影像学存在缺血性脑血管病变患者痴呆发生率及相关影响因素分析  

Analysis related risk factors in dementia in patients with cerebral ischemia imaging

作　　者：董梅[1] 唐丽梅[1] 范昊龙 赵田祎 王素欢 李震中[1] Dong Mei;Tang Limei;Fan Haolong;Zhao Tianyi;Wang Suhuan;Li Zhenzhong(Department of Neurology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,石家庄050000

出　　处：《脑与神经疾病杂志》2022年第1期32-36,共5页Journal of Brain and Nervous Diseases

摘　　要：目的影像学检查发现许多中老年人无论是否发生脑梗死,都存在缺血性脑血管病相关影像学改变,本研究旨在探讨在特定影像学条件下,血管性痴呆(vascular dementia,VaD)发生率及相关影响因素分析。方法以影像学存在缺血性脑血管病病变的患者或轻型脑梗死患者作为研究对象,MRI影像学检查,表现为新发脑梗死、陈旧性脑梗死、多发腔隙性脑梗死、脑白质病变、脑萎缩等病灶,发病后7d内进行MMSE认知检测,分为VaD组和非痴呆组,对比两组一般资料、影像学表现、既往疾病、生活方式及跌倒评分、ADL评分等情况,探讨MRI影像学存在脑缺血病灶的患者及发生脑梗死的患者中,VaD发生率及相关影响因素。结果选取的460例患者符合影像学表现。临床表现为脑梗死局灶症状、短暂性脑缺血发作、头晕、头痛、反应迟钝等症状,与非VaD组相比,VaD组患者在性别、年龄、NIHSS评分、跌倒评分、ADL评分、累积脑梗死发病及影像学伴有脑白质病变和/或脑萎缩方面与非痴呆组均有差异(P<0.05);两组在TOAST分型、病灶部位和范围、吸烟、饮酒、高血压、糖尿病、冠心病、跌倒病史等方面无差异。Logistic多因素分析,男性、跌倒评分、ADL评分、影像学为脑白质病变和/或脑萎缩的表现与VaD的发生密切相关。结论存在脑梗死、多发性腔隙性脑梗死、脑白质病变、脑萎缩的影像学条件下,无论是否发生脑梗死,均有较高的痴呆发生风险;男性、跌倒评分、ADL评分、影像学表现脑白质病变和/或脑萎缩可以预示VaD发生的风险。Objective Many elderly patients have imaging abnormal changes with or without cerebral infarction.The purpose of this study was to explore the incidence of vascular dementia(VaD) and related factors under specific imaging conditions.Method patients were selected with new cerebral infarction,old cerebral infarction,multiple lacunar infarction,white matter hyperintensities,brain atrophy.MMSE cognitive test was performed within 7 days after onset,which were divided into VaD group and non-dementia group.The imaging results,past history,lifestyle,fall score,ADL score and MRI of the two groups were compared.Result 460 patients were selected in accordance with the imaging findings.The clinical manifestations were as focal symptoms of cerebral infarction,transient ischemic attack,dizziness,headache,slow response and so on.There were significant differences in sex,age,NIHSS score,fall score,ADL score,cumulative cerebral infarction and imaging with white matter lesions and/or brain atrophy between two groups.There was no difference in TOAST classification,location and extent of lesions,smoking,drinking,hypertension,diabetes,coronary heart disease,history of falls between two groups.Logistic multivariate analysis showed that male,fall score,ADL score,imaging manifestations with white matter hyperintensities and/or Brain atrophy were closely related to vascular dementia.Conclusion There is a higher risk of dementia with imaging of cerebral infarction,multiple lacunar infarction,white matter lesion and brain atrophy.Male,fall score,ADL score,imaging of white matter hyperintensities and/or brain atrophy can predict vascular dementia.

关 键 词：血管性痴呆 脑梗死 影像学 认知 脑白质病变 

分 类 号：R743.32[医药卫生—神经病学与精神病学]