摘要【目的】探讨老年脑梗死患者继发血管性痴呆(VD)的危险因素。【方法】在两院就诊的193例老年脑梗死患者根据是否发生VD将患者分为VD组(74例)与非VD组(119例),比较两组患者一般资料,采用Logistic回归分析影响患者发生VD的危险因素;采用受试者工作特征曲线(ROC)分析计量指标诊断VD发生的效能;采用Pearson分析各因素之间的相关性;分析各危险因素在不同痴呆程度的表达。【结果】多因素分析显示年龄( OR =4.926, P <0.05)、受教育年限>6年( OR =1.953, P <0.05)、梗死面积( OR =5.147, P <0.05)、血管重度狭窄( OR =3.031, P <0.05)、合并高血压( OR =2.853, P <0.05)、血管内皮生长因子(VEGF)水平( OR =5.452, P <0.05)、脑神经营养因子(BDNF)水平( OR =4.524, P <0.05)为脑梗死后VD的独立影响因素,其中年龄>60岁、血管重度狭窄、合并高血压、梗死面积>7.18 cm2、VEGF<4.47 ng/mL、BDNF<236.83 pg/mL患者需警惕VD的发生。相关性分析显示年龄与梗死面积呈正相关,与VEGF及BDNF呈负相关;VEGF与BDNF呈正相关;VEGF及BDNF水平随痴呆严重程度增加,其水平呈降低趋势,而血管重度狭窄例数及合并高血压例数随痴呆严重程度增加而增加。【结论】老年初发性脑梗死患者高龄、梗死面积较大、合并高血压、低VEGF及BDNF水平增加患者发生VD的概率,而受教育年限长者可能降低VD发生的风险。
Abstract：【Objective】To explore the risk factors of vascular dementia (VD) in elderly patients with cerebral infarction. 【Methods】 A total of 193 elderly patients with cerebral infarction were selected for the study. According to the occurrence of VD, the patients were divided into the VD group (74 cases) and the non VD group (119 cases). General data of the two groups were compared. Risk factors for VD were evaluated by Logistic regression analysis, and the diagnostic efficacy of VD was analyzed using receiver operating characteristic curve (ROC). Pearson was used to explore the correlation among various factors and analyze the expression of risk factors in different degrees of dementia. 【Results】The multivariate analysis showed that age (OR=4.926, P <0.05), >6 years of Education ( OR =1.953, P <0.05), infarct area ( OR =5.147, P <0.05), severe vascular stenosis ( OR =3.031, P <0.05), hypertension ( OR =2.853, P <0.05), vascular endothelial growth factor (VEGF) level ( OR =5.452, P <0.05), and brain Neurotrophic factor (BDNF) ( OR =4.524, P <0.05) were independent influencing factors of VD after cerebral infarction. Particularly, age >60 years old, severe stenosis of blood vessels, hypertension, infarct area >7.18 cm2, VEGF<4.47ng/mL and BDNF<236.83 pg/mL patients need to be alert to the occurrence of VD. Correlation analysis showed that age was positively correlated with infarct size and negatively correlated with VEGF and BDNF. VEGF was positively correlated with BDNF. The levels of VEGF and BDNF increased with the severity of dementia, and the number of severe vascular stenosis and the number of hypertension increased with the severity of dementia as well. 【Conclusion】 Elderly patients with older age of primary cerebral infarction, large infarct area, high blood pressure (hypertension), high VEGF and BDNF level increase the probability of VD, while the elderly with more years of education may reduce the risk of VD.
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2021, Vol. 38 
