缺血性小血管病与血管性痴呆的相关性研究

目的探讨缺血性小血管病(SVD),包括多发性腔隙性脑梗死(MLI)和脑白质病变(WML)与血管性痴呆(VD)的关系。方法采用简易精神量表(MMSE)和蒙特利尔认知评估量表(MoCA)对90例经颅脑CT或颅脑MRI证实的SVD患者(单纯MLI组、MLI+WML组、单纯WML组)和23例非SVD患者进行检测并分析比较。结果 (1)MMSE评分显示,与对照组比较,单纯MLI组即刻记忆、短程记忆、物体命名、语言复述、阅读理解、言语表达的分值均降低(均P<0.05);MLI+WML组时间定向、短程记忆、语言复述较对照组降低(均P<0.05),而单纯WML组与对照组比较,各分值差异均无统计学意义(P均>0.05)。单纯MLI组与MLI+WML组比较,阅读理解分值降低(P<0.05)。(2)单纯MLI组、MLI+WML组、单纯WML组的MMSE评分在不同等级痴呆人数上差异有统计学意义(P<0.05)。(3)单纯MLI组与MLI+WML组相比,各梗死部位差别无统计学意义(P>0.05)。(4)单纯WML组与对照组Logistic回归显示:高血压病史(P=0.045,OR=5.158)、糖尿病病史(P=0.032,OR=0.049)与脑白质病变相关,其中高血压病史对脑白质病变影响大。结论缺血性小血管病变可导致痴呆,主要表现在时间定向、地点定向、即刻记忆等亚项。三组中MLI+WML组的痴呆发生率最高。对于脑白质病变,高血压对其影响最大。

Association between Ischemic Small Vessel Disease and Vascular Dementia

Objective To explore the relationship between small vessel disease(SVD) and vascular dementia(VD).Methods 90 patients with small vessel disease(SVD) confirmed by MRI or CT images were divided into pure MLI group(35cases),both MLI and WML group(31cases) and pure WML group(24cases).23 normal persons were selected as control grou.All subjects were analyzed by MMSE scores and MoCA scores.Results(1) Temporal orientation had significant difference between both MLI and WML group and control group(P < 0.05);Immediate memory and verbal exposition had significant difference among pure MLI and pure WML、between control group and pure MLI;Short memory had significant difference between pure MLI and control group、between pure MLI and pure WML,between group with both MLI and WML and control group,between group with both MLI and WML and pure WML(P < 0.05);Baptize and MMSE scores had significant difference between pure MLI and control group(P < 0.05);Language repeat had significant difference between pure MLI and control group,between group with both MLI and WMLand control group;Reading comprehension had significant difference between pure MLI and control group,between pure MLI and group with both MLIand WML,between pure MLI and pure WML(P < 0.05),Reading comprehension had significant difference between pure MLI and group with both MLIand WML(P < 0.05).(2) MMSE scores in pure MLI,group with both MLI and WML,pure WML had significant difference among VD at different extent(P < 0.05)(3).Infarcted position had not significant difference between pure MLI and group with both MLI and WML(P >0.05).(4) Logistic regression between pure WML and control group : hypertension and diabetes were related to WML,hypertension influence WML at some extent.Conclusion Ischemic SVD can lead to VD which show in temporal orientation,place orientation,immediate memory and so on.In three groups,both MLI and WML group were the easiest to lead to VD.Hypertension were easier to put impact on white matter lesion than diabetes do.