无症状颈动脉狭窄病人发生认知功能障碍的危险因素研究

张心璐; 冯晨芳; 陶瑞明

无症状颈动脉狭窄病人发生认知功能障碍的危险因素研究

Analysis of risk factors for cognitive impairment in patients with asymptomatic carotid stenosis

摘要

摘要:
目的： 分析无症状颈动脉狭窄病人出现认知功能障碍的风险因素，并对相关的干预策略展开探讨。
方法： 筛选110例无症状颈动脉狭窄病人，采用蒙特利尔认知评估量表（Montreal cognitive assessment，MoCA）评价其认知状况，并将其分为认知功能障碍组（n = 46）和非认知功能障碍组（n = 64），比较2组一般资料。采用二元logistic回归分析影响无症状颈动脉狭窄病人认知功能障碍发生的危险因素，建立ROC曲线分析各项变量预测无症状颈动脉狭窄病人认知功能障碍发生的效能。
结果： 认知功能障碍组的体质量指数（body mass index，BMI）、高血压比例、颈动脉狭窄程度为重度比例、同型半胱氨酸（homocysteine，Hcy）水平均高于非认知功能障碍组（P ＜ 0.01）。高BMI、有高血压、高颈动脉狭窄程度、高Hcy水平都是影响无症状颈动脉狭窄病人认知功能障碍发生的独立危险因素（P ＜ 0.01）。BMI、高血压、颈动脉狭窄程度、Hcy、联合预测的AUC分别为0.768、0.698、0.706、0.893、0.961，敏感度分别为0.543、0.739、0.609、0.891、0.935，特异度分别为0.891、0.656、0.750、0.797、0.844。表明联合多指标预测的效能最佳，且敏感度和特异度良好。
结论： 无症状颈动脉狭窄病人认知功能障碍受多重因素影响，包括高BMI、高血压、颈动脉狭窄程度及Hcy水平，联合多项指标预测效能最佳，需综合干预以预防认知功能障碍。

Abstract:
Objective To analyze the risk factors for cognitive impairment in patients with asymptomatic carotid artery stenosis and to explore related intervetion strategies.
Methods 110 patients with asymptomatic carotid stenosis were screened. Cognitive status was assessed via the Montreal Cognitive Assessment (MoCA). Patients were divided into a cognitive impairment group (n = 46) and a non-cognitive impairment group (n = 64), with baseline demographics compared. Binary logistic regression was employed to identify the risk factors affecting the occurrence of cognitive impairment in patients with asymptomatic carotid stenosis, and ROC curves were constructed to assess the predictive efficacy of each variable for cognitive impairment in these patients.
Results Body mass index (BMI), the proportion of hypertension, the proportion of severe carotid stenosis, and homocysteine (Hcy) levels were all higher in the cognitive impairment group than in the non-cognitive impairment group (P ＜ 0.01). Independent predictors of cognitive impairment included high BMI, hypertension, high-degree carotid stenosis, and high Hcy levels (P ＜ 0.01). The AUCs for BMI, hypertention, degree of carotid artery stenosis, Hcy were 0.768, 0.698, 0.706, 0.893, and 0.961 respectively; the sensitivities for these predictors were 0.543, 0.739, 0.609, 0.891, and 0.935 respectively; and the specificities were 0.891, 0.656, 0.750, 0.797, and 0.844 respectively. These findings indicate that the combined prediction model had the best efficacy, with good sensitivity and specificity.
Conclusions Cognitive impairment in patients with asymptomatic carotid stenosis is influenced by multiple factors including BMI, hypertension, stenosis severity, and Hcy levels. The predictive power of these factors, particularly when combined, underscores the importance of comprehensive intervention strategies to address cognitive decline in this patient population. The combined multiple indicators provides the best predictive efficacy, and comprehensive interventions are needed to prevent cognitive impairment.

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