老年缺血性脑小血管病患者海马代谢水平及发生认知功能障碍的危险因素分析  

Hippocampal metabolism and risk factors of cognitive impairment in elderly patients with ischemic cerebral small vessel disease

作　　者：张萌 杨小林 Zhang Meng;Yang Xiaolin(Department of Neurosurgery,Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,Shaanzi Province,China)

机构地区：[1]空军军医大学第二附属医院神经外科,西安710038 [2]空军军医大学第二附属医院急诊科,西安710038

出　　处：《中华老年心脑血管病杂志》2025年第4期422-425,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：陕西省自然科学基础研究计划项目(2024JC-YBMS-752)。

摘　　要：目的分析老年缺血性脑小血管病患者海马代谢水平及发生认知功能障碍的危险因素。方法选取2020年5月至2023年12月空军军医大学第二附属医院收治的老年缺血性脑小血管病患者164例,根据认知功能情况分为认知功能障碍组52例和认知功能正常组112例。比较2组肌醇(myo-inositol,MI)/肌酸(creatine,Cr)、MI/N-乙酰天门冬氨酸(N-acetyl aspartate,NAA)、胆碱/Cr、NAA/Cr水平;比较2组一般临床资料;采用多因素logistic回归分析影响老年缺血性脑小血管病患者认知功能障碍的危险因素。结果认知功能障碍组左侧、右侧海马MI/Cr、MI/NAA显著高于认知功能正常组,右侧海马NAA/Cr显著低于认知功能正常组,差异有统计学意义(P<0.05)。认知功能障碍组年龄≥65岁、高血压、动脉粥样硬化、低密度脂蛋白胆固醇、高敏C反应蛋白、同型半胱氨酸水平显著高于认知功能正常组(P<0.05,P<0.01)。多因素logistic回归分析显示,左侧海马MI/Cr、右侧海马MI/Cr、左侧海马MI/NAA、右侧海马MI/NAA、右侧海马NAA/Cr、年龄≥65岁、高血压、动脉粥样硬化、低密度脂蛋白胆固醇是老年缺血性脑小血管病患者认知功能障碍的危险因素(OR=2.795,95%CI:1.532~5.102,P=0.000;OR=2.782,95%CI:1.616~4.787,P=0.000;OR=2.177,95%CI:1.355~3.498,P=0.000;OR=3.364,95%CI:1.846~6.127,P=0.000;OR=0.450,95%CI:0.259~0.784,P=0.000;OR=2.740,95%CI:1.024~7.330,P=0.012;OR=3.074,95%CI:1.554~6.080,P=0.000;OR=2.942,95%CI:1.338~6.468,P=0.000;OR=2.418,95%CI:1.496~3.909,P=0.000)。结论老年缺血性脑小血管病患者发生认知功能障碍的风险较高,可能与海马代谢水平、患者年龄、合并症、低密度脂蛋白胆固醇、高敏C反应蛋白、同型半胱氨酸等因素密切相关,临床应重点筛查此类指标,并采取积极防治措施,以降低认知功能障碍的发生风险。Objective To analyze the level of hippocampal metabolism in elderly patients with ischemic cerebral small vessel disease(ICSVD),and explore the risk factors for the occurrence of cognitive impairment.Methods A total of 164 elderly patients with ICSVD admitted in our hospital from May 2020 to December 2023 were enrolled,and divided into cognitively impaired group(52 cases)and cognitively normal group(112 cases)according to their cognitive function.The clinical data and the ratios of myo-inositol(MI)/creatine(Cr),MI/N-acetyl aspartate(NAA),choline/Cr,and NAA/Cr were compared between the two groups.Multivariate logistic regression analysis was applied to identify the risk factors of cognitive impairment in elderly ICSVD patients.Results The left and right hippocampal MI/Cr and MI/NAA ratios were significantly higher,while the right hippocampal NAA/Cr ratio was obviously lower in the cognitively impaired group than the cognitively normal group(P<0.05).The former group had notably larger proportions of aged≥65 years,hypertension and atherosclerosis,and higher levels of LDL-C,hs-CRP and Hcy than the latter group(P<0.05,P<0.01).Multivariate logistic regression analysis indicated that left and right hippocampal MI/Cr ratios,left and right hippocampal MI/NAA ratios,right hippocampal NAA/Cr ratio,aged≥65 years,hypertension,atherosclerosis,LDL-C were risk factors for cognitive impairment in elderly ICSVD patients(OR=2.795,95%CI:1.532-5.102,P=0.000;OR=2.782,95%CI:1.616-4.787,P=0.000;OR=2.177,95%CI:1.355-3.498,P=0.000;OR=3.364,95%CI:1.846-6.127,P=0.000;OR=0.450,95%CI:0.259-0.784,P=0.000;OR=2.740,95%CI:1.024-7.330,P=0.012;OR=3.074,95%CI:1.554-6.080,P=0.000;OR=2.942,95%CI:1.338-6.468,P=0.000;OR=2.418,95%CI:1.496-3.909,P=0.000).Conclusion The elderly ICSVD patients are at high risk of cognitive impairment,which may be closely associated with hippocampal metabolism level,age,comorbidity,LDL-C,hs-CRP,Hcy and other factors.It is necessary to focus on clinical screening of these indicators and take active prevention and control

关 键 词：大脑小血管疾病 认知功能障碍 海马 代谢 

分 类 号：R74[医药卫生—神经病学与精神病学]