皮质下缺血性脑血管病的临床特点和危险因素

目的 研究皮质下缺血性脑血管病（SIVD）在缺血性卒中患者中的发病率、临床特点和危险因素。方法 门诊连续登记的526例发病3个月后的卒中患者入选该研究。对入选患者进行多种神经心理学和功能量表评定以及神经影像学评估，并记录人口学资料、卒中临床特点和血管危险因素。结果 526例患者中，SIVD患者110例（20.9%），其中男性占61.8%，平均年龄66.8±10.5岁。高血压是最常见的危险因素（80.0%），其次是血脂异常和吸烟史，分别为52.7%和40.9%，有57.3%的患者有2个以上的危险因素。32.7%的患者有抑郁障碍。用Lawton FAQ量表评定显示工具性日常生活能力下降的SIVD患者53人（48.0%），用Barthel 指数（BI）测定显示日常生活能力下降者14人（12.8%）。49例（44.5%）有血管性认知功能损害，其中26例（23.6%）符合血管性痴呆标准。结论 缺血性卒中患者中，SIVD约占1/5，SIVD患者认知损害、抑郁、工具性日常生活能力受累较常见，并伴有多种危险因素。

The Clinical Characteristics and Risk Factors of Subcortical Ischemic Vascular Disease

Objective To investigate the prevalence, characteristics and risk factors of subcortical ischemicvascular disease(SIVD) among patients with ischemic stroke.Methods 526 consecutive patients, 3 months after an ischemic stroke were recruited in thisstudy. Multiple neuropsychological, functional rating scales and neuroimaging assessmentwere administrated on the patients. Demographic information, vascular risk factors and strokecharacteristics were also documented.Results Of the 526 patients, 20.9% of patients fulfilled neuroimaging defined diagnostic standardof SIVD(n=110), with 61.8% of them were male and average age was 66.8±10.5. Hypertension(80.0%) was the most frequent risk factor among these patients, followed by dyslipidemia(52.7%) and cigarette smoking history (40.9%). Furthermore, 57.3% of SIVD had more than tworisk factors. Among the patients, 32.7% of them were depressed. Fifty-three patients (48.0%)had impaired instrumental activities of daily living(IADL) function as measured by Lawton’sFunctional Activities Questionnaire(FAQ) scale and 14 patients (12.8%) had impaired activities ofdaily living(ADL) function as measured by Barthel index (BI). Forty-nine patients (44.5%) werediagnosed as vascular cognitive impairment(VCI) and 26 (23.6%)of them as vascular dementia.Conclusion About one fifth ischemic stroke patients suffer from SIVD. They often have cognitiveimpairment, depression, impaired IADL and multiple vascular risk factors.