摘要
目的 探讨同型半胱氨酸(Hey)与血压变异性指标对缺血性脑小血管病患者并发认知障碍的预测价值.方法 选择2021年1月至2023年1月开滦总医院开滦精神卫生中心收治的缺血性脑小血管病患者136例为研究对象.采用蒙特利尔认知评估量表(MoCA)评估患者的认知功能,并根据认知功能将患者分为认知正常组(MoCA评分≥25,n=52)和认知障碍组(MoCA评分＜25分,n=84).比较2组患者的一般临床资料;检测所有患者的Hey及血压变异性指标[包括夜间收缩压标准差(nSSD)、夜间舒张压标准差(nDSD)、日间收缩压标准差(dSSD)、日间舒张压标准差(dDSD)];采用logistic回归分析影响缺血性脑小血管病患者发生认知障碍的影响因素,受试者操作特征(ROC)曲线分析Hey及血压变异性指标对缺血性脑小血管病患者发生认知障碍的预测价值.结果 认知正常组与认知障碍组患者的年龄、体质量指数、性别、吸烟史、饮酒史、糖尿病史、冠状动脉性心脏病等比较差异无统计学意义(P＞0.05);2组患者高血压史占比比较差异有统计学意义(P＜0.05).认知障碍组患者的Hey、nSSD、nDSD、dSSD及dDSD显著高于认知正常组(P＜0.05).多因素logistic回归分析结果显示,Hcy、nSSD、nDSD、dSSD、dDSD为影响缺血性脑小血管病患者发生认知障碍的危险因素(P＜0.05).ROC曲线分析结果显示,Hey、nSSD、nDSD、dSSD、dDSD及五者联合预测缺血性脑小血管病患者发生认知障碍的灵敏度分别为67.86％、80.95％、61.90％、78.57％、65.48％、94.05％,特异度分别为 78.85％、67.31％、94.23％、88.46％、82.69％、96.15％,曲线下面积分别为 0.778、0.772、0.835、0.893、0.810、0.977.Hcy、nSSD、nDSD、dSSD、dDSD五者联合的预测价值显著高于单独预测(P＜0.05).结论 发生认知障碍的缺血性脑小血管病患者Hcy、nSSD、nDSD、dSSD、dDSD指标均升高,这些指标对缺血性脑小血管病患者发生认知障碍具有预测价值,且五者联合的预测价值优于单独预测.
Abstract
Objective To explore the predictive value of homocysteine(Hey)and blood pressure variability indicators for cognitive impairment in patients with ischemic cerebral small vessel disease.Methods A total of 136 patients diagnosed with ischemic cerebral small vessel disease in the Kailuan Mental Health Center of Kailuan General Hospital from January 2021 to January 2023 were selected as the research subjects.The Montreal cognitive assessment(MoCA)was used to evaluate patients'cognitive function.According to the cognitive function,the patients were divided into cognitively normal group(MoCA score ≥25,n=52)and cognitively impaired group(MoCA score＜25,n=84).The general clinical data of patients in the two groups were compared.The Hey and blood pressure variability indicators[nighttime systolic blood pressure standard deviation(nSSD),nighttime diastolic blood pressure standard deviation(nDSD),daytime systolic blood pressure standard deviation(dSSD),and daytime diastolic blood pressure standard deviation(dDSD)]of all patients were detected.Logistic regression was used to analyze the influencing factors of cognitive impairment in patients with ischemic cerebral small vessel disease.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of Hey and blood pressure variability indicators for cognitive impairment in patients with ischemic cerebral small vessel disease.Results There was no statistically significant difference in age,body mass index,gender,smoking history,drinking history,diabetes history,and coronary heart disease of patients between the cognitively normal group and the cognitively impaired group(P＞0.05).The proportion of patients with hypertension history showed a statistically significant difference between the two groups(P＜0.05).The Hey,nSSD,nDSD,dSSD,and dDSD of patients in the cognitively impaired group were significantly higher than those in the cognitively normal group(P＜0.05).The multivariate logistic regression analysis showed that Hey,nSSD,nDSD,dSSD,and dDSD were risk factors for cognitive impairment in patients with ischemic cerebral small vessel disease(P＜0.05).The ROC curve analysis showed that the sensitivities of Hey,nSSD,nDSD,dSSD,dDSD,and their combination for predicting cognitive impairment in patients with ischemic cerebral small vessel disease were 67.86％,80.95％,61.90％,78.57％,65.48％,and 94.05％,respectively;the specificities were 78.85％,67.31％,94.23％,88.46％,82.69％,and 96.15％,respectively;and the areas under the curve were 0.778,0.772,0.835,0.893,0.810,and 0.977,respectively.The predictive value of the combined Hey,nSSD,nDSD,dSSD,and dDSD was higher than that of each indicator alone(P＜0.05).Conclusion The Hey,nSSD,nDSD,dSSD,and dDSD in patients with ischemic cerebral small vessel disease who experience cognitive impairment increase,and which have predictive value for the occurrence of cognitive impairment in patients with ischemic cerebral small vessel disease.The predictive value of the combined five indicators is better than that of individual indicators.
维普
万方数据