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目的 分析老年缺血性脑小血管病患者海马代谢水平及发生认知功能障碍的危险因素。方法 选取2020年5月至2023年12月空军军医大学第二附属医院收治的老年缺血性脑小血管病患者164例，根据认知功能情况分为认知功能障碍组52例和认知功能正常组112例。比较2组肌醇(myo-inositol, MI)/肌酸(creatine, Cr)、MI/N-乙酰天门冬氨酸(N-acetyl aspartate, NAA)、胆碱/Cr、NAA/Cr水平；比较2组一般临床资料；采用多因素logistic回归分析影响老年缺血性脑小血管病患者认知功能障碍的危险因素。结果 认知功能障碍组左侧、右侧海马MI/Cr、MI/NAA显著高于认知功能正常组，右侧海马NAA/Cr显著低于认知功能正常组，差异有统计学意义(P<0.05)。认知功能障碍组年龄≥65岁、高血压、动脉粥样硬化、低密度脂蛋白胆固醇、高敏C反应蛋白、同型半胱氨酸水平显著高于认知功能正常组(P<0.05,P<0.01)。多因素logistic回归分析显示，左侧海马MI/Cr、右侧海马MI/Cr、左侧海马MI/NAA、右侧海马MI/NAA、右侧海马NAA/Cr、年龄≥65岁、高血压、动脉粥样硬化、低密度脂蛋白胆固醇是老年缺血性脑小血管病患者认知功能障碍的危险因素(OR=2.795,95%CI:1.532～5.102,P=0.000;OR=2.782,95%CI:1.616～4.787,P=0.000;OR=2.177,95%CI:1.355～3.498,P=0.000;OR=3.364,95%CI:1.846～6.127,P=0.000;OR=0.450,95%CI:0.259～0.784,P=0.000;OR=2.740,95%CI:1.024～7.330,P=0.012;OR=3.074,95%CI:1.554～6.080,P=0.000;OR=2.942,95%CI:1.338～6.468,P=0.000;OR=2.418,95%CI:1.496～3.909,P=0.000)。结论 老年缺血性脑小血管病患者发生认知功能障碍的风险较高，可能与海马代谢水平、患者年龄、合并症、低密度脂蛋白胆固醇、高敏C反应蛋白、同型半胱氨酸等因素密切相关，临床应重点筛查此类指标，并采取积极防治措施，以降低认知功能障碍的发生风险。
Abstract：Objective To analyze the level of hippocampal metabolism in elderly patients with ischemic cerebral small vessel disease(ICSVD),and explore the risk factors for the occurrence of cognitive impairment.Methods A total of 164 elderly patients with ICSVD admitted in our hospital from May 2020 to December 2023 were enrolled, and divided into cognitively impaired group(52 cases) and cognitively normal group(112 cases) according to their cognitive function.The clinical data and the ratios of myo-inositol(MI)/creatine(Cr),MI/N-acetyl aspartate(NAA),choline/Cr, and NAA/Cr were compared between the two groups.Multivariate logistic regression analysis was applied to identify the risk factors of cognitive impairment in elderly ICSVD patients.Results The left and right hippocampal MI/Cr and MI/NAA ratios were significantly higher, while the right hippocampal NAA/Cr ratio was obviously lower in the cognitively impaired group than the cognitively normal group(P<0.05).The former group had notably larger proportions of aged ≥65 years, hypertension and atherosclerosis, and higher levels of LDL-C,hs-CRP and Hcy than the latter group(P<0.05,P<0.01).Multivariate logistic regression analysis indicated that left and right hippocampal MI/Cr ratios, left and right hippocampal MI/NAA ratios, right hippocampal NAA/Cr ratio, aged ≥65 years, hypertension, atherosclerosis, LDL-C were risk factors for cognitive impairment in elderly ICSVD patients(OR=2.795,95%CI:1.532-5.102,P=0.000;OR=2.782,95%CI:1.616-4.787,P=0.000;OR=2.177,95%CI:1.355-3.498,P=0.000;OR=3.364,95%CI:1.846-6.127,P=0.000;OR=0.450,95%CI:0.259-0.784,P=0.000;OR=2.740,95%CI:1.024-7.330,P=0.012;OR=3.074,95%CI:1.554-6.080,P=0.000;OR=2.942,95%CI:1.338-6.468,P=0.000;OR=2.418,95%CI:1.496-3.909,P=0.000).Conclusion The elderly ICSVD patients are at high risk of cognitive impairment, which may be closely associated with hippocampal metabolism level, age, comorbidity, LDL-C,hs-CRP,Hcy and other factors.It is necessary to focus on clinical screening of these indicators and take active prevention and control measures to reduce the risk of cognitive impairment.
[1] Markus HS,de Leeuw FE.Cerebral small vessel disease:recent advances and future directions[J].Int J Stroke,2023,18(1):4-14.DOI:10.1177/17474930221144911.
[2] Zanon Zotin MC,Sveikata L,Viswanathan A,et al.Cerebral small vessel disease and vascular cognitive impairment:from diagnosis to management[J].Curr Opin Neurol,2021,34(2):246-257.DOI:10.1097/WCO.0000000000000913.
[3] Yang Q,Wei X,Deng B,et al.Cerebral small vessel disease alters neurovascular unit regulation of microcirculation integrity involved in vascular cognitive impairment[J].Neurobiol Dis,2022,170:105750.DOI:10.1016/j.nbd.2022.105750.
[4] Hainsworth AH,Markus HS,Schneider JA.Cerebral small vessel disease,hypertension,and vascular contributions to cognitive impairment and dementia[J].Hypertension,2024,81(1):75-86.DOI:10.1161/HYPERTENSIONAHA.123.19943.
[5] Fang J,Yuan Q,Du Z,et al.Overexpression of GPX4 attenuates cognitive dysfunction through inhibiting hippocampus ferroptosis and neuroinflammation after traumatic brain injury[J].Free Radic Biol Med,2023,204:68-81.DOI:10.1016/j.freeradbiomed.2023.04.014.
[6] Yang L,Hao JR,Gao Y,et al.HDAC3 of dorsal hippocampus induces postoperative cognitive dysfunction in aged mice[J].Behav Brain Res,2022,433:114002.DOI:10.1016/j.bbr.2022.114002.
[7] 中国研究型医院学会脑小血管病专业委员会《中国脑小血管病诊治专家共识》编写组.中国脑小血管病诊治专家共识2021[J].中国卒中杂志，2021,16(7):716-726.DOI:10.3969/j.issn.1673-5765.2021.07.013.
[8] Chapman JE,Cadilhac DA,Gardner B,et al.Comparing face-to-face and videoconference completion of the Montreal cognitive assessment (MoCA) in community-based survivors of stroke[J].J Telemed Telecare,2021,27(8):484-492.DOI:10.1177/1357633X19890788.
[9] Sleight E,Stringer MS,Clancy U,et al.Cerebrovascular reactivity in patients with small vessel disease:a cross-sectional study[J].Stroke,2023,54(11):2776-2784.DOI:10.1161/STROKEAHA.123.042656.
[10] Wardlaw JM,Woodhouse LJ,Mhlanga II,et al.Isosorbide mononitrate and cilostazol treatment in patients with symptomatic cerebral small vessel disease:the lacunar intervention trial-2 (LACI-2) randomized clinical trial[J].JAMA Neurol,2023,80(7):682-692.DOI:10.1001/jamaneurol.2023.1526.
[11] Vestergaard SB,Damsbo AG,Pedersen NL,et al.Exploring vascular contributions to cognitive impairment and dementia (ENIGMA):protocol for a prospective observational study[J].BMC Neurol,2024,24(1):110-117.DOI:10.1186/s12883-024-03601-7.
[12] Webb AJS,Birks JS,Feakins KA,et al.Cerebrovascular effects of sildenafil in small vessel disease:the OxHARP trial[J].Circ Res,2024,135(2):320-331.DOI:10.1161/CIRCRESAHA.124.324327.
[13] 闫振国，陈婡，胡春梅，等.脑小血管病相关轻度认知功能障碍患者海马代谢水平及相关因素研究[J].卒中与神经疾病，2023,30(2):183-187.DOI:10.3969/j.issn.1007-0478.2023.02.011.
[14] Carvalho TL,Mertens Brainer de Queiroz Lima AC,de Araújo NS,et al.Aspects of cognitive assessments and spectroscopic magnetic resonance imaging in people with chronic hepatitis C:a systematic review[J].Psychol Health Med,2023,28(4):1013-1029.DOI:10.1080/13548506.2022.2029915.
[15] Zhang X,Li J,Li X.Use of magnetic resonance spectroscopy to explore metacognitive ability[J].Behav Neurosci,2023,137(2):120-126.DOI:10.1037/bne0000545.
[16] Scuteri A,Antonelli Incalzi R.Subclinical HMOD in hypertension:brain imaging and cognitive function[J].High Blood Press Cardiovasc Prev,2022,29(6):577-583.DOI:10.1007/s40292-022-00546-1.
基本信息:
DOI：
中图分类号:R743;R749.1
引用信息:
[1]张萌,杨小林.老年缺血性脑小血管病患者海马代谢水平及发生认知功能障碍的危险因素分析[J].中华老年心脑血管病杂志,2025,27(04):422-425.
基金信息:
陕西省自然科学基础研究计划项目(2024JC-YBMS-752)