Analysis Of The Influencing Factors Of Fazekas Classification Of Cerebral Small Vessel Disease-related White Matter Hyperintensity And Its Correlation With Cognitive Impairment

Background:Cerebral small vascular disease（CSVD）is also known as"subclinical stroke","silent stroke"or"silent stroke"because of the occult clinical symptoms and slow progression of the disease.The main diagnostic method of CSVD is imaging examination,in which white matter hyperintensity（WMH）is one of the main imaging signs.WMH showed white spot,patch or confluent hyperintensity around bilateral ventricle or subcortex.According to Fazekas classification,the deep white matter and periventricular lesions were scored respectively and the total score was calculated,which could be divided into 4 grades:No WMH:0;mild WMH:Fazekas1（1-2 points）;Moderate WMH:Fazekas grade 2（3-4 points）;Severe WMH:Fazekas grade 3（score 5-6）.Severe WMH can cause cognitive decline in patients.Red blood cell distribution width（RDW）is a convenient and easy elevated biochemical parameter representing the variability of circulating red blood cell size,and its elevation is associated with a variety of diseases.At present,it is found that RDW,as a new predictor and independent risk factor,plays an important role in evaluating the severity and progression of cardiovascular diseases（such as coronary heart disease）and non-cardiovascular diseases（such as acute pancreatitis）^[1],but the relationship between RDW and WMH is still unclear.Plasma fibrinogen was also found to be significantly associated with the risk of new lacunar or WML progression,regardless of clinical SVD presentation.However,some domestic studies have shown that fibrinogen（FIB）is not associated with WMH.Therefore,the relationship between FIB and WMH is not very clear,and further research is needed.Objective:1.To evaluate the risk factors of white matter lesions in different grades of Fazekas cerebral small vessel disease2.To explore the risk factors of cognitive impairment in white matter hyperintensity and the prediction model of related indexes.Methods:Patients admitted to the Department of Neurology at the The first affiliated hospital of nanchang university from March 2022 to February 2023 were collected,and 3.0 T cranial MRI was perfected,suggesting 61 patients with cerebral white matter lesions,and 20 cases of non-cerebral white matter disease admissions were selected to be included in the healthy control group.（1）Gender,age,residence（rural or urban）,education,smoking history,alcohol history,history of hypertension,admission systolic blood pressure and admission diastolic blood pressure,history of diabetes mellitus,history of hyperlipidemia,erythrocyte distribution width,fasting glucose,triglycerides,total cholesterol,plasma fibrinogen,low-density lipoprotein,blood homocysteine,and cranial MRI scan were collected from all admitted cases.（2）Cognitive function was scored（0-30 points）using the Montreal cognitive assessment scale（MOCA）and the Mini Mental State Examination MMSE,and the total score was recorded,according to the education level and total score.Those with abnormal MMSE or MOCA were identified as having cognitive abnormalities and were divided into a group with no cognitive impairment（NON-Cognitive impairment,NCI）and a group with cognitive impairment（Cognitive impairment,CI）.Factors influencing the Fazekas classification of cerebral white matter lesions and their relationship with cognitive impairment were studied.Results:1.Fazekas classification was performed on 81 patients according to magnetic resonance imaging,including 20 patients without WMH,30 patients with mild WMH,20 patients with moderate WMH and 11 patients with severe WMH.There were significant differences in age（P=0.00）,serum homocysteine（P=0.00）and hypertension（P=0.01）among patients with different Fazekas grades of white matter hyperintensity.FIB（Z=-0.33,P=0.74）,RDW（Z=-1.12,P=0.26）were not statistically different.Age（OR=1.21,95%CI 1.09-1.35）and homocysteine（OR=1.37,95%CI 1.02-1.84）were independent risk factors for white matter hyperintensity.2.There was significant difference in serum homocysteine and uric acid between cognitive impairment group and non-cognitive impairment group（P<0.05）.Serum homocysteine was negatively correlated with Fazekas score（r=-0.275,p<0.05）,uric acid was negatively correlated with MMSE score（r=-0.276,p<0.05）.The area under ROC curve of homocysteine,uric acid and homocysteine combined with uric acid in predicting cognitive impairment in WMH patients were 0.704,0.716 and 0.755,and the best critical values were 12.05umol/L,256.55umol/L and 0.76umol/L.Conclusion:（1）By analyzing the data,the risk factors of different grades of white matter lesions related to cerebral small vascular disease are age and homocysteine,which are independent risk factors,while there is no statistical difference in red blood cell distribution volume width,fibrinogen and other factors.（2）The influencing factors of cognitive impairment in patients with cerebral white matter hyperintensity are blood Hcy and blood uric acid,which can better predict the occurrence of cognitive impairment in patients with cerebral white matter hyperintensity,and are conducive to early detection of cognitive impairment and timely intervention to avoid progression to vascular dementia.