摘要
目的分析老年脑小血管病(cerebral small vessel disease,CSVD)患者影像学总负荷评分(总负荷评分)、血压变异性(blood pressure variability,BPV)与认知功能的关系。方法回顾性收集2022年12月至2024年1月收治的182例老年CSVD患者临床资料,参考《脑小血管病相关认知功能障碍中国诊疗指南(2019)》,使用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)等工具判断患者认知功能障碍,并以此分为障碍组76例和正常组106例,比较2组影像学总负荷评分及BPV指标[24 h收缩压变异系数(24 h systolic blood pressure coefficient of variation,24 h SBPCV)、24 h舒张压变异系数(24 h diastolic blood pressure coefficient of variation,24 h DBPCV)]差异,使用ROC曲线评估影像学总负荷评分及24 h SBPCV、24 h DBPCV对老年CSVD患者认知功能障碍的诊断价值,使用多因素logistic回归分析老年CSVD患者认知功能障碍的危险因素;并根据障碍组认知功能障碍程度分为轻度障碍亚组43例(MoCA评分为18~25分)和中重度障碍亚组33例(MoCA评分<18分),比较2个亚组影像学总负荷评分、24 h SBPCV、24 h DBPCV差异,使用Pearson相关系数评估老年CSVD患者认知功能障碍程度与影像学总负荷评分、24 h SBPCV、24 h DBPCV的相关性。结果障碍组总负荷评分、24 h SBPCV、24 h DBPCV显著高于正常组,差异有统计学意义(P<0.01)。ROC曲线分析显示,总负荷评分(曲线下面积为0.953,95%CI:0.926~0.980,P=0.000)、24 h SBPCV(曲线下面积为0.850,95%CI:0.795~0.906,P=0.000)、24 h DBPCV(曲线下面积为0.761,95%CI:0.690~0.832,P=0.000)均对老年CSVD患者认知功能障碍具有较好的诊断效能,其截断值分别为1.5分、11.82%、8.92%。多因素logistic回归分析显示,总负荷评分、24 h SBPCV、24 h DBPCV均为老年CSVD患者认知功能障碍的危险因素(P<0.05,P<0.01)。轻度障碍亚组总负荷评分、24 h SBPCV、24 h DBPCV均显著低于中重度障碍亚组(P<0.01)。Pearson相关性分析显示,老年CSVD患者MoCA评分与总负荷评分、24 h SBPCV、24 h DBPCV均呈显著负相关(r=-0.755、-0.632、-0.601,P<0.01)。结论检测总负荷评分及BPV指标对判断老年CSVD患者认知功能障碍有利,且总负荷评分越高、BPV越大者认知功能障碍越严重,可为临床诊疗开拓新思路。
Objective To analyze the relationship of total imaging burden score with blood pressure variability(BPV)and cognitive function in elderly patients with cerebral small vessel disease(CSVD).Methods Clinical data of 182 elderly CSVD patients admitted in our hospital from December 2022 to January 2024 were collected and analyzed retrospectively.According to the results of Chinese Guidelines for Diagnosis and Treatment of CSVD-Related Cognitive Dysfunction(2019),Montreal Cognitive Assessment(MoCA)and other tools for their cognitive impairment,they were divided into cognitively impaired group(76 cases)and cognitively normal group(106 cases).The total burden score and BPV indicators[24 h systolic blood pressure coefficient of variation(24 h SBPCV),24 h diastolic blood pressure coefficient of variation(24 h DBPCV)]were compared between the two groups.ROC curve was plotted to evaluate the diagnostic value of total burden score,24 h SBPCV and 24 h DBPCV on cognitive impairment in elderly CSVD patients.Multivariate logistic regression analysis was used to identify the risk factors of cognitive impairment in the patients.Based on the MoCA score of the cognitively impaired group,these patients were further assigned into mild and moderate-to-severe cognitive impairment subgroups[with a MoCA score of 18-25(43 cases)and<18(33 cases),respectively].Then the total burden score,24 h SBPCV and 24 h DBPCV were compared between the two subgroups.Pearson correlation coefficient was adopted to evaluate the correlation of severity of cognitive impairment with total burden score,24 h SBPCV and 24 h DBPCV in the elderly CSVD patients.Results The total burden score,24 h SBPCV and 24 h DBPCV were significantly higher in the cognitively impaired group than the cognitively normal group(P<0.01).ROC curve analysis indicated that total burden score(AUC=0.953,95%CI:0.926-0.980,P=0.000),24 h SBPCV(AUC=0.850,95%CI:0.795-0.906,P=0.000)and 24 h DBPCV(AUC=0.761,95%CI:0.690-0.832,P=0.000)had good diagnostic efficiency for cognitive impairment in the elderly CSVD patients,with a cut-off value of 1.5,11.82%,and 8.92%,respectively.Multivariate logistic regression analysis revealed that the above three indicators were risk factors for cognitive impairment in the elderly patients with CSVD(P<0.05,P<0.01).Their values were significantly lower in the mild than the moderate-to-severe cognitive impairment subgroups(P<0.01).Pearson correlation analysis displayed that MoCA score was negatively correlated with total burden score,24 h SBPCV and 24 h DBPCV in elderly patients with CSVD(r=-0.755,-0.632,-0.601,P<0.01).Conclusion Detection of total burden score and BPV indicators is beneficial to the assessment of cognitive impairment in elderly CSVD patients.The higher the total burden score and the greater the BPV indicators,the more severe the cognitive impairment is,which may explore new ideas for clinical diagnosis and treatment of CSVD.
作者
吴恺迪
顾诗渊
史路遥
杨怡尧
钱振宇
任占云
Wu Kaidi;Gu Shiyuan;Shi Luyao;Yang Yiyao;Qian Zhenyu;Ren Zhanyun(Department of Neurology,Yixing People's Hospital,Yixing 214200,Jiangsu Province,China)
出处
《中华老年心脑血管病杂志》
北大核心
2025年第4期412-416,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
无锡市卫生健康委科技成果与适宜技术推广项目(M202143)。
关键词
脑血管障碍
认知功能障碍
血压
影像学总负荷评分
cerebrovascular disorders
cognitive dysfunction
blood pressure
total imaging burden score
