脑小血管病与轻型卒中后认知障碍的关系

Advances in Clinical Medicine 临床医学进展, 2020, 10(4), 645-651

Published Online April 2020 in Hans. /journal/acm

https:///10.12677/acm.2020.104101

The Relationship between Cerebral Small

Vessel Disease and Cognitive Impairment

after Minor Stroke

Bing Zhao, Renliang Zhao*

The Department of Neurology, The Affliated Hospital of Qingdao University, Qingdao Shandong

Received: Apr. 5th, 2020; accepted: Apr. 22nd, 2020; published: Apr. 29th, 2020

Abstract

Objective: To investigate the effects of cerebral small vessel disease (CSVD) on cognitive impair-ment after minor stroke. Methods: The patients with minor stroke were collected from October 2017 to September 2019 in the Department of Neurology, affiliated Hospital of Qingdao University, and the CSVD score and cognitive impairment score were carried out. The patients were divided into cognitive impairment group and non-cognitive impairment group. Logistic regression analy-sis was used to screen the independent risk factors of cognitive impairment in 3 months after on-set. Results: Multivariate logistic regression analysis showed that years of education, number of PVS, WMH Fazekas scores, and the total burden of CSVD were independent risk factors for cogni-tive impairment in 3 months after minor stroke. Conclusions: Years of education, number of PVS, WMH Fazekas scores and the total burden of CSVD are independent risk factors for cognitive im-pairment after minor stroke.

Keywords

Minor Stroke, Cerebral Small Vessel Disease, Cognitive Impairment

脑小血管病与轻型卒中后认知障碍的关系

赵冰，赵仁亮*

青岛大学附属医院神经内科，山东青岛

收稿日期：2020年4月5日；录用日期：2020年4月22日；发布日期：2020年4月29日

*通讯作者。

赵冰，赵仁亮

摘 要

目的：探究脑小血管病(Cerebral Small Vessel Disease, CSVD)对轻型卒中后认知障碍的影响。方法：收集2017年10月到2019年9月期间在青岛大学附属医院神经内科就诊的轻型卒中患者，进行CSVD 评分及认知障碍评分，将发病3个月的患者分为认知障碍组和非认知障碍组，采用logistic 回归分析筛选发病3个月时认知功能障碍的独立危险因素。结果：多因素logistic 回归分析显示，教育年限、PVS 数量、脑白质高信号Fazekas 评分、CSVD 总体负担是轻型卒中后3个月认知障碍的独立危险因素。结论：综上所述，教育年限、PVS 数量、WMH Fazekas 评分、CSVD 总体负担是轻型卒中后3个月认知障碍的独立危险因素。

关键词

轻型卒中，脑小血管病，认知障碍

Copyright © 2020 by author(s) and Hans Publishers Inc.

This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). /licenses/by/4.0/

1. 引言

脑小血管病(Cerebral Small Vessel Disease, CSVD)是指由于各种病因影响脑内小动脉、微动脉、毛细血管、微静脉和小静脉所导致的一系列临床、神经影像、病理综合征[1]。脑小血管病的磁共振影像学表现有新发小的皮质下梗死(Recent Small Subcortical Infarct, RSSI)、可能为血管起源的脑白质高信号(White Matter Hyperintensity of Presumed Vascular Origin, WMH)、脑微出血(Cerebral microbleeds, CMBs)、血管周围间隙(Perivascular Space, PVS)、可能为血管起源性腔隙(Lacune of Presumed Vascular Origin, Lacune) [2]。CSVD 是老年人中最常见的脑血管疾病，也是一种全身性、全脑性的慢性重大疾病，为老龄化社会带来沉重的疾病负担。CSVD 不仅可以引起急性症状，如腔隙性脑梗死、脑出血等，占症状性卒中的20%，同时也可隐匿起病，如痴呆、步态障碍、尿潴留及情绪障碍等[3]。20%~40%的老年性痴呆与CSVD 相关[4]。轻型卒中患者常合并不同程度的CSVD ，CSVD 会影响卒中后认知障碍的形成及预后[5] [6]。

2. 对象和研究方法

2.1. 研究对象

前瞻性收集2017年10月到2019年9月期间在青岛大学附属医院神经内科就诊的轻型卒中患者221例患者作为研究对象。本研究入选患者资料获得受试者的知情同意，并在我院伦理委员会备案。

纳入标准：1) 轻型卒中定义为美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分≤3分的急性缺血性脑卒中[7]，并经颅脑CT 或颅脑磁共振证实；2) 年龄 ≥ 18岁，临床资料完整，发病至就诊时间≤7天；3) 意识清楚，无精神疾病史，无药物依赖史；4) 患者与家属充分知情，同意签署确认书。排除标准：1) 接收溶栓或血管内治疗的患者；2) 有神经系统其他疾病(如颅内感染、帕金森病、癫痫、脑肿瘤、脱髓鞘病、遗传变性病等)的患者；3) 合并其他影响认知功能的疾病(如阿尔兹海默病、癫痫等)和服用药物或酗酒影响认知功能者；4) 功能性精神异常，包括焦虑、抑郁状态的患者；5) 有其他严重的心、肝、肾及血液系统等内科疾病的患者；6) 因各种原因(语言障碍、听力障碍、视力