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目的:评估MRI脑小血管病(cerebral small vessel disease, CSVD)总体负担和高半胱氨酸(homocysteine, Hcy)联合预测CSVD患者血管性认知损害(vascular cognitive impairment, VCI)风险的价值。方法:选择2017年7月至2019年12月在天津市泰达医院神经内科住院就诊的CSVD患者作为研究对象。采用蒙特利尔认知评估量表和临床痴呆评定量表进行VCI诊断。采用多变量n logistic回归模型明确CSVD总体负担以及Hcy与CSVD患者VCI风险的独立相关性，采用受试者工作特征(receiver operating characteristics, ROC)曲线评估CSVD总体负担和Hcy单独及联合预测VCI的价值。n 结果:共纳入182例CSVD患者。其中，男性98例(53.8%)，年龄(68.97±5.14)岁；VCI组103例(56.6%)，非VCI组79例(43.4%)。单变量分析显示，VCI组年龄、糖尿病、高脂血症、空腹血糖、CSVD总体负担、Hcy、叶酸和维生素Bn 12与非VCI组差异有统计学意义。多变量n logistic回归分析显示，校正年龄、受教育年限、糖尿病和空腹血糖后，高脂血症[优势比(odds ratio, n OR)1.539，95%可信区间(confidence interval, n CI)1.263～3.048；n P＝0.021]、CSVD总体负担(n OR 1.405，95% n CI 1.198～2.962；n P＝0.033)和Hcy(n OR 1.617，95% n CI 1.315～3.192；n P＝0.018)是VCI的独立危险因素，叶酸(n OR 0.702，95% n CI 0.477～0.895；n P＝0.012)和维生素Bn 12(n OR 0.726，95% n CI 0.494～0.913；n P＝0.039)是VCI的独立保护因素。ROC曲线分析显示，CSVD总体负担预测VCI的价值较低[曲线下面积(area under curve, AUC)＝0.639]，Hcy的预测价值中等(AUC＝0.717)，二者联合的预测价值较高(AUC＝0.836)。二者联合预测的AUC显著大于CSVD总体负担(n Z＝3.860，n P<0.001)和Hcy(n Z＝2.489，n P＝0.006)。n 结论:CSVD总体负担与Hcy联合预测CSVD患者VCI风险的价值较高，具有一定的临床应用潜力。“,”Objective:To evaluate the value of combination of MRI cerebral small vessel disease (CSVD) total burden and homocysteine (Hcy) in predicting the risk of vascular cognitive impairment (VCI) in patients with CSVD.Methods:Patients with CSVD admitted to the Department of Neurology, Tianjin TEDA Hospital from July 2017 to December 2019 were selected as the research objects. The Montreal Cognitive Assessment scale and Clinical Dementia Rating scale were used to diagnose VCI. Multivariate n logistic regression model was used to identify the independent correlation between the total burden of CSVD and Hcy and VCI risk in patients with CSVD. The Receiver Operating Characteristics (ROC) curve was used to evaluate the value of the total burden of CSVD and Hcy alone and in combination for predicting VCI.n Results:A total of 182 patients with CSVD were included. Among them, 98 (53.8%) were male, their age was 68.97±5.14 years, 103 (56.6%) were in the VCI group and 79 (43.4%) were in the non-VCI group. Univariate analysis showed that there were significant differences in age, diabetes, hyperlipidemia, fasting blood glucose, total burden of CSVD, Hcy, folic acid and vitamin Bn 12 between the VCI group and the non-VCI group. Multivariate n logistic regression analysis showed that after adjusting for age, years of education, diabetes, and fasting blood glucose, hyperlipidemia (odds ratio [n OR] 1.539, 95% confidence interval [n CI] 1.263-3.048; n P=0.021), total burden of CSVD (n OR 1.405, 95% n CI 1.198-2.962; n P=0.033) and Hcy (n OR 1.617, 95% n CI 1.315-3.192; n P=0.018) were the independent risk factors for VCI. Folic acid (n OR 0.702, 95% n CI 0.477-0.895; n P=0.012) and vitamin Bn 12 (n OR 0.726, 95% n CI 0.494-0.913; n P=0.039) were the independent protective factors of VCI. ROC curve analysis showed that the total burden of CSVD had a lower predictive value for VCI (area under curve[AUC]=0.639), Hcy had a medium predictive value (AUC=0.717), and the combination of the two had a higher predictive value (AUC=0.836). The AUC of the combination of the two for predicting VCI was significantly greater than the total burden of CSVD (n Z=3.860, n P<0.001) and Hcy (n Z=2.489, n P=0.006).n Conclusion:The combination of total burden of CSVD and Hcy had higher value in predicting VCI risk in patients with CSVD, which had certain clinical application potential.