微血管功能障碍相关危险因素与老年抑郁症患者认知损害的相关分析  

Correlation between risk factors of microvascular dysfunction and cognitive impairment in late-life depression

作　　者：周华荣[1] 王天乐 钟笑梅[3] 陈贲[1] 吴章英[1] 张敏[1] 王强[1] 麦乃铿 彭琪[3] 宁玉萍[1] Zhou Huarong;Wang Tianle;Zhong Xiaomei;Chen Ben;Wu Zhangying;Zhang Min;Wang Qiang;Mai Naikeng;Peng Qi;Ning Yuping(Neuropsychiatric Research Institute,the Affiliated Brain Hospital of Guangzhou Medical University,Guangzhou 510370,China;Department of Science and Education,the Affiliated Brain Hospital of Guangzhou Medical University,Guangzhou 510370,China;Department of Geriatrics,the Affiliated Brain Hospital of Guangzhou Medical University,Guangzhou 510370,China;Department of Neurology,the Affiliated Brain Hospital of Guangzhou Medical University,Guangzhou 510370,China)

机构地区：[1]广州医科大学附属脑科医院精神神经科学研究所,510370 [2]广州医科大学附属脑科医院科教信息科,510370 [3]广州医科大学附属脑科医院老年科,510370 [4]广州医科大学附属脑科医院神经内科,510370

出　　处：《中华精神科杂志》2021年第4期252-258,共7页Chinese Journal of Psychiatry

基　　金：广东省科技计划项目(2019B030316001);广州市科技计划项目(201805010009)。

摘　　要：目的探讨微血管功能障碍相关危险因素与老年抑郁症患者认知损害的相关性。方法于2014年5月至2019年5月共纳入89名健康老年人(对照组)和113例老年抑郁症患者(老年抑郁症组),并将老年抑郁症组分为认知正常组(33例)和伴轻度认知功能障碍(mild cognitive impairment,MCI)组(80例)。收集微血管功能障碍相关病史(高血压、2型糖尿病、冠心病和高脂血症)、血液指标[同型半胱氨酸(homocysteine,Hcy)和C反应蛋白]及脑小血管病的磁共振成像表现[脑白质高信号、血管周围间隙扩大(enlarged perivascular space,EPVS)和腔隙性梗死]等资料,完成包括总体认知功能及各认知域的相关测验。比较各组间微血管功能及认知的差异,进一步分析各组中微血管功能障碍相关标记物与认知评分的相关性,最后采用Logistic回归分析探索微血管功能障碍对老年抑郁症患者认知损害的独立风险。结果伴MCI老年抑郁症组患高血压比例及Hcy浓度明显高于对照组及认知正常老年抑郁症组(χ^(2)=15.67,P<0.01;F=7.05,P=0.001),半卵圆区EPVS严重程度明显高于对照组(χ^(2)=10.64,P=0.005)。伴MCI老年抑郁症组Hcy浓度(r=-0.25,P=0.024)及脑白质高信号评分(r=-0.33,P=0.017)与执行功能呈负相关。Logistic回归分析显示,高血压(β=2.34,P=0.005)、高Hcy(β=1.74,P=0.039)及半卵圆区EPVS增多(β=1.31,P=0.028)可能是老年抑郁症患者认知障碍的独立危险因素。结论老年抑郁症患者认知功能损害可能与微血管功能障碍有关。Objective To explore the correlation between risk factors of microvascular dysfunction and cognitive impairment in Late-life depression(LLD).Methods From May 2014 to May 2019,a total of 89 healthy elderly people(normal control group)and 113 patients with LLD(LLD group)were recruited.Patients with LLD were divided into normal cognition group(n=33)and mild cognitive impairment(MCI)group(n=80).The related medical history of microvascular dysfunction(e.g.hypertension,type 2 diabetes,coronary heart disease and hyperlipidemia),plasma concentration of homocysteine and C-reactive protein,and MRI features of cerebral small vessel disease(e.g.white matter hyperintensities,enlarged perivascular space and lacunar infarction)were collected or detected.All participants completed the comprehensive neuropsychological assessment on global cognition and other cognitive domains.The differences of microvascular function and cognition among the groups were compared.The correlation between microvascular dysfunction related biomarkers and the cognitive scores was further analyzed.Finally,Logistic regression analysis was used to explore the risk factors affecting cognitive impairment in patients with LLD.Results The proportion of hypertension and the concentration of homocysteine in LLD with MCI group were significantly higher than those in normal control group and LLD with normal cognition group(χ^(2)=15.67,P<0.01;F=7.05,P=0.001).Enlarged perivascular space in centrum semiovale in LLD with MCI group was more severe than that in normal control group(χ^(2)=10.64,P=0.005).Both homocysteine(r=-0.25,P=0.024)and white matter hyperintensities(r=-0.33,P=0.017)were negatively correlated with executive function in LLD with MCI group.Hypertension(β=2.34,P=0.005),high levels of homocysteine(β=1.74,P=0.039)and increased EPVS in the semi-oval area(β=1.31,P=0.028)were the independent risk factors for cognitive impairment in patients with LLD.Conclusion The cognitive impairment of LLD patients may be related to microvascular dysfunction.

关 键 词：抑郁症 老年人 认知 微血管功能 

分 类 号：R749.4[医药卫生—神经病学与精神病学] R749.1[医药卫生—临床医学]