Zhongguo cuzhong zazhi (Jul 2022)
脑微出血与认知功能障碍的相关性研究 Correlation between Cerebral Microbleeds and Cognitive Impairment
Abstract
目的 探讨脑微出血（cerebral microbleeds，CMBs）患者认知功能损害的临床特征及相关因素。 方法 前瞻性入组2017年1月-2021年1月就诊的CMBs患者（CMBs组）和受教育程度相匹配的健康人群（对照组），采用MMSE、MoCA和临床痴呆评定量表（clinical dementia rating，CDR）评价整体认知功能和不同认知域功能状态。比较2组的临床资料和认知功能的差异。在CMBs组中分析CMBs的数量和部位与MoCA总分和不同认知域得分的相关性。在CMBs组中分析认知下降的危险因素。 结果 CMBs组和对照组各纳入110例研究对象，CMBs组年龄（P=0.045）、高血压比例（P=0.003）以及使用抗血小板药物比例（P=0.015）高于对照组，MMSE（P=0.019）、MoCA（P=0.026）低于对照组，CDR评分（P＜0.001）高于对照组。在CMBs患者中，CMBs数目与MoCA量表得分负相关（rs=-0.93，P＜0.001）；深部CMBs与视空间及执行能力（F=-8.09，P=0.017）、定向力（F=-1.33，P=0.041）及抽象能力（F=-8.03，P=0.023）呈负相关，皮质-皮质下CMBs与延迟记忆（F=-28.57，P=0.001）、语言能力（F=-2.88，P=0.038）呈负相关，混合型CMBs与注意力得分呈负相关（F=-8.70，P=0.012）。多因素logistic回归分析显示，CMBs数量是认知障碍的独立危险因素（OR 7.106，95%CI 3.026～15.309，P=0.001）。 结论 CMBs与年龄、高血压及使用抗血小板药物有关，在CMBs人群中，CMBs是认知障碍的独立危险因素，且与视空间及执行、定向力及抽象能力、延迟记忆、语言能力及注意力等认知域的损害相关。 Abstract: Objective To investigate the clinical characteristics and related factors of cognitive impairment in patients with cerebral microbleeds (CMBs). Methods This prospective study enrolled the consecutive patients with CMBs (CMBs group) and healthy people with matched education level (control group) from January 2017 to January 2021. MMSE, MoCA and clinical dementia rating (CDR) were used to evaluate global cognitive function and functional status in different cognitive domains. The clinical characteristics and cognitive function of the two groups were compared. The correlation of the number and location of CMBs with the total score of MoCA and different cognitive domains score were analyzed in the CMBs group. Independent risk factors for cognitive decline were analyzed in the CMBs group. Results There were 110 subjects in CMBs group and control group respectively. The age (P=0.045), proportion of hypertension (P=0.003) and rate of taking antiplatelet drugs (P=0.015) were higher in CMBs group than those in control group. The scores of MMSE (P=0.019), MoCA (P=0.026) and CDR (P<0.001) in CMBs group were lower than those of control group. In patients with CMBs, the number of CMBs was negatively correlated with MoCA score (rs=-0.930, P<0.001). Deep CMBs was negatively correlated with visual space and executive ability (F=-8.09, P=0.017), orientation (F=-1.33, P=0.041) and abstraction ability (F=-8.03, P=0.023). Cortical-subcortical CMBs were negatively correlated with delayed memory (F=-28.57, P=0.001), language ability (F=-2.88, P=0.038), and mixed CMBs were negatively correlated with attention score (F=-8.70, P=0.012). Multivariate logistic regression analysis showed that the number of CMBs was an independent risk factor for cognitive impairment (OR 7.106, 95%CI 3.026-15.309, P=0.001). Conclusions CMBs is associated with age, hypertension and the use of antiplatelet drugs. In CMBs population, CMBs is an independent risk factor for cognitive impairment, and associated with impairment of visual space and executive function, orientation and abstraction ability, delayed memory, language ability and attention.
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