摘要
目的探讨无症状颈动脉狭窄（asymptomatic carotid stenosis, ACS）患者认知损害的危险因素。方法纳入ACS患者，收集年龄、性别、血压、血脂、糖化血红蛋白、高半胱氨酸（homocysteine, Hcy）、脑白质损害（white matter lesion, WML）程度、颈动脉狭窄程度等相关临床资料。采用蒙特利尔认知评估量表（Montreal cognitive assessment, MoCA）评估认知功能，将研究对象分为认知损害组（〈26分）和认知正常组（≥26分）。应用多变量logistic回归分析确定ACS患者认知损害的危险因素。结果共纳入123例ACS患者，认知损害组45例（36.6%），认知正常组78例（63.4%）。两组在颈动脉狭窄程度、WML严重程度、受教育水平、年龄和Hcy水平方面存在统计学差异（P均〈0.05）。多变量logistic回归分析显示，重度颈动脉狭窄[优势比（odds ratio, OR）3.232，95%可信区间（confidence interval, CI）1.134～9.208；P＝0.028]、重度WML（OR 8.930，95% CI 2.683～31.688；P＝0.015）、高同型半胱氨酸血症（OR 2.671，95% CI 1.877～3.609；P＝0.037）是ACS患者认知损害的独立危险因素，而受教育年限是ACS患者认知损害的独立保护因素（OR 0.607，95% CI 0.461～0.817；P＝0.043）。结论ACS患者可出现认知损害，受教育年限是ACS患者认知损害的独立保护因素，而重度颈动脉狭窄、重度WML和高同型半胱氨酸血症是其独立危险因素。
Objective To investigate the risk factors for cognitive impairment in patients with asymptomatic carotid stenosis （ACS）. Methods Patients with ACS were enrolled. The related clinical data were collected, including age, gender, blood pressure, blood lipid, glycosylated hemoglobin, homocysteine （Hcy）, white matter lesion （WML） and the degree of carotid stenosis. Montreal cognitive assessment （MoCA） was used to evaluate cognitive function. The patients were divided into either a cognitive impairment group （〈26） or non-cognitive impairment group （≥26）. Multivariate logistic regression analysis was used to identify the risk factors for cognitive impairment in patients with ACS. Results A total of 123 patients with ACS were enrolled in the study, including 45 （36. 6% ） in the cognitive impairment group and 78 （63.4%） in the non-cognitive impairment group. There were significant differences in the degree of carotid stenosis, WML severity, years of education, age, and Hcy level between the 2 groups （all P 〈0. 05）. Multivariable logistic regression analysis showed that severe carotid artery stenosis （odds ratio [ OR] 3. 232, 95% confidence interval [ CI] 1. 134-9.208; P =0. 028）, severe WML （OR 8. 930, 95% CI 2. 683-31. 688; P =0. 015）, and hyperhomocysteinemia （OR 2. 671,95% CI 1. 877-3.609; P =0. 037） were the independent risk factors for cognitive impairment in patients with ACS, while years of education were an independent protective factor of cognitive impairment in patients with ACS （OR 0.607, 95%CI 0.461-0. 817; P= 0. 043）. Conclusions Cognitive impairment may occur in patients with ACS. Years of education are an independent protective factor of cognitive impairment in patients with ACS, and severe carotid artery stenosis, severe WML, and hyperhomocysteinemia are its independent risk factors.
作者
张斌
杨瑞
靳瑜
李贯清
Zhang Bin;Yang Rui;Jin Yu;Li Guanqing(Department of Neurology, Bozhou People＇s Hospital, Bozhou 236000, Chin)
出处
《国际脑血管病杂志》
2018年第1期21-25,共5页
International Journal of Cerebrovascular Diseases
关键词
颈动脉狭窄
认知障碍
神经心理学测验
危险因素
Carotid Stenosis
Cognition Disorders
Neuropsychological Tests
Risk Factors
