| Objective:To investigate the relationship between red blood cell distribution width(RDW)and white matter lesions(WML)in patients with cerebral small vascular disease(CSVD)and to further study the relationship between RDW and cognitive function.Methods:(1)A total of 198 patients hospitalized in the Department of Neurology of Hebei Provincial People’s Hospital from October 2018 to October 2021 and diagnosed with CSVD were selected as the study subjects,and all of the above patients were complete with magnetic resonance imaging(MRI).Firstly,according to the MRI result,the WML lesions were grouped into three groups,periventricular WML(PWML),deep WML(DWML)and total WML,and then grouped according to the severity of different lesions.The patients were divided into PWML mild group(0～1 points)and PWML moderate and severe group(2～3 points),DWML mild group(0～1 points)and DWML moderate and severe group(2～3 points),total WML mild group(0～2 points)and total WML moderate and severe group(3～6 points).The general clinical data and blood test indicators of patients were collected.The t-test,Mann-Whitney U test,x~2test and Logistic regression were used to explore the influencing factors of WML,and the ROC curve was used to analyze the predictive value of RDW for PWML,DWML and total WML.(2)A total of 198 patients who were hospitalized in the Department of Neurology of Hebei Provincial People’s Hospital from October 2018 to October 2021 and diagnosed with CSVD were selected as research subjects,and cognitive function was evaluated according to the Montreal cognitive assessment(Mo CA),and the patients were divided into normal cognitive function group and cognitive dysfunction group according to the Mo CA score,and the t-test,Mann-Whitney U,and x~2 tests were used Logistic regression explored the influencing factors of cognitive impairment,Spearman correlated analysis of the relationship between RDW and Mo CA score and various cognitive domains,and used ROC curve to analyze the predictive value of RDW for cognitive impairment.Results:1.In the PWML group,compared with the mild PWML group,the moderate-severe PWML group was older,had a higher proportion of patients with previous history of diabetes,hypertension and stroke,and had a higher RDW level(P<0.05).Multivariate Logistic regression analysis showed that age,hypertension and RDW were independent risk factors for PWML lesion severity.The ROC curve for predicting the occurrence of moderate to severe PWML was plotted according to RDW values.The results showed that the AUC of RDW was 0.630(95%CI:0.552～0.709,P=0.002),the sensitivity was 0.582,the specificity was 0.682,the Yoden index was 0.265,and the optimal cut-off point was 12.75%.2.In the DWML group,the moderate-to-severe DWML group was older,had a lower BMI,and had a higher monocyte count than the mild DWML group(P<0.05).Multiple Logistic regression analysis showed that age was an independent risk factor for the severity of DWML lesions.The ROC curve for predicting the occurrence of moderate to severe DWML was plotted according to RDW values.The results showed that the AUC of RDW was 0.574(95%CI:0.490～0.657,P=0.085),the sensitivity was 0.197,the specificity was 0.945,the Yodin index was 0.142,and the optimal cut-off point was 13.95%.3.In the total WML group,compared with the mild WML group,the moderate-severe WML group was older,had a higher proportion of patients with previous diabetes and hypertension,and had a higher RDW level(P<0.05).Multiple Logistic regression analysis showed that age and RDW were independent risk factors for WML lesion severity.The ROC curve for predicting the occurrence of moderate and severe WML was plotted according to RDW values.The results showed that the AUC of RDW was0.635(95%CI:0.557～0.713,P=0.001),the sensitivity was 0.568,the specificity was 0.680,the Yodin index was 0.248,and the optimal cut-off point was 12.75%.4.Compared with the cognitively normal group,the age,diabetes,stroke history and RDW in the cognitively impaired group were statistically significant(P<0.05).Multivariate Logistic regression analysis showed age(OR:1.041,95%CI:1.009～1.075,P=0.013);RDW(OR:1.536,95%CI:1.025～2.301,P=0.037)was an independent risk factor for cognitive impairment.Spearman correlation analysis showed that RDW was negatively correlated with total score of Mo CA(r=-0.213,P=0.003)and attention(r=-0.154,P=0.030).RDW value was used to draw the ROC curve for predicting moderate-to-severe cognitive dysfunction in CSVD patients.The results showed that:The AUC of RDW was 0.604(95%CI:0.520-0.687,P=0.019),the sensitivity was 0.304,the specificity was 0.873,the Yoden index was 0.177,and the optimal cut-off point was 13.35%.Conclusion:1.Age was an independent risk factor for PWML,DWML,and total WML in patients with CSVD.2.Hypertension was an independent risk factors for PWML and total WML in patients with CSVD.3.Higher RDW was an independent risk factor for PWML and total WML in patients with CSVD,and had some predictive value for the severity of white matter lesions.4.Age and RDW were independent risk factors for cognitive impairment in patients with CSVD.5.In patients with CSVD,the higher the RDW level,the greater the cognitive impairment,mainly in attention.In addition,high levels of RDW have certain predictive value for cognitive dysfunction. |
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