	0.50±0.50	0.423	0.002
CMBs评分[M(P25, P75)]	0.00 (0.00,1.00)	0.00 (0.00,0.00)	0.409	0.002
WMH评分( $x -$ ±s)	0.69±0.46	0.35±0.48	0.710	<0.01
EPVS评分( $x -$ ±s)	0.28±0.45	0.27±0.44	0.027	0.838
CSVD总负荷[M(P25, P75)]	2.00(1.00,2.00)	1.00 (1.00,1.50)	1.101	<0.01

表1 两组临床资料及影像学指标比较

Tab.1 Comparison of clinical data and imaging indicators between the two groups

项目	认知障碍组 ( $n$ =100)	认知正常组 ( $n$ =127)	χ²/ $t$ / $F$ 值	$P$ 值
性别[例(%)]
男女	69(69.0) 31(31.0)	87(68.5) 40(31.5)	0.011	1.000
年龄( $x -$ ±s)	69.00±6.73	64.80±6.66	0.619	<0.01
教育年限( $x -$ ±s)	9.39±3.35	9.35±3.05	0.014	0.919
吸烟[例(%)]
无有	45(45.0) 55(55.0)	77(60.6) 50(39.4)	0.317	0.023
饮酒[例(%)]
无有	62(62.0) 38(38.0)	75(59.1) 52(40.9)	0.060	0.683
高血压病[例(%)]
无有	43(43.0) 57(57.0)	79(62.2) 48(37.8)	0.392	0.005
冠心病[例(%)]
无有	57(57.0) 43(43.0)	81(63.8) 46(36.2)	0.139	0.339
糖尿病[例(%)]
无有	63(63.0) 37(37.0)	76(59.8) 51(40.2)	0.065	0.681
卒中史[例(%)]
无有	53(53.0) 47(47.0)	76(59.8) 51(40.2)	0.138	0.345
TG(mmol/L)	2.17±0.71	2.04±0.67	0.198	0.140
CHOL(mmol/L)	4.85±1.07	4.57±1.12	0.258	0.055
HDL(mmol/L)	1.93±0.51	1.89±0.52	0.081	0.544
LDL(mmol/L)	2.49±1.12	2.44±1.02	0.051	0.702
HCY(mmol/L)	17.20±6.16	14.00±5.84	0.533	<0.01
UA(mmol/L)	396.00±65.50	378.00±69.20	0.262	0.050
FBG(mmol/L)	6.01±1.12	5.89±0.97	0.110	0.407
Lac评分(分)	0.70±0.46	0.50±0.50	0.423	0.002
CMBs评分[M(P25, P75)]	0.00 (0.00,1.00)	0.00 (0.00,0.00)	0.409	0.002
WMH评分( $x -$ ±s)	0.69±0.46	0.35±0.48	0.710	<0.01
EPVS评分( $x -$ ±s)	0.28±0.45	0.27±0.44	0.027	0.838
CSVD总负荷[M(P25, P75)]	2.00(1.00,2.00)	1.00 (1.00,1.50)	1.101	<0.01

表2 Model 1的多因素回归结果

Tab. 2 Multivariate regression results for model 1

变量		β值	$t$ 值	$P$ 值	95% $C I$
变量		β值	$t$ 值	$P$ 值	下限	上限
年龄	[49, 83]	-0.07	-3.495	<0.01	-0.11	-0.03
吸烟	0( $n$ =122) 1( $n$ =105)	0.01	0.050	0.961	-0.52	0.55
高血压病	0( $n$ =122) 1( $n$ =105)	-0.96	-3.545	<0.01	-1.49	-0.43
HCY	[4, 46]	-0.06	-2.857	0.005	-0.11	-0.02
UA	[226, 656]	-0.00	-2.500	0.013	-0.01	-0.00
CHOL	[2.5, 7.6]	-0.17	-1.432	0.154	-0.41	0.07
Lac评分	[0, 1]	-0.83	-2.360	0.019	-1.52	-0.14
CMBs评分	[0, 1]	0.38	0.826	0.410	-0.53	1.29
WMH评分	[0, 1]	-0.48	-1.230	0.220	-1.25	0.29
CSVD评分	[1, 4]	-2.20	-6.658	<0.01	-2.85	-1.55

表2 Model 1的多因素回归结果

Tab. 2 Multivariate regression results for model 1

变量		β值	$t$ 值	$P$ 值	95% $C I$
变量		β值	$t$ 值	$P$ 值	下限	上限
年龄	[49, 83]	-0.07	-3.495	<0.01	-0.11	-0.03
吸烟	0( $n$ =122) 1( $n$ =105)	0.01	0.050	0.961	-0.52	0.55
高血压病	0( $n$ =122) 1( $n$ =105)	-0.96	-3.545	<0.01	-1.49	-0.43
HCY	[4, 46]	-0.06	-2.857	0.005	-0.11	-0.02
UA	[226, 656]	-0.00	-2.500	0.013	-0.01	-0.00
CHOL	[2.5, 7.6]	-0.17	-1.432	0.154	-0.41	0.07
Lac评分	[0, 1]	-0.83	-2.360	0.019	-1.52	-0.14
CMBs评分	[0, 1]	0.38	0.826	0.410	-0.53	1.29
WMH评分	[0, 1]	-0.48	-1.230	0.220	-1.25	0.29
CSVD评分	[1, 4]	-2.20	-6.658	<0.01	-2.85	-1.55

图1 model 1的森林图

Fig.1 Forest diagram of model 1

表3 Model 2 的多因素回归结果

Tab. 3 Multivariate regression results for model 2

变量		β值	$t$ 值	$P$ 值	95% $C I$
变量		β值	$t$ 值	$P$ 值	下限	上限
年龄	[49, 83]	-0.07	-3.57	<0.01	-0.11	0.03
高血压病	0( $n$ =122) 1( $n$ =105)	-0.94	-3.47	<0.01	-1.48	-0.41
HCY	[4, 46]	-0.07	-3.10	0.002	-0.11	-0.03
UA	[226, 656]	-0.01	-2.53	0.012	-0.01	-0.00
Lac评分	[0, 1]	-0.74	-2.65	0.009	-1.28	-0.19
CSVD总负荷	[1, 4]	-2.27	-11.43	<0.01	-2.66	-1.88

表3 Model 2 的多因素回归结果

Tab. 3 Multivariate regression results for model 2

变量		β值	$t$ 值	$P$ 值	95% $C I$
变量		β值	$t$ 值	$P$ 值	下限	上限
年龄	[49, 83]	-0.07	-3.57	<0.01	-0.11	0.03
高血压病	0( $n$ =122) 1( $n$ =105)	-0.94	-3.47	<0.01	-1.48	-0.41
HCY	[4, 46]	-0.07	-3.10	0.002	-0.11	-0.03
UA	[226, 656]	-0.01	-2.53	0.012	-0.01	-0.00
Lac评分	[0, 1]	-0.74	-2.65	0.009	-1.28	-0.19
CSVD总负荷	[1, 4]	-2.27	-11.43	<0.01	-2.66	-1.88

图2 Model 2的森林图

Fig. 2 Forest diagram of model 2

图3 Model 2的线性回归模型注:蓝色代表回归曲线,红色代表预测区间,灰色代表可信区间

Fig.3 Linear regression model for model 2 Blue represents the regression curve, red represents the prediction interval, and gray represents the confidence interval

图4 MoCA分数对model 2模型的回归诊断图

Fig.4 Regression diagnosis diagram of MoCA score on model 2

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