缺血性白质高信号严重程度的独立危险因素及相关认知功能障碍的中医证候要素分析

Analysis of independent risk factors of the severity of white matter hyperintensity and the Chinese medicine syndrome elements of related correlation with cognitive impairment

关键词:  缺血性白质高信号  独立危险因素  认知功能障碍  证候要素  相关性

Key words:  white matter hyperintensity  the independent risk factors  cognitive impairment  syndrome element  correlation

摘要:

[目的] 探讨缺血性白质高信号（WMH）严重程度的独立危险因素、WMH与认知障碍的关系及认知障碍患者的证候要素特征。[方法] 选取2019年1月—2022年12月北京中医药大学东直门医院脑病科住院的WMH患者130例，根据Fazekas量表评分分为轻度组26例、中度组39例和重度组65例。收集患者的一般资料，采用有序多分类logistic回归分析WMH严重程度的独立危险因素，采用Spearman秩相关分析WMH与认知障碍、认知障碍与证候要素的相关性。[结果] 中、重度组的年龄、2型糖尿病比例明显高于轻度组，重度组的陈旧性脑梗死比例、急性缺血性脑卒中比例和认知异常比例明显高于轻度组，重度组的颈动脉硬化伴斑块比例明显高于轻、中度组，差异有统计学意义（P＜0.05或P＜0.001）；重度组的简易精神状态评价量表（MMSE）评分和蒙特利尔认知评估量表（MoCA）评分明显低于轻、中度组，重度组的画钟试验（CDT）评分明显低于轻度组，重度组的日常生活能力量表（ADL）评分明显高于轻度组，差异有统计学意义（P＜0.05或P＜0.001）。校正混杂因素后，年龄（OR=1.105，95%CI：1.042～1.171，P=0.001）、陈旧性脑梗死（OR=6.567，95%CI：2.428～17.76，P＜0.001）、急性缺血性脑卒中（OR=8.514，95%CI：2.625～27.617，P＜0.001）和气虚程度（OR=1.12，95%CI：1.007～1.245，P=0.036）是WMH严重程度的独立危险因素。Spearman秩相关结果显示，WMH严重程度与认知异常比例呈正相关（r_s=0.304，P＜0.001），合并认知异常的WMH总分、脑室旁白质高信号（PVH）和深部白质高信号（DWMH）评分分别与MMSE（r_s=-0.358，r_s=-0.388，r_s=-0.301）、MoCA（r_s=-0.397，r_s=-0.323，r_s= -0.401）评分呈负相关（P＜0.05），WMH总分与ADL评分呈正相关（r_s=0.24，P＜0.05），DWMH评分与CDT评分呈负相关（r_s=-0.247，P＜0.05）；认知异常比例与气虚比例呈正相关（r_s=0.265，P＜0.05）；认知异常者的MoCA评分与气虚评分呈负相关（r_s=-0.257，P＜0.05）。[结论] 年龄、陈旧性脑梗死、急性缺血性脑卒中和气虚程度是WMH严重程度的独立危险因素；WMH程度越重认知障碍风险越高、认知损害程度越重；气虚是WMH相关认知障碍的重要证候要素。

Abstract:

[Objective] To investigate the independent risk factors of the severity of white matter hyperintensity（WMH），the relationship between WMH and cognitive impairment and the syndrome elements characteristics of cognitive impairment patients. [Methods] The 130 WMH patients admitted to the Department of Encephalopathy of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2019 to December 2022 were selected and divided into mild group（26 cases），moderate group（39 cases） and severe group（65 cases） according to Fazekas score scale. The general data of the patients were collected，and the independent risk factors of WMH severity were analyzed by multivariate ordered logistic regression. Spearman rank correlation was used to analyze the correlation between WMH and cognitive impairment and the correlation between cognitive impairment and syndrome elements.[Results] The age and the proportion of diabetes patients in the moderate and severe group were higher than the mild group；the proportion of patients with remote cerebral infarction，the proportion of acute ischemic stroke patients and the proportion of patients with cognitive impairment in the severe group were higher than the mild group；the proportion of patients with carotid atherosclerosis with plaque in the severe group was higher than the mild and moderate group，with statistical significance（P＜0.05，P＜0.001）；the mini-mental state examination（MMSE） and the Montreal cognitive assessment（MoCA） score of the severe group were lower than the mild and moderate group；the clock drawing test（CDT） score of the severe group were lower than the mild group；the severe group had a higher activity of daily living（ADL） score than the mild group，with statistical significance（P＜0.05，P＜0.001）. After adjusting for the confounding factors，age（OR=1.105，95%CI：1.042~1.171，P=0.001），remote cerebral infarction（OR=6.567，95%CI：2.428~17.76，P＜0.001），acute ischemic stroke（OR=8.514，95%CI：2.625~27.617，P＜0.001）and the severity of deficiency of vital energy（OR=1.12，95%CI：1.007~1.245，P=0.036） were the independent risk factors of WMH severity. Spearman correlation analysis showed that the WMH severity was positively correlated with the proportion of cognitive impairment patients（r_s=0.304，P＜0.001）；the total WMH score combined with cognitive impairment，the periventricular hyperintensity（PVH） score and the deep white matter hyperintensity（DWMH） score of the cognitive impairment were negatively correlated with the score of MMSE（r_s=-0.358，r_s=-0.388，r_s=-0.301，P＜0.05） and MoCA（r_s=-0.397，r_s=-0.323，r_s=-0.401，P＜0.05，P＜0.05）；the total WMH score was positively correlated with the score of ADL（r_s=0.24，P＜0.05）；the DWMH score was negatively correlated with CDT score（r_s=-0.247，P＜0.05）. The proportion of patients with cognitive impairment was positively correlated with the proportion of patients with deficiency of vital energy（r_s=0.265，P＜0.05）. The MoCA score of the cognitive impairment was negatively correlated with the score of deficiency of vital energy（r_s=-0.257，P＜0.05）. [Conclusion] Age，remote cerebral infarction，acute ischemic stroke and the severity of deficiency of vital energy are the independent risk factors of WMH severity；the more WMH serious，the higher risk and the greater degree of cognitive impairment；the deficiency of vital energy is the important syndrome element of cognitive impairment correlated with WMH.