脑小血管病总负荷与中老年癫痫患者认知功能的相关性

doi:10.3969/j.issn.1673-5765.2022.06.012

摘要/Abstract

摘要：

目的探讨中老年癫痫患者脑小血管病（cerebral small vessel disease，CSVD）总负荷以及单个CSVD影像标志物与认知功能的关系。

方法回顾性连续纳入首都医科大学附属北京天坛医院神经内科2019年1月-2021年12月住院的50岁及以上中老年癫痫患者。收集患者的一般临床资料、脑电图、影像学信息和MoCA分值。判读此次住院前1周或住院期间首次头颅MRI中的CSVD影像标志物，包括腔隙、白质高信号、微出血和血管周围间隙扩大，并计算CSVD总负荷评分。采用简单及多重线性回归模型分析中老年癫痫患者CSVD总负荷评分以及单个CSVD影像标志物与MoCA评分的关系。

结果共纳入54例患者，平均年龄63.6±8.7岁，男性35例（64.8%）。校正了混杂因素的多重线性回归显示CSVD总负荷评分与MoCA评分呈负相关（β －1.713，95%CI －3.388～－0.038，P =0.045）。单独分析单个CSVD影像标志物，在对相同混杂因素进行校正后，只有针对白质高信号的Fazekas评分与MoCA评分呈负相关（β －1.457，95%CI －2.599～－0.315，P =0.014）。

结论合并高CSVD负荷的中老年癫痫患者认知功能较差，脑血管病理与中老年癫痫患者认知功能障碍之间的关系值得被进一步研究。

文章导读： 本研究通过对住院中老年癫痫患者的资料进行回顾性分析，比较了不同CSVD负荷患者认知功能的差异，结果显示，CSVD负荷增高是中老年癫痫患者认知功能下降的独立影响因素。

关键词: 癫痫; 脑小血管病; 认知功能; 脑小血管病总负荷; 白质高信号

Abstract:

Objective To investigate the association of the total cerebral small vessel disease (CSVD) burden and single CSVD imaging marker with cognitive function in middle-aged and older patients with epilepsy.

Methods This retrospective study enrolled consecutive middle-aged and elder patients (≥50 years) with epilepsy in Department of Neurology of Beijing Tiantan Hospital between January 2019 and December 2021. The clinical data, electroencephalogram data, imaging information, and MoCA scores were collected. The MRI imaging markers of CSVD 1 week before admission and during the hospitalization, including lacunes, white matter hyperintensity (WMH), enlarged perivascular spaces and cerebral microbleeds, were assessed to calculate the total CSVD burden score. The association between total CSVD burden score and MoCA score was analyzed using simple and multiple linear regression models.

Results A total of 54 patients were included, with a mean age of 63.6±8.7 years old and 35 males (64.8%). After adjusting for the confounding factors, the multiple linear regression analysis showed a negative correlation between the total CSVD burden score and MoCA score (β=-1.713, 95%CI -3.388--0.038, P=0.045). When analyzing single imaging marker after adjusting for the same factors, only Fazekas score for WMH was negatively associated with MoCA score (β=-1.457, 95%CI -2.599--0.315, P=0.014).

Conclusions The middle-aged and older epilepsy patients with high total CSVD burden had poor cognitive function.

Key words: Epilepsy; Cerebral small vessel disease; Cognitive function; Total cerebral small vessel disease burden; White matter hyperintensity

陈超, 万慧娟, 董文玉, 王圣松, 余苹, 邵晓秋. 脑小血管病总负荷与中老年癫痫患者认知功能的相关性[J]. 中国卒中杂志, 2022, 17(06): 622-627.

CHEN Chao, WAN Huijuan, DONG Wenyu, WANG Shengsong, YU Ping, SHAO Xiaoqiu. The Association between Total Cerebral Small Vessel Disease Burden and Cognitive Function in Middle-aged and Elderly Patients With Epilepsy[J]. Chinese Journal of Stroke, 2022, 17(06): 622-627.

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