目的 研究不同程度脑白质病变(white matter lesion,WML)的危险因素,分析WML与认知功能的相关性.方法 选取2022年2月至2023年2月于山东第一医科大学第二附属医院神经内科住院的WML患者的临床资料、血液指标,并对其进行颅脑核磁共振检查,同时完成蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)、简易精神状态检查量表(mini-mental state examination,MMSE)、日常生活活动能力量表(activity of daily living scale,ADL)、汉密顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密顿抑郁量表(Hamilton depression scale,HAMD)等神经心理评定.根据Fazekas评分量表将其分为无WML组、轻度WML组、中度WML组、重度WML组,比较4组患者的临床资料、血液指标、MoCA量表相关认知领域评分、MoCA总分、MMSE评分、ADL评分、HAMA评分、HAMD评分,研究患者发生不同程度WML的危险因素,分析不同程度WML与认知障碍的相关性.根据发生WML的部位,将其分为正常对照组、侧脑室周围白质病变(PVL)组和脑深部白质病变(DWML)组,比较3组患者的MoCA量表相关认知领域评分、MoCA总分,分析不同部位WML与认知障碍的相关性.结果 4组患者在年龄、高血压、糖尿病、冠心病、脑梗死、吸烟史、高同型半胱氨酸血症方面的差异有统计学意义(P<0.05).通过有序logistic 回归分析得出,年龄、高血压、糖尿病、高同型半胱氨酸血症是出现不同程度WML的危险因素(P<0.05).不同程度WML患者的认知障碍比较:轻度WML组与无WML组的认知功能比较,差异无统计学意义((P>0.05)),中重度WML组与无WML组的MoCA总分、视空间与执行功能、注意力评分比较,差异有统计学意义(P<0.001).不同部位WML患者的认知障碍比较:DWML组的MoCA总分显著低于PVL组,且DWML组的定向力、延迟回忆功能均显著降低,差异有统计学意义(P<0.05).WML对认知障碍的预测价值:基于MoCA评估患者的认知功能,以Fazekas评分预测患者认知障碍的受试者工作特征(receiver operating characteristic,ROC)曲线分析,表明中度WML对患者认知障碍的发生具有一定程度的预测价值.结论 年龄、高血压、糖尿病、高同型半胱氨酸血症是患者发生不同程度WML的危险因素,WML的严重程度、部位均与认知障碍呈相关性,对认知障碍的发生发展具有预测价值.
A study on the risk factors of white matter lesions and their correlation with cognitive functions
Objective:To investigate the risk factors for different degree of white matter lesions(WML)and analyze the correlation between WML and cognitive functions.Methods:Clinical data and blood indicators of WML patients admitted to the Neurology Department of the Second Affiliated Hospital of Shandong First Medical University from February 2022 to February 2023 were selected,and brain magnetic resonance imaging was performed on them.At the same time,Neuropsychological assessments such as the Montreal cognitive assessment scale(MoCA),minimal mental state examination Scale(MMSE),activities of daily living scale(ADL),Hamilton anxiety scale(HAMA),the Hamilton depression scale(HAMD)were completed.According to the Fazekas scoring scale,patients were divided into no WML group,mild WML group,moderate WML group,and severe WML group.The clinical data,blood indicators,MoCA related cognitive domain scores,MoCA total score,MMSE score,ADL score,HAMA score,HAMD score of the four groups were compared,the risk factors for different degrees of WML patients were analyzed.To analyze the correlation between different degrees of WML and cognitive impairment.According to the location of WML,related data was divided into normal control group,lateral ventricle peripheral white matter lesion(PVL)group and deep brain white matter lesion(DWML)group.Results:There were significant differences among the four groups in age,hypertension,diabetes,coronary heart disease,cerebral infarction,smoking history,and hyperhomocysteinemia(P<0.05).By ordinal logistic regression analysis,age,hypertension,diabetes,and hyperhomocysteinemia were the risk factors for different degrees of WML patients(P<0.05).Comparison of cognitive impairment in patients with different degrees of WML:There was no significant difference in cognitive function between the mild WML group and the non WML group.The differences in MoCA total score,visual space and executive function,and attention score between the moderate to severe WML group and the non WML group were statistically significant(P<0.001).Comparison of cognitive impairment among WML patients in different regions:The total MoCA score of the DWML group was significantly lower than that of the PVL group,and the directional ability and delayed recall function of the DWML group were significantly reduced(P<0.05).The predictive value of WML for cognitive impairment:Based on the MoCA to evaluate patients'cognitive functions,the ROC curve analysis using Fazekas scores to predict cognitive impairment in patients indicates that moderate WML have a certain predictive value for the occurrence of cognitive impairment.Conclusion:Age,hypertension,diabetes and hyperhomocysteinemia are the risk factors for different degrees of WML patients.The severity and location of WML are correlated with cognitive impairment,which has predictive value for the occurrence and development of cognitive impairment.
white matter lesionsmild cognitive impairmentrisk factorrelevance
万方数据
维普
