作者：郭文娟1，李蕊萍1，张綦慧2

单位：

1.100029 北京市，北京中医药大学　2.100078 北京市，北京中医药大学东方医院脑病二科

Units：

1.Beijing University of Chinese Medicine, Beijing 100029, China 2.The Second Department of Encephalopathy, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078,China

关键词：

脑小血管病；认知障碍；危险因素；Meta 分析

Keywords：

Cerebral small vessel disease; Cognitive impairment; Risk factors; Meta-analysis

CLC：

R 743

DOI：

10.12114/j.issn.1008-5971.2021.00.148

Funds：

国家自然科学基金资助项目（81704051）；2014 年教育部国家留学回国人员科研启动基金（pj07 ZYYS-2013）；科技部国家重点研发计划（2018YFC1312300）

摘要：

背景　脑小血管病（CSVD）具有起病隐匿、早期症状不典型、易被忽视等特征，一旦进展为血管 性认知障碍（VCI）将不可逆转。因此，识别CSVD 患者认知障碍的危险因素并尽早防治或可降低VCI 发生风险。 目的　系统评价CSVD 患者认知障碍的危险因素，以期为CSVD 患者认知障碍风险预测模型建立提供参考依据。方 法　计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据知识服务平台、维普网、 中国生物医学文献数据库公开发表的探讨CSVD 进展为认知障碍影响因素的病例对照研究或队列研究，检索时限为建 库至2021-02-28。由两名研究员独立完成文献筛选、方法学质量评价及资料提取，应用Stata 13.1 和RevMan 5.3 软件 进行Meta 分析。结果　本Meta 分析最终纳入47 篇文献，共8 218 例患者。本Meta 分析仅合并纳入文献数≥ 5 条的 危险因素，结果显示，受教育程度低〔OR=0.78，95%CI（0.66，0.92）〕、吸烟〔OR=1.88，95%CI（1.33，2.65）〕、 高血压〔OR=1.48，95%CI（1.24，1.77）〕、高脂血症〔OR=1.97，95%CI（1.46，2.66）〕、同型半胱氨酸（Hcy） 〔OR=1.22，95%CI（1.13，1.31）〕、CSVD 核磁总负荷评分〔OR=3.02，95%CI（1.79，5.08）〕、脑白质高信号 （WMH）评分〔OR=1.99，95%CI（1.50，2.64）〕、腔隙性脑梗死（LI）病灶计数〔OR=2.19，95%CI（1.82，2.64）〕 是CSVD 患者认知障碍的危险因素（P ＜ 0.05）。结论　现有证据表明，受教育程度低、吸烟、高血压、高脂血症、 Hcy、CSVD 核磁总负荷评分、WMH 评分、LI 病灶计数是识别和预测CSVD 患者认知障碍首要考虑的危险因素，临床 上针对伴有上述危险因素的CSVD 患者应加强管理，以降低CSVD 进展为认知障碍的风险。

Abstract：

Background　Cerebral small vessel disease (CSVD) is characterized by insidious onset，atypical early symptoms, and easy to be neglected，and once it progresses to vascular cognitive impairment (VCI) , and it will be irreversible. Therefore, early identification and prevention of risk factors of cognitive impairment in patients with CSVD may reduce the risk of VCI. Objective　To systematically evaluate the risk factors for cognitive impairment in patients with CSVD，and to provide a basis for establishing a risk prediction model for cognitive impairment in patients with CSVD. Methods　PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang, VIP, and CBM databases were searched for literature on risk factors for cognitive impairment in patients with CSVD, with a search time frame from the date of database creation to February 28, 2021. Two researchers independently performed literatures screening, quality evaluation, and data extraction, and Stata 13.1/RevMan 5.3 software were used for Meta-analysis. Results　A total of 47 literatures with 9 539 study subjects were included. In this study, only the risk factors of more than 5 articles included were merged for analysis, Meta-analysis results showed that low level of education [OR=0.78, 95%CI (0.66, 0.92) ] , smoking [OR=1.88, 95%CI (1.33, 2.65) ] , hypertension [OR=1.48, 95%CI (1.24, 1.77) ] , hyperlipidemia [OR=1.97, 95%CI (1.46, 2.66) ] , homocysteine (Hcy) [OR=1.22, 95%CI (1.13, 1.31) ] , CSVD total nuclear magnetic load score [OR=3.02, 95%CI (1.79, 5.08) ] , white matter hyperintensity (WMH) score [OR=1.99, 95%CI (1.50, 2.64) ] , lacunar infarction (LI) lesion count [OR=2.19, 95%CI (1.82, 2.64) ] were risk fators for cognitive impairment in patients with CSVD（P

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