脑小血管病磁共振总负担对认知功能的影响

doi:10.3969/j.issn.1004-583X.2023.11.004

摘要/Abstract

摘要：

目的探索脑小血管病患者脑磁共振总负担与认知功能的相关性。方法选择2021年9月至2022年10月入住我院神经内科并经脑磁共振成像(magnetic resonance imaging,MRI)确诊的227例脑小血管病患者,收集相应的临床资料、脑影像资料、血液学指标,使用蒙特利尔认知评估量表(MoCA)评估认知状态,探索磁共振影像学标志物与认知功能障碍的相关性。结果 ①经多因素分析,年龄、高血压病、同型半胱氨酸、尿酸、腔隙性梗死评分和脑小血管病总负荷均与MoCA分数存在相关性,差异有统计学意义( $P$ <0.05)。②其他变量保持不变的情况下,脑小血管病总负荷每增加1分,MoCA分数下降2.27分;腔隙评分每增加1分,MoCA分数下降0.74分;同无高血压病的患者相比,合并高血压病者MoCA分数下降0.94分;尿酸和同型半胱氨酸水平每升高1个单位,MoCA分数分别下降0.01分和0.07分;年龄每长1岁,MoCA分数下降0.07分。总体来看,所有的预测变量解释了MoCA分数下降55.1%的变化。结论脑小血管病患者的认知功能受多种因素影响,脑MRI表现在一定程度上代表了脑小血管病脑内的病理状态,提示脑MRI总负担对认知功能下降有预警意义。

关键词: 脑小血管病, MRI总负担, 认知, MoCA量表

Abstract:

Objective To explore the correlation between total cerebral magnetic resonance imaging (MRI) burden and cognitive function in patients with cerebral small vessel diseases (CSVDs). Methods A total of 227 CSVD patients diagnosed by the brain MRI and hospitalized in the Department of Neurology from September 2021 to October 2022 were recruited. Their clinical data, brain imaging data, and hematological indicators were collected. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) scale. The correlation between MRI markers and cognitive dysfunction was explored. Results The multivariate analysis showed that age, hypertension, homocysteine (HCY), uric acid (UA), lacunar stroke score (Lac) and total burden of CSVDs were all significantly correlated with the MoCA score ( $P$ <0.05). When other variables remained unchanged, the MoCA score decreased by 2.27 points for each point increase in the total burden of CSVD. The MoCA score decreased by 0.74 points for each point increase in the Lac score. The MoCA score decreased by 0.94 points for patients with a history of hypertension compared with those lacking the history of hypertension. The MoCA score decreased by 0.01 points and 0.07 points for each unit increase in UA and HCY levels, respectively. The MoCA score decreased by 0.07 points for one year older. Overall, all predictors explained the 55.1% decrease in MoCA scores. Conclusion The cognitive function of CSVD patients is affected by many factors, and the brain MRI visualizes the intracranial pathological state. It is suggested that the total burden of brain MRI has an early warning significance for cognitive decline.

Key words: cerebral small vessel disease, total MRI burden, cognitive function, MoCA scale

中图分类号:

R743

朱方方, 魏学志, 冯敏. 脑小血管病磁共振总负担对认知功能的影响[J]. 临床荟萃, 2023, 38(11): 984-990.

Zhu Fangfang, Wei Xuezhi, Feng Min. Effect of total magnetic resonance imaging burden on the cognitive function in patients with cerebral small vessel diseases[J]. Clinical Focus, 2023, 38(11): 984-990.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.11.004

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I11/984

图/表 7

表1 两组临床资料及影像学指标比较

Tab.1 Comparison of clinical data and imaging indicators between the two groups

项目	认知障碍组 ( $n$ =100)	认知正常组 ( $n$ =127)	χ²/ $t$ / $F$ 值	$P$ 值
性别[例(%)]
男女	69(69.0) 31(31.0)	87(68.5) 40(31.5)	0.011	1.000
年龄( $x -$ ±s)	69.00±6.73	64.80±6.66	0.619	<0.01
教育年限( $x -$ ±s)	9.39±3.35	9.35±3.05	0.014	0.919
吸烟[例(%)]
无有	45(45.0) 55(55.0)	77(60.6) 50(39.4)	0.317	0.023
饮酒[例(%)]
无有	62(62.0) 38(38.0)	75(59.1) 52(40.9)	0.060	0.683
高血压病[例(%)]
无有	43(43.0) 57(57.0)	79(62.2) 48(37.8)	0.392	0.005
冠心病[例(%)]
无有	57(57.0) 43(43.0)	81(63.8) 46(36.2)	0.139	0.339
糖尿病[例(%)]
无有	63(63.0) 37(37.0)	76(59.8) 51(40.2)	0.065	0.681
卒中史[例(%)]
无有	53(53.0) 47(47.0)	76(59.8) 51(40.2)	0.138	0.345
TG(mmol/L)	2.17±0.71	2.04±0.67	0.198	0.140
CHOL(mmol/L)	4.85±1.07	4.57±1.12	0.258	0.055
HDL(mmol/L)	1.93±0.51	1.89±0.52	0.081	0.544
LDL(mmol/L)	2.49±1.12	2.44±1.02	0.051	0.702
HCY(mmol/L)	17.20±6.16	14.00±5.84	0.533	<0.01
UA(mmol/L)	396.00±65.50	378.00±69.20	0.262	0.050
FBG(mmol/L)	6.01±1.12	5.89±0.97	0.110	0.407
Lac评分(分)	0.70±0.46	0.50±0.50	0.423	0.002
CMBs评分[M(P25, P75)]	0.00 (0.00,1.00)	0.00 (0.00,0.00)	0.409	0.002
WMH评分( $x -$ ±s)	0.69±0.46	0.35±0.48	0.710	<0.01
EPVS评分( $x -$ ±s)	0.28±0.45	0.27±0.44	0.027	0.838
CSVD总负荷[M(P25, P75)]	2.00(1.00,2.00)	1.00 (1.00,1.50)	1.101	<0.01

表1 两组临床资料及影像学指标比较

Tab.1 Comparison of clinical data and imaging indicators between the two groups

项目	认知障碍组 ( $n$ =100)	认知正常组 ( $n$ =127)	χ²/ $t$ / $F$ 值	$P$ 值
性别[例(%)]
男女	69(69.0) 31(31.0)	87(68.5) 40(31.5)	0.011	1.000
年龄( $x -$ ±s)	69.00±6.73	64.80±6.66	0.619	<0.01
教育年限( $x -$ ±s)	9.39±3.35	9.35±3.05	0.014	0.919
吸烟[例(%)]
无有	45(45.0) 55(55.0)	77(60.6) 50(39.4)	0.317	0.023
饮酒[例(%)]
无有	62(62.0) 38(38.0)	75(59.1) 52(40.9)	0.060	0.683
高血压病[例(%)]
无有	43(43.0) 57(57.0)	79(62.2) 48(37.8)	0.392	0.005
冠心病[例(%)]
无有	57(57.0) 43(43.0)	81(63.8) 46(36.2)	0.139	0.339
糖尿病[例(%)]
无有	63(63.0) 37(37.0)	76(59.8) 51(40.2)	0.065	0.681
卒中史[例(%)]
无有	53(53.0) 47(47.0)	76(59.8) 51(40.2)	0.138	0.345
TG(mmol/L)	2.17±0.71	2.04±0.67	0.198	0.140
CHOL(mmol/L)	4.85±1.07	4.57±1.12	0.258	0.055
HDL(mmol/L)	1.93±0.51	1.89±0.52	0.081	0.544
LDL(mmol/L)	2.49±1.12	2.44±1.02	0.051	0.702
HCY(mmol/L)	17.20±6.16	14.00±5.84	0.533	<0.01
UA(mmol/L)	396.00±65.50	378.00±69.20	0.262	0.050
FBG(mmol/L)	6.01±1.12	5.89±0.97	0.110	0.407
Lac评分(分)	0.70±0.46	0.50±0.50	0.423	0.002
CMBs评分[M(P25, P75)]	0.00 (0.00,1.00)	0.00 (0.00,0.00)	0.409	0.002
WMH评分( $x -$ ±s)	0.69±0.46	0.35±0.48	0.710	<0.01
EPVS评分( $x -$ ±s)	0.28±0.45	0.27±0.44	0.027	0.838
CSVD总负荷[M(P25, P75)]	2.00(1.00,2.00)	1.00 (1.00,1.50)	1.101	<0.01

表2 Model 1的多因素回归结果

Tab. 2 Multivariate regression results for model 1

变量		β值	$t$ 值	$P$ 值	95% $C I$
变量		β值	$t$ 值	$P$ 值	下限	上限
年龄	[49, 83]	-0.07	-3.495	<0.01	-0.11	-0.03
吸烟	0( $n$ =122) 1( $n$ =105)	0.01	0.050	0.961	-0.52	0.55
高血压病	0( $n$ =122) 1( $n$ =105)	-0.96	-3.545	<0.01	-1.49	-0.43
HCY	[4, 46]	-0.06	-2.857	0.005	-0.11	-0.02
UA	[226, 656]	-0.00	-2.500	0.013	-0.01	-0.00
CHOL	[2.5, 7.6]	-0.17	-1.432	0.154	-0.41	0.07
Lac评分	[0, 1]	-0.83	-2.360	0.019	-1.52	-0.14
CMBs评分	[0, 1]	0.38	0.826	0.410	-0.53	1.29
WMH评分	[0, 1]	-0.48	-1.230	0.220	-1.25	0.29
CSVD评分	[1, 4]	-2.20	-6.658	<0.01	-2.85	-1.55

表2 Model 1的多因素回归结果

Tab. 2 Multivariate regression results for model 1

变量		β值	$t$ 值	$P$ 值	95% $C I$
变量		β值	$t$ 值	$P$ 值	下限	上限
年龄	[49, 83]	-0.07	-3.495	<0.01	-0.11	-0.03
吸烟	0( $n$ =122) 1( $n$ =105)	0.01	0.050	0.961	-0.52	0.55
高血压病	0( $n$ =122) 1( $n$ =105)	-0.96	-3.545	<0.01	-1.49	-0.43
HCY	[4, 46]	-0.06	-2.857	0.005	-0.11	-0.02
UA	[226, 656]	-0.00	-2.500	0.013	-0.01	-0.00
CHOL	[2.5, 7.6]	-0.17	-1.432	0.154	-0.41	0.07
Lac评分	[0, 1]	-0.83	-2.360	0.019	-1.52	-0.14
CMBs评分	[0, 1]	0.38	0.826	0.410	-0.53	1.29
WMH评分	[0, 1]	-0.48	-1.230	0.220	-1.25	0.29
CSVD评分	[1, 4]	-2.20	-6.658	<0.01	-2.85	-1.55

图1 model 1的森林图

Fig.1 Forest diagram of model 1

表3 Model 2 的多因素回归结果

Tab. 3 Multivariate regression results for model 2

变量		β值	$t$ 值	$P$ 值	95% $C I$
变量		β值	$t$ 值	$P$ 值	下限	上限
年龄	[49, 83]	-0.07	-3.57	<0.01	-0.11	0.03
高血压病	0( $n$ =122) 1( $n$ =105)	-0.94	-3.47	<0.01	-1.48	-0.41
HCY	[4, 46]	-0.07	-3.10	0.002	-0.11	-0.03
UA	[226, 656]	-0.01	-2.53	0.012	-0.01	-0.00
Lac评分	[0, 1]	-0.74	-2.65	0.009	-1.28	-0.19
CSVD总负荷	[1, 4]	-2.27	-11.43	<0.01	-2.66	-1.88

表3 Model 2 的多因素回归结果

Tab. 3 Multivariate regression results for model 2

变量		β值	$t$ 值	$P$ 值	95% $C I$
变量		β值	$t$ 值	$P$ 值	下限	上限
年龄	[49, 83]	-0.07	-3.57	<0.01	-0.11	0.03
高血压病	0( $n$ =122) 1( $n$ =105)	-0.94	-3.47	<0.01	-1.48	-0.41
HCY	[4, 46]	-0.07	-3.10	0.002	-0.11	-0.03
UA	[226, 656]	-0.01	-2.53	0.012	-0.01	-0.00
Lac评分	[0, 1]	-0.74	-2.65	0.009	-1.28	-0.19
CSVD总负荷	[1, 4]	-2.27	-11.43	<0.01	-2.66	-1.88

图2 Model 2的森林图

Fig. 2 Forest diagram of model 2

图3 Model 2的线性回归模型注:蓝色代表回归曲线,红色代表预测区间,灰色代表可信区间

Fig.3 Linear regression model for model 2 Blue represents the regression curve, red represents the prediction interval, and gray represents the confidence interval

图4 MoCA分数对model 2模型的回归诊断图

Fig.4 Regression diagnosis diagram of MoCA score on model 2

参考文献 28

[1]	王维维, 申致远, 李凡, 等. 血浆低密度脂蛋白胆固醇和同型半胱氨酸与脑小血管病患者认知功能的相关性研究[J]. 中国脑血管病杂志, 2021, 18(12):836-842.
[2]	张泽阳, 王倩, 陈卓友. 脑小血管病影像学特征及其总体负荷与血管性认知障碍关系的研究进展[J]. 中国脑血管病杂志, 2022, 19(9):642-647.
[3]	王雅楠, 姚琳, 毛文静, 等. 脑小血管病患者氧化应激标志物、磁共振总负担与血管性认知障碍的相关性[J]. 中华行为医学与脑科学杂志, 2020, 29(10):898-903.
[4]	Staals J, Booth T, Morris Z, et al. Total MRI load of cerebral small vessel disease and cognitive ability in older people[J]. Neurobiol Aging, 2015, 36(10): 2806-2811. doi: 10.1016/j.neurobiolaging.2015.06.024 pmid: 26189091
[5]	应云清, 王轶卿, 夏忆玮, 等. 脑小血管病影像学标志物与认知功能障碍相关性分析:基于上海社区老年人队列[J]. 中国现代神经疾病杂志, 2021, 21(10):843-852.
[6]	熊静, 王瑾, 张婕, 等. 脑小血管病患者磁共振总负担与认知障碍的相关性研究[J]. 中国慢性病预防与控制, 2019, 27(3):214-218.
[7]	中国研究型医院学会脑小血管病专业委员会《中国脑小血管病诊治专家共识2021》编写组. 中国脑小血管病诊治专家共识2021[J]. 中国卒中杂志, 2021, 16(7):716-726.
[8]	李娅, 楚兰, 贺电, 等. 脑小血管病非痴呆患者脑微出血与认知功能相关性研究[J]. 临床神经病学杂志, 2016, 29(4):270-273.
[9]	Jokinen H, Koikkalainen J, Laakso HM, et al. Global burden of small vessel disease-related brain changes on MRI predicts cognitive and functional decline[J]. Stroke, 2020, 51(1): 170-178. doi: 10.1161/STROKEAHA.119.026170 pmid: 31699021
[10]	Klarenbeek P, van Oostenbrugge RJ, Rouhl RP, et al. Ambulatory blood pressure in patients with lacunar stroke: Association with total MRI burden of cerebral small vessel disease[J]. Stroke, 2013, 44(11): 2995-2999. doi: 10.1161/STROKEAHA.113.002545 pmid: 23982717
[11]	Yu C, Lu W, Qiu J, et al. Alterations of the whole cerebral blood flow in patients with different total cerebral small vessel disease burden[J]. Front Aging Neurosci, 2020, 12: 175. doi: 10.3389/fnagi.2020.00175 pmid: 32655393
[12]	Lu T, Liang J, Wei N, et al. Extracranial artery stenosis is associated with total MRI burden of cerebral small vessel disease in ischemic stroke patients of suspected small or large artery origins[J]. Front Neurol, 2019, 10: 243. doi: 10.3389/fneur.2019.00243 pmid: 30949118
[13]	朱方方, 许媛媛, 寿广丽, 等. 缺血性脑卒中脑微出血的危险因素及其与认知功能的相关性研究[J]. 蚌埠医学院学报, 2022, 47(6):726-730.
[14]	袁锡球, 冯辉庭, 陈仰昆, 等. 急性基底节区梗死的脑小血管病总负荷与认知功能损害相关性分析[J]. 中国神经精神疾病杂志, 2022, 48(2):65-71.
[15]	Amier RP, Marcks N, Hooghiemstra AM, et al. Hypertensive exposure markers by MRI in relation to cerebral small vessel disease and cognitive impairment[J]. JACC Cardiovasc Imaging, 2021, 14(1):176-185. doi: 10.1016/j.jcmg.2020.06.040 pmid: 33011127
[16]	李瑞珍, 李星辉, 曾璟, 等. 高血压认知功能障碍机制的研究进展[J]. 临床荟萃, 2023, 38(1):88-92.
[17]	王雅楠, 牛雪芬, 范少凯, 等. 缺血性脑小血管病患者凝血标志物及同型半胱氨酸与血管性认知障碍的相关性[J]. 中华老年心脑血管病杂志, 2020, 22(3):281-284.
[18]	Nam KW, Kwon HM, Jeong HY, et al. Serum homocysteine level is related to cerebral small vessel disease in a healthy population[J]. Neurology, 2019, 92(4): e317-e325.
[19]	Teng Z, Feng J, Liu R, et al. Cerebral small vessel disease mediates the association between homocysteine and cognitive function[J]. Front Aging Neurosci, 2022, 14: 868777. doi: 10.3389/fnagi.2022.868777 URL
[20]	Sun J, Lv X, Gao X, et al. The association between serum uric acid level and the risk of cognitive impairment after ischemic stroke[J]. Neuroscience Letters, 2020, 734: 135098. doi: 10.1016/j.neulet.2020.135098 URL
[21]	Serdarevic N, Stanciu AE, Begic L, et al. Serum uric acid concentration in patients with cerebrovascular disease (ischemic stroke and vascular dementia)[J]. Med Arch, 2020, 74(2): 95-99. doi: 10.5455/medarh.2020.74.95-99 pmid: 32577048
[22]	Wang F, Xiang J, Yang S, et al. Correlation of serum uric acid, cystatin C and high-sensitivity C-reactive protein with cognitive impairment in lacunar cerebral infarction[J]. Am J Transl Res, 2021, 13(6): 6717-6723. pmid: 34306417
[23]	Kim JW, Byun MS, Yi D, et al. Serum uric acid, alzheimer-related brain changes, and cognitive impairment[J]. Front Aging Neurosci, 2020, 12:160. doi: 10.3389/fnagi.2020.00160 pmid: 32581770
[24]	Liu M, Wang J, Zeng J, et al. Relationship between serum uric acid level and mild cognitive impairment in Chinese community elderly[J]. BMC Neurol, 2017, 17(1): 146. doi: 10.1186/s12883-017-0929-8 pmid: 28764656
[25]	Vannorsdall TD, Jinnah HA, Gordon B, et al. Cerebral ischemia mediates the effect of serum uric acid on cognitive function[J]. Stroke, 2008, 39(12): 3418-3420. doi: 10.1161/STROKEAHA.108.521591 pmid: 18772442
[26]	李倩, 赵建华, 彭雪, 等. H型高血压患者血尿酸水平与轻度认知功能障碍的相关性分析[J]. 中国全科医学, 2021, 24(3):2527-2531.
[27]	Liu Q, Liao X, Pan Y, et al. Association between serum uric acid levels and cognitive function in patients with ischemic stroke and transient ischemic attack (TIA): A 3-month follow-up study[J]. Neuropsychiatr Dis Treat, 2021, 17:991-999. doi: 10.2147/NDT.S300893 URL
[28]	Fan Y, Xu Y, Shen M, et al. Total cerebral small vessel disease burden on MRI correlates with cognitive impairment in outpatients with amnestic disorders[J]. Front Neurol, 2021, 12: 747115. doi: 10.3389/fneur.2021.747115 URL