Zhao W, Zhu X Q, Liu H, Tong X X, Wu Y L, Zhang H, Zhou X, Sun Z W
Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
Zhonghua Yi Xue Za Zhi. 2019 Apr 2;99(13):971-976. doi: 10.3760/cma.j.issn.0376-2491.2019.13.003.
To explore the correlation of left heart function changes with cognitive impairment in patients with cerebral small vessel diseases (CSVD). From February 2012 to June 2018, 199 CSVD patients admitted to the Department of Neurology of the First Affiliated Hospital of Anhui Medical University were enrolled as CSVD group. A total of 103 healthy elderly persons without cognition disorders were included as normal control group (NC group). According to the diagnostic criteria, CSVD patients were divided into 112 CSVD patients with vascular cognitive impairment (CSVD-VCI group) and 87 CSVD patients without cognitive impairment (CSVD-NCI group). Neuroimaging markers of CSVD (including lacunar infarction and white matter hyperintensity) were assessed through brain MRI. Cognitive function was evaluated by The Mini-Mental State Examination (MMSE), the Cambridge Cognitive Examination-Chinese Version (CAMCOG-C), etc. Routine echocardiography was performed to evaluate left ventricular ejection fraction (LVEF), left atrial diameter (LAD) and other parameters. Compared with NC group, the LVEF level was significantly decreased in CSVD group [(65±5)% and (63±6)%, respectively] (0.007), while LAD level was significantly increased in CSVD group (0.024). The LVEF level of CSVD-VCI group [(62±6)%] was significantly lower than that of CSVD-NCI group [(64±5)%] (0.02). Correlation analysis revealed MMSE and CAMCOG-C scores in CSVD group were positively correlated with LVEF level (0.210, 0.003; 0.238, 0.001). Logistic regression analysis revealed that declined LVEF was an independent risk factor associated with CSVD (0.937, 95 0.890-0.986) and CSVD-VCI (0.900, 95 0.829-0.977). Left heart function changes play important roles in the occurrence of CSVD and severity of its cognitive impairment. The declined LVEF may represent an independent risk factor for CSVD and its cognitive impairment.
探讨脑小血管病（CSVD）患者左心功能变化与认知障碍的相关性。2012年2月至2018年6月，安徽医科大学第一附属医院神经内科收治的199例CSVD患者作为CSVD组。纳入103例无认知障碍的健康老年人作为正常对照组（NC组）。根据诊断标准，将CSVD患者分为112例伴有血管性认知障碍的CSVD患者（CSVD-VCI组）和87例无认知障碍的CSVD患者（CSVD-NCI组）。通过脑部MRI评估CSVD的神经影像学标志物（包括腔隙性脑梗死和白质高信号）。采用简易精神状态检查表（MMSE）、剑桥认知检查表中文版（CAMCOG-C）等评估认知功能。进行常规超声心动图检查以评估左心室射血分数（LVEF）、左心房内径（LAD）等参数。与NC组相比，CSVD组的LVEF水平显著降低[分别为（65±5）%和（63±6）%]（P = 0.007），而CSVD组的LAD水平显著升高（P = 0.024）。CSVD-VCI组的LVEF水平[（62±6）%]显著低于CSVD-NCI组[（64±5）%]（P = 0.02）。相关性分析显示，CSVD组的MMSE和CAMCOG-C评分与LVEF水平呈正相关（r = 0.210，P = 0.003；r = 0.238，P = 0.001）。Logistic回归分析显示，LVEF下降是与CSVD（OR = 0.937，95%CI 0.890-0.986）和CSVD-VCI（OR = 0.900，95%CI 0.829-0.977）相关的独立危险因素。左心功能变化在CSVD的发生及其认知障碍严重程度中起重要作用。LVEF下降可能是CSVD及其认知障碍的独立危险因素。
