摘要
目的 探讨皮质下小血管病性认知功能障碍非痴呆型（VCIND-SIVD）患者认知功能恶化的独立危险因素和预测因子.方法 详细记录96例来自2010年3月至2012年3月间韶关市第一人民医院神经内科住院部及门诊就诊的急性缺血性脑血管病发病6个月以上的VCIND-SIVD患者的临床资料和神经心理学特点,随访1年后再次评估患者的认知功能状态,对研究资料进行单因素分析,然后进行多因素Logistic回归分析明确认知恶化的危险因素和预测因子.结果 随访1年后96例VCIND-SIVD患者有8例脱失,2例死亡,保留的86例患者,男48例,女38例,平均年龄（64±5）岁,其中17例（19.8%）认知功能障碍恶化为痴呆,24例（27.9%）转归为认知功能正常,45例（52.3%）保持认知功能不变.以新发痴呆者为痴呆组,认知功能正常者和VCIND者作为对照组.一般资料和血管危险因素经单因素分析筛选后,Logistic回归分析发现,受教育年限为认知功能恶化的保护因素（P〈0.05,OR=0.7）,年龄（P〈0.05,OR=1.2）、高血压病（P〈0.05,OR=5.6）和高同型半胱氨酸血症（P〈0.05,OR=4.2）是认知功能恶化的独立危险因素.神经心理学成绩经单因素分析筛选后,Logistic回归分析发现,即刻视觉再生测试（P〈0.05,OR=3.4）、数字广度顺背（P〈0.05,OR=1.2）、画钟测试（P〈0.05,OR=6.8）、伦敦塔完成时间（P〈0.05,OR=5.4）与认知功能恶化显著相关,是认知功能恶化的独立预测因子.结论 VCIND-SIVD患者即刻视觉再生测试、数字广度顺背、画钟测试、伦敦塔完成时间成绩差者应积极控制高血压病、高同型半胱氨酸血症等血管危险因素,防止认知功能恶化.
Objective To explore the independent risk factors and predictive factors of cognitive deterioration in patients of vascular cognitive impairment no dementia with subeortieal ischemie vascular disease （VCIND-SIVD）. Methods The clinical and neuropsychological characteristics of 96 VCIND-SIVD patients were collected and their cognitive states re-assessed after one year. The distribution of continuous and categorical variables was examined with univariate analysis. And Logistic regression in multivariate modeling was employed to identify the risk and predictive factors of cognitive deterioration. Results After 1-year follow-up, 8 patients dropped out, 2 died and the remainder remained. There were 48 males and 38 females with an average age of 64.3 ± 5.4 years. Among them, 17 （19.8%） deteriorated into dementia, 24 （27.9%） upgraded to normal cognition and 45 （52. 3% ） maintained their cognitive status. They were divided into dementia group （cognition deteriorating into dementia） and control group （elevated/sustained cognition）. After univariate analysis of general information and vascular risk factors, Logistic regression demonstrated that education level （ P 〈 0. 05, OR = 0. 7 ） was a preventive factor of dementia while age （ P 〈 0. 05, OR = 1.2）, hypertension （P 〈 0. 05, OR = 5.6） and high homocysteine （P 〈 0. 05, OR = 4. 2） were independent risk factors of dementia. After univariate analysis of neuropsyehologieal scores, Logistic regression demonstrated that visual reproduction-immediate recall （ P 〈 0.05, OR = 3.4） , digit span forward （ P 〈 0. 05, OR = 1.2 ） , clock drawing test （ P 〈 0. 05, OR = 6. 8 ） and completion time of London tower （P 〈 0. 05, OR = 5.4） were predictive factors of dementia. Conclusion VCIND-SIVD patients with low score of visual reproduction-immediate recall, digit span forward, clock drawing test and completion time of London tower should receive vigorous controls of hypertension and high homocysteine.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第5期352-355,共4页
National Medical Journal of China
