血管源性脑白质高信号与血管性认知障碍的相关性研究

Correlation Study between White Matter Hyperintensities and Vascular Cognitive Impairment

摘要: 目的：探讨血管源性脑白质高信号(WMH)的严重程度与血管性认知障碍(VCI)相关性，并分析其对不同认知功能的影响。方法：本研究共纳入102例WMH患者，根据临床及神经心理学测验等结果综合评估，将患者分为血管性认知障碍组(VCI组，n = 45)与非认知障碍组(非VCI组，n = 57)。收集所有患者的基线资料、实验室指标和影像学检查，采用Fazekas量表评估WMH严重程度，使用简易精神状态量表(MMSE)及血管性痴呆评估量表(VaDAS-cog)评估认知功能。通过单因素及多因素Logistic回归分析WMH与VCI的相关性。通过ROC曲线评估预测效能。应用Spearman相关与多元线性回归分析WMH严重程度与各认知评分的相关性。结果：VCI组患者年龄、文化程度、脑梗死病史、抗栓药物的使用、他汀类药物的使用、白细胞计数、纤维蛋白原、Fazekas评分、MMSE评分、VaDAS-cog总分及其各子项评分与非VCI组比较，差异均有统计学意义(P < 0.05)。在调整了年龄、文化程度、脑梗死病史、白细胞计数及纤维蛋白原等混杂因素后，多因素Logistic回归显示WMH Fazekas评分仍是VCI的独立危险因素(OR = 1.936, 95%CI: 1.245~3.012, P = 0.003)。ROC曲线分析显示，联合模型的预测效能最高，其AUC为0.892，敏感度为93.3%，特异度为63.2%。在校正上述混杂因素的线性模型中，WMH Fazekas评分与MMSE评分(β = −0.207, P = 0.005)呈独立负相关，与VaDAS-cog总分(β = 0.236, P = 0.001)及各子项评分(P < 0.05)呈独立正相关，其中WMH对执行/注意功能(β = 0.254, P = 0.003)效应较为突出。结论：脑白质高信号是血管性认知障碍的独立危险因素，其中执行/注意功能是主要受累的认知领域。

Abstract: Objective: To investigate the correlation between the severity of vascular white matter hyperintensities (WMH) and vascular cognitive impairment (VCI), and to analyze its impact on different cognitive domains. Methods: A total of 102 patients with WMH were enrolled in this study. Based on comprehensive clinical and neuropsychological assessments, patients were divided into a vascular cognitive impairment group (VCI group, n = 45) and a non-cognitive impairment group (Non-VCI group, n = 57). Baseline characteristics, laboratory parameters, and neuroimaging data were collected for all patients. WMH severity was assessed using the Fazekas scale. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and the Vascular Dementia Assessment Scale-cognitive subscale (VaDAS-cog). Univariate and multivariate logistic regression analyses were employed to examine the association between WMH and VCI. The predictive value was assessed using receiver operating characteristic (ROC) curve analysis. Spearman’s correlation and multiple linear regression were applied to analyze the relationship between WMH severity and various cognitive scores. Results: Compared to the Non-VCI group, the VCI group showed significant differences in age, education level, history of cerebral infarction, use of antithrombotic drugs, use of statins, white blood cell count, fibrinogen level, Fazekas score, MMSE score, VaDAS-cog total score, and all its subdomain scores (P < 0.05). After adjusting for confounding factors including age, education level, history of cerebral infarction, white blood cell count, and fibrinogen, multivariate logistic regression revealed that a higher Fazekas score remained an independent risk factor for VCI (OR = 1.963, 95% CI: 1.245~3.012, P = 0.003). ROC curve analysis indicated that the combined predictive model had the highest efficacy, with an area under the curve (AUC) of 0.892, a sensitivity of 93.3%, and a specificity of 63.2%. In linear regression models adjusted for the aforementioned confounders, the Fazekas score was independently and negatively correlated with the MMSE score (β = −0.207, P = 0.005), and independently and positively correlated with the VaDAS-cog total score (β = 0.236, P = 0.001) and all its subdomain scores (P < 0.05). Notably, the association between WMH and the executive/attention function domain was particularly prominent (β = 0.254, P = 0.003). Conclusion: White matter hyperintensities constitute an independent risk factor for vascular cognitive impairment, with the executive/attention domain being the primarily affected cognitive sphere.