脑微出血的危险因素及其对认知功能影响的临床研究  

Effect of cerebral microbleeds risk factors on cognitive function

作　　者：汪国宏[1,2] 吴竹青[1,2] 王小强[1,2] 张持[1,2] 岳宏[1,2] 群森[1,2] 吴君仓[1,2] 

机构地区：[1]安徽医科大学附属合肥医院 [2]合肥市第二人民医院神经内科,230011

出　　处：《中华老年心脑血管病杂志》2014年第7期736-739,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：安徽省科技计划项目(1301043051)

摘　　要：目的 探讨腔隙性脑梗死患者脑微出血（CMB）的危险因素及其对认知功能影响.方法 选择腔隙性脑梗死患者113例,根据头颅MRI磁敏感加权成像（SWI）检查结果分为CMB组33例和无CMB组80例.比较2组患者的一般临床资料及生化指标,并进一步回归分析CMB发生的相关危险因素.于入院后第2天应用蒙特利尔认知评估量表（MoCA）对患者的认知功能进行评估.结果 CMB组收缩压和同型半胱氨酸（Hcy）高于无CMB组[（158.3±13.7） mm Hg vs （138.2±15.2）mm Hg（1 mm Hg=0.133 kPa）和（13.7±4.5）μmol/L vs （9.4±2.4）μmol/L],差异有统计学意义（P=0.000）;CMB组总胆固醇低于无CMB组[（4.2±0.9） mmol/L vs （4.9±0.8）mmol/L],差异有统计学意义（P=0.000）;与无CMB组比较,CMB组的MoCA总分、视空间与执行功能和注意得分明显降低[（22.98±2.30）分 vs（27.49±1.15）分、（2.73±0.94）分 vs（3.78士0.66）分及（3.70±1.35）分vs（4.23±1.08）分],差异有统计学意义（P=0.000,P=0.030）.logistic回归分析显示,Hcy是CMB的独立危险因素（OR=0.735,95％CI：0.532～0.921,P=0.001）.结论 Hcy是CMB的独立危险因素;CMB会引起认知功能障碍,表现为视空间与执行功能和注意障碍.Objective To study the effect of cerebral microbleeds （CMB） risk factors in lacunar infarction patients on their cognitive function.Methods One hundred and thirteen lacunar infarction patients were divided into CMB group （n=33） and non-CMB group （n=80） according to their MRI susceptibility-weighted imaging.Their general clinical data and biochemical indicators were compared.CMB-related risk factors were analyzed by logistic regression analysis.Their cognitive function after admission was assessed following MoCA.Results The systolic pressure and plasma homocysteine （Hcy） level were significantly higher while the serum TC level was significantly lower in CMB group than in non-CMB group （158.3±13.7 mm Hg vs 138.2±15.2 mm Hg,13.7±4.5 μmol/L vs 9.4±2.4 μmol/L,P=0.000;4.2±0.9 mmol/L vs 4.9±0.8 mmol/L,P=0.000）.The scores of total MoCA,visual space function,executive function,and attention were significantly lower in non-CMB group than in CMB group （22.98±2.30 vs 27.49± 1.15,2.73± 0.94 vs 3.78±0.66,3.70±1.35 vs 4.23±1.08,P=0.000,P=0.030）.Logistic regression analysis showed that Hcy was an independent risk factor for CMB （OR=0.735,95％CI：0.532-0.921,P=0.001）.Conclusion Hey is an independent risk factor for CMB.CMB can lead to cognition impairement which is manifestaed as visual space,executive and attention dysfunction.

关 键 词：脑梗死 脑出血 认知障碍 高半胱氨酸 危险因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学]