脑白质疏松患者的脑血管储备与心脑血管事件以及认知功能障碍的关系

目的 评估脑白质疏松（LA）的脑血管储备功能（CVR）,并探讨脑白质疏松与后期发生的心脑血管事件及认知功能障碍之间的关系.方法 将连续入组神经内科门诊和住院的128例患者,根据MRI结果分为LA组和对照组,并按照LA的严重程度,将LA组分为轻度组、中度组、重度组.通过屏气诱发高碳酸血症,行经颅多普勒检测大脑中动脉血流速度变化并计算屏气指数（BHI）以评估脑血管储备功能.随访1年,主要终点事件为首次非致死性或者致死性卒中,并采用简明精神状态量表（MMSE）和蒙特利尔认知评估量表（MoCA）评估认知功能.结果 LA组与对照组比较,LA中、重度组的BHI值明显低于对照组（P＜0.05）.LA重度组血管性认知功能障碍的发生率明显高于对照组（P＜0.05）.而轻、中度组与对照组之间发生血管性认知功能障碍的比例差异无统计学意义.在随访期间,分别有16例LA组患者（20.51％）和2例对照组患者（4.0％）出现卒中（P＜0.01）.LA组出现11例急性脑梗死和5例出血性卒中,对照组出现1例脑梗死和1例出血性卒中.与对照组比较,LA组发生脑梗死的几率明显增加（P＜0.05）;而两组发生脑出血的几率差异无统计学意义（P＞0.05）.发生冠心病的风险明显升高（P＜0.05）.进一步比较,LA重度组发生急性脑梗死和中重度组发生冠心病的比例显著增高.两组总死亡率相似,LA组有2例死亡,对照组有1例,差异无统计学意义（P＞0.05）.结论 LA患者认知障碍明显高于非LA人群,且1年内发生缺血性脑卒中和冠心病的比例也高于非LA人群.脑白质疏松是影响CVR的危险因素,检测CVR可能预测脑白质疏松的严重程度及其发生心脑血管事件和认知功能障碍的可能性大小.

Relations between cerebrovascular reserve in patient with leukoaraiosis and subsequent cardiovascular events,cerebrovascular events,and cognitive function impairment

Objective To assess cerebrovascular reserve （CVR） function in patients with leukoaraiosis （LA）.Compare and analyze whether the presence of leukoaraiosis is a risk factor for subsequentcerebrovascular and cardiovascular disease and cognitive impairment.Methods One hundred and twenty-eight consecutive outpatients and inpatients at the department of neurology were enrolled.The patients were divided into two groups according the MRI results：patients with leukoaraiosis （LA group） and patients without leukoaraiosis （control group）.According to the scores,the patients of LA group were divided into mild,moderate and severe groups.Hypercapnia was induced by holding breath.The blood flow rate in middle cerebral artery was measured by bilateral transcranial Doppler.Breath-holding index（BHI） was evaluated.All patients were followed-up for 1 year.The primary end point was a first -episode nonfatal or fatal stroke.Mini Mental State Examination （MMSE） and Montreal Cognitive Assessment （MoCA） were used to assess the cognitive function at the end of the 1 year followed-up.Results The BHI in moderate and severe LA groups was much lower than control group （P ＜ 0.05）.The prevalence of vascular cognitive impairment in severe LA group was much higher than those in control group （P ＜ 0.05）,but the incidences of vascular cognitive impairment in mild or moderate LA groups were not significantly different from control group.16 patients （20.51％）in LA group and 2 patients （4.0％） in control group had a fatal or nonfatal stroke （P ＜ 0.01）.The LA group had 11 cases of acute cerebral infarction and 5 cases of hemorrhagic stroke,whereas the control group had 1 case of cerebral infarction and 1 case of hemorrhagic stroke.The incidence of acute cerebral infarction in LA group increased significantly in comparison with the control group （P ＜0.05）,whereas the incidences of hemorrhagic stroke are not significant deviated in the two groups （P ＞ 0.05）.The risk of coronary heart dis