皮质下缺血性脑血管病的临床特征及其认知损害的危险因素  

Clinical Feature and Risk Factor of Cognitive Impairment in Patients with Subcortical Ischemic Cerebrovascular Disease

作　　者：王贺波[1] 齐亚超[1] 吕佩源[1] 赵宝华[1] 郭宗成[1] 王天俊[1] 张和振[1] 刘昌林[1] 靳玮[1] 李玲[1] 赵大卫[1] 王建华[1] 

机构地区：[1]河北省人民医院神经内科,河北省石家庄市050051

出　　处：《中国全科医学》2010年第5期485-489,共5页Chinese General Practice

摘　　要：目的观察皮质下缺血性脑血管病(SIVD)患者的临床特征,分析确定SIVD患者认知损害的危险因素。方法根据Erkinjuntti提出的MRI诊断标准入选SIVD患者70例,根据神经心理学评估分为认知正常(NCI)组和血管性认知损害(VCI)组;详细记录其血管性危险因素、症状和体征,应用单因素和多因素Logistic逐步回归进行分析。结果多数(81.4%)患者表现为肢体肌力减退,其次为步态不稳和构音障碍(分别为40.0%、20.0%),但症状较轻;饮水呛咳和尿失禁各占14.3%。50例(71.4%)患者可检出上运动神经元受损体征;假性延髓麻痹和锥体外系体征者分别为10例、7例(14.3%、10.0%),共济失调步态异常者仅5例(7.1%)。NCI组和VCI组患者在年龄、性别和受教育年限方面差异无统计学意义(P>0.05);VCI组患者高血压、糖尿病和高脂血症的发生率明显高于NCI组(P<0.05),贫血、饮酒和吸烟史在两组之间差异无统计学意义(P>0.05)。非条件Logistic逐步回归分析仅证实有高血压、糖尿病的SIVD患者更易出现认知损害(P<0.05),其OR值分别为5.265(1.563,17.731),3.445(1.008,11.772),高脂血症〔OR3.649(0.974,11.466);P=0.027〕对SIVD患者出现认知损害所起的作用尚不能明确。结论年龄可能并不是SIVD认知损害的危险因素;SIVD认知损害的危险因素可能为高血压、糖尿病,而高脂血症与SIVD认知损害的关系尚不确定。Objective To investigate the clinical feature of subcortical ischemic cerebrovascular disease（SIVD） and the risk factor of its cognitive impairment.Methods Seventy SIVD patients,enrolled according to MRI diagnosis criteria proposed by Erkinjuntti,were divided,based on neuropsychological assessment,into groups NC（with normal cognition） and VCI（with vascular cognitive impairment）.Vascular risk factors,symptoms and signs were recorded and analyzed by Logistic univariate-and multi-factor stepwise regression.Results Most patients presented with limb weakness（81.4%）,followed by unsteady gait and dysarthria（40.0%,20.0%,respectively）,but the symptoms were relatively mild.Drinking cough and urinary incontinence accounted for 14.3%,respectively.Upper motor neurom damage signs were detected in 50 patients（71.4%）,pseudo-bulbar palsy and extrapyramidal symptoms in 10 and 7,respectively 14.3% and 10.0%,ataxia gait in 5（7.1%）.There was not significant difference in age,gender,year of education between groups NC and VCI（P〉0.05）.The incidences of hypertension,diabetes,coronary heart disease and hyperlipidemia were significantly higher in VCI group than in NC group（P〈0.05）.No significant difference was noted in anemia,alcohol consumption and smoking history between 2 groups（P〉0.05）.Non-conditional Logistic regression analysis confirmed that SIVD patients with hypertension and diabetes were more likely to present with cognitive damage,OR value=5.265（1.563,17.731）,3.445（1.008,11.772）,respectively,and the role of hyperlipidemia（OR=3.649（0.974,11.466）;P=0.027）in cognitive damage was not clear.Conclusion It is likely that age is not correlated with cognitive impairment in SIVD patients.Hypertension and diabetes mellitus are the main risk factors of SIVD cognitive impairment,but the relationship between hyperlipidemia and cognitive impairment is still unclear.

关 键 词：皮质下缺血性脑血管病 临床特征 认知损害 危险因素 

分 类 号：R743.31[医药卫生—神经病学与精神病学]