老年类风湿关节炎患者认知功能障碍与脑白质疏松及脑血管储备的关系  

Relationship between leukoaraiosis and cerebrovascular reserve in elderly rheumatoid arthritis with cognitive impairment

作　　者：杜永库 乔琳 李娟 孙钟慧 史雅锋 荆鑫 李超 闫俊 DU Yongku;QIAO Lin;LI Juan;SUN Zhonghui;SHI Yafeng;JING Xin;LI Chao;YAN Jun(Department of Radiology,Xi’an Fifth Hospital,Xi’an 710082,China;Department of Neurology,Xi’an Fifth Hospital,Xi’an 710082,China;Department of Rheumatology and Immunology,Xi’an Fifth Hospital,Xi’an 710082,China;Department of Surgical Anesthesiology,Xi’an Fifth Hospital,Xi’an 710082,China;Department of Pharmacy,Xi’an Fifth Hospital,Xi’an 710082,China)

机构地区：[1]西安市第五医院影像科,陕西西安710082 [2]西安市第五医院神经内科,陕西西安710082 [3]西安市第五医院风湿免疫科,陕西西安710082 [4]西安市第五医院手术麻醉科,陕西西安710082 [5]西安市第五医院药剂科,陕西西安710082

出　　处：《实用放射学杂志》2025年第2期181-185,共5页Journal of Practical Radiology

基　　金：西安市创新能力强基计划项目(22YXYJ0014,22YXYJ0069,24YXYJ0076);西安市第五医院院级项目(2023dx01,2023lc07)。

摘　　要：目的探讨老年类风湿关节炎(RA)患者认知功能改变与脑白质疏松(LA)及脑血管储备(CVR)的相关性。方法选取老年RA患者160例并评估其认知功能,依据蒙特利尔认知评估量表(MoCA)评分结果分为认知功能正常组[非认知功能障碍(CI)组]及CI组。记录患者临床资料,通过头颅MRI评估LA、屏气指数(BHI)评估CVR。分析2组RA患者的相关危险因素,采用单因素及多因素logistic回归分析并筛查老年RA患者认知功能下降的独立危险因素,比较LA评分及BHI在2组患者中的预测效能。结果2组患者受教育程度、冠心病、糖尿病、疾病活动性评分(DAS28评分)、BHI、LA评分均有统计学差异(P<0.05);多因素logistic回归结果显示,BHI、LA评分为认知功能下降的独立危险因素;受试者工作特征(ROC)曲线提示BHI对老年RA患者认知功能下降的预测价值较高。结论老年RA患者CI的LA评分升高而BHI明显降低,BHI对预测老年RA患者认知功能下降的诊断价值较高。Objective To explore the relationship between cognitive function changes and leukoaraiosis(LA)and cerebrovascular reserve(CVR)in elderly patients with rheumatoid arthritis(RA).Methods A total of 160 elderly patients with RA were selected and their cognitive function were also evaluated.Based on the scoring results of Montreal cognitive assessment(MoCA),all patients were categorized into normal cognitive function group[non cognitive impairment(CI)group] and CI group,respectively.The general clinical information of the patients were recorded,LA via head MRI were evaluated,and CVR through breath holding index(BHI)were assessed,respectively.The relevant risk factors of the two groups of RA patients were analyzed,and univariate and multivariate logistic regression analyses were used to screen the independent risk factors for cognitive decline in elderly patients with RA,and the predictive efficacy of LA score and BHI in the two groups of patients were compared,respectively.Results There were significant differences in education level,coronary heart disease,diabetes,disease activity score(DAS28 score),BHI and LA score between the two groups(P<0.05).Multivariate logistic regression results displayed that BHI and LA score were independent risk factors for cognitive decline.The receiver operating characteristic(ROC)curve suggested that BHI had a higher predictive value for cognitive decline in elderly RA patients.Conclusion The LA score of elderly RA patients with CI increases while BHI significantly decreases.BHI has a high diagnostic value in predicting cognitive decline in elderly RA patients.

关 键 词：类风湿关节炎 认知功能障碍 脑白质疏松 脑血管反应性 

分 类 号：R593.22[医药卫生—内科学] R742[医药卫生—临床医学]