老年腔隙性脑梗死合并高血压患者认知功能障碍影响因素分析及25-羟基维生素D的预测价值  

Analysis of factors influencing cognitive dysfunction in elderly patients with lacunar infarction plus hypertension and predictive value of cholecalciferol

作　　者：陈笛[1] 顾亮亮[1] 孙军[1] 高军 张东焕 温昌明[1] 张保朝[1] Chen Di;Gu Liangliang;Sun Jun;Gao Jun;Zhang Donghuan;Wen Changming;Zhang Baochao(Nanyang Center Hospital,Nanyang 473000,Henan,China)

机构地区：[1]南阳市中心医院,河南南阳473000

出　　处：《临床心身疾病杂志》2023年第5期28-34,共7页Journal of Clinical Psychosomatic Diseases

基　　金：河南省医学科技攻关计划项目(编号192102310349);南阳市医学科技发展计划项目(编号KJGG2018082)。

摘　　要：目的探讨老年腔隙性脑梗死合并高血压患者认知功能障碍的影响因素及25-羟基维生素D对其预测价值。方法回顾性分析219例老年腔隙性脑梗死合并高血压患者的临床资料及实验室检测结果,根据蒙特利尔认知评估量表评分将患者分为认知功能障碍组(132例)和认知正常组(87例)。采用单因素分析及多因素Logistic回归分析法探讨老年腔隙性脑梗死合并高血压患者发生认知功能障碍的影响因素,并绘制受试者工作特征曲线分析25-羟基维生素D对老年腔隙性脑梗死合并高血压患者发生认知功能障碍的预测价值。结果219例老年腔隙性脑梗死合并高血压患者发生认知功能障碍132例,发生率为60.27%。不同年龄、高血压病程、收缩压、血压控制效果、糖尿病、头颈动脉狭窄程度、25-羟基维生素D水平患者认知功能比较差异有统计学意义(P<0.05或0.01)。多因素Logistic回归分析显示,年龄(OR=1.841,95%CI为1.079~3.137,P=0.025)、高血压病程(OR=1.887,95%CI为1.199~2.968,P=0.006)、入院时收缩压(OR=1.740,95%CI为1.194~2.535,P=0.004)、血压控制不达标(OR=2.034,95%CI为1.106~3.741,P=0.022)、合并糖尿病(OR=1.840,95%CI为1.084~3.124,P=0.024)、头颈动脉中/重度狭窄(OR中度=1.804,95%CI中度为1.149~2.831,P中度=0.011;OR重度=1.985,95%CI重度为1.293~3.050,P重度=0.002)、25-羟基维生素D水平(OR=1.887,95%CI为1.293~2.755,P=0.001)是老年腔隙性脑梗死合并高血压患者发生认知功能障碍的影响因素。受试者工作特征曲线显示,25-羟基维生素D水平预测老年腔隙性脑梗死合并高血压患者认知功能障碍的曲线下面积为0.891,最佳诊断点为66.08 nmol·L^(-1),此时灵敏度为77.01%,特异度为91.67%。结论老年腔隙性脑梗死合并高血压患者认知功能障碍发生率较高,其影响因素较多,临床应早期综合评估并采取预防干预措施;25-羟基维生素D水平可作为此类患者发生认知功能障碍的�Objective To explore factors influencing cognitive dysfunction in elderly patients with lacunar infarction(LI)complicated with hypertension and predictive value of cholecalciferol[25(OH)D].Methods Clinical data and laboratory results of 219 elderly patients with LI plus hypertension were retrospectively analyzed and they assigned to cognition dysfunction(n=132)and normal cognitive state(n=87)group according to the Montreal Cognitive Assessment(MoCA).Influencing factors of cognitive dysfunction in elderly patients with LI plus hypertension were explored using univariate analysis and multi-factor logistics regression analysis and receiver operating characteristic(ROC)cu predictive value of the 25(OH)D to the occurrence of cognition dysfunction in elderly patients with LI plusrve was charted to analyze and explore hypertension.Results Of 219 elderly patients with LI plus hypertension 132 developed-cognitive dysfunction,with an incidence rate of 60.27%.Differences in cognitive functions among patients with different ages,courses of hypertension,systolic blood pressures,control effect of blood pressures,diabetes,degrees of head and carotid artery stenosis,and 25(OH)D levels were statistically significant(P<0.05 or 0.01).Multivariate logistic regression analysis showed that ages(OR=1841,95%CI 1.079~3.137,P=0.025),hypertension course(OR=1.887,95%CI 1.199~2.968,P=0.006),systolic blood pressure on admission(OR=1.740,95%CI 1.194~2.535,P=0.004),blood pressure control failure(OR=2.034,95%CI 1.106~3.741,P=0.022),combined diabetes(OR=1.840,95%CI 1.084~3.124,P=0.024),moderate/severe stenosis of head and neck artery(OR moderate=1.804,95%CI moderate 1.149~2.831,P moderate=0.011;OR severe=1.985,95%CI severe 1.293~3.050,P severe=0.002;),and 25(OH)D levels(OR=1.887,95%CI 1.293~2.755,P=0.001)were factors influencing the occurrence of cognitive dysfunction in elderly patients with LI plus hypertension.The ROC showed that the area under the curve of 25(OH)D predicting cognitive dysfunction in elderly patients with LI and hypertension w

关 键 词：腔隙性脑梗死 高血压 老年人 认知功能障碍 影响因素 25-羟基维生素D 

分 类 号：R743.2[医药卫生—神经病学与精神病学]