脑小血管病亚型和颅外颈动脉硬化与血管性认知障碍的相关性研究

Study on the correlation between subtypes of cerebral small vessel disease, extracranial carotid arteriosclerosis and vascular cognitive impairment

摘要:

目的： 研究脑小血管病（cerebral small vessel disease，CSVD）亚型与颅外颈动脉粥样硬化及血管性认知障碍（vascular cognitive impairment，VCI）的相关性。 方法： 收集200例无卒中CSVD患者的人口学、用药等资料，行颈动脉超声并使用颅外颈动脉硬化评分评估颈动脉粥样硬化程度，行头颅磁共振（magnetic resonance imaging，MRI）并评估各类CSVD亚型病变程度。采用蒙特利尔认知评估量表（Montreal cognitive assessment，MoCA）筛查认知功能异常患者，根据MoCA总分<23分将患者分成VCI组和无VCI组。采用单因素分析和多因素logistic回归筛选无卒中患者VCI的独立危险因素。建立模型并使用受试者工作特征曲线（receiver operating characteristic，ROC）评估独立危险因素，计算临界值等。根据独立危险因素中的CSVD评分最佳界值计算脑小血管性认知负荷评分并使用ROC曲线评估。 结果： Logistic回归分析得出腔隙性脑梗死（lacunar infarction，LI）+腔隙灶个数之和、Fazekas评分、全脑皮层萎缩（global cortical atrophy，GCA）评分与VCI显著正相关（P<0.05），颅外颈动脉硬化评分与VCI无明显相关性（P>0.05）；所建立预测模型和脑小血管性认知负荷评分曲线下面积（area under the curve，AUC）>0.7。 结论： 部分CSVD亚型与VCI存在明显相关性，颅外轻度颈动脉粥样硬化与VCI无明显相关性；可通过CSVD建立模型或使用临床更方便的脑小血管性认知负荷评分筛查无卒中患者的小血管性认知障碍。

Abstract:

Objective: To study the correlation between subtypes of cerebral small vessel disease (CSVD) and extracranial carotid atherosclerosis and vascular cognitive impairment (VCI). Methods: The demographic and medication history data of 200 stroke-free CSVD patients were collected in the study. Carotid ultrasound was performed and carotid atherosclerosis was assessed using extracranial carotid atherosclerosis score. Brain magnetic resonance imaging (MRI) was performed and the lesions of various subtypes of CSVD were assessed. Montreal cognitive assessment (MoCA) score was used to screen patients with cognitive dysfunction. According to the total score of MoCA<23, the patients were divided into VCI group and non-VCI group. Univariate analysis and multivariate logistic regression were used to screen independent risk factors for VCI in strokefree patients. We also established a model and used the receiver operating characteristic (ROC) curve to assess independent risk factors and calculated the cut-off value, etc. The best cut-off value of the CSVD score among the independent risk factors was used as a baseline to assess the cognitive impairment of the cerebral small vessels, cerebral small vascular cognitive burden score was calculated and was evaluated by the ROC curve. Results: Logistic regression analysis showed that the sum of lacunar infarction (LI) +lacune, Fazekas score and global cortical atrophy (GCA) score were positively correlated with VCI (P<0.05), while there was no significant correlation between extracranial carotid arteriosclerosis score and VCI (P>0.05). The area under the curve (AUC) of the established prediction model and the AUC of the cerebral small vascular cognitive burden score were>0.7, respectively. Conclusion: Some subtypes of CSVD are significantly correlated with VCI, while extracranial mild carotid atherosclerosis has no obvious correlation with VCI. The model can be established by CSVD or the cerebral small vascular cognitive burden score which is more convenient in clinic can be used to screen the small vascular cognitive impairment in strokefree patients.