缺血性卒中后认知损害的危险因素：回顾性病例系列研究  

Risk factors for cognitive impairment after ischemic stroke： a retrospective case series study

作　　者：杨明华[1] 秦锦标[1] 

机构地区：[1]南京江北人民医院神经内科,210048

出　　处：《国际脑血管病杂志》2012年第4期247-250,共4页International Journal of Cerebrovascular Diseases

基　　金：基金项目：南京市医学科技发展项目（YKK08144）

摘　　要：目的 探讨缺血性卒中后认知损害的危险因素.方法 应用简易智能状态检查量表（mini-mental state examination,MMSE）筛查在缺血性卒中发病后3d内出现认知损害的患者.根据MMSE评分将患者分为认知损害组与非认知损害组,比较两组人口统计学、血管危险因素、临床资料.采用多变量logistic回归分析缺血性卒中后认知损害的独立危险因素.结果 共纳入缺血性卒中患者202例,其中认知损害组48例（23.8％）.认知损害组年龄[（66 ±6）岁对（57±5）岁；t=2.231,P=0.038]、糖尿病（39.6％对18,2％;χ2=9.388,P=0.003）、卒中或短暂性脑缺血发作史（39.6％对20.8％;x2=6.856,P=0.007）的比例、基线美国国立卫生研究院卒中量表评分[（11.8±2.4）分对（8.1±1.9）分；t=2.046,P=0.043]以及血清同型半胱氨酸[（29.2±7.8）μmol/L对（19.9±6.5） μmol/L;t =2.781,P=0.008]、尿酸[（401.5±51.1） μmol/L对（312.4± 60.7） μmol/L;t=3.042,P=0.003]和C反应蛋白[（18.4±5.2）μmol/L对（11.3±4.2）μmol/L; =2.903,P=0.004]水平均显著高于非认知损害组.多变量logistic回归分析显示,年龄[优势比（odds ratio,OR）1.812,95％可信区间（confidence interval,CI）1.138～3.205；P=0.039]、糖尿病史（OR2 520,95％ CI 1.854 ～4.111；P=0.025）、卒中或短暂性脑缺血发作史（OR4.232,95％ CI 1.905 ～8.582；P=0.014）以及血清同型半胱氨酸（OR3.618,95％ CI 2.061 ～6.312；P =0.018）、尿酸（OR 2.179,95％ CI 1.654 ～3.836;P =0.031）和C反应蛋白（OR 2.716,95％ CI 1.507 ～5.552;P=0.022）水平增高为缺血性卒中后认知损害的独立危险因素.结论 缺血性卒中发病后的认知损害发生率较高,年龄、卒中或短暂性脑缺血发作病史、糖尿病史以及血清C-反应蛋白、尿酸和同型半胱氨酸水平增高为缺血性卒中后发生认知损害的独立危险因素.Objective To investigate the risk factors for cognitive impairment after ischemic stroke.Metbods The Mini-Mental State Examination （MMSE） scale was used to screen the patients with cognitive impairment within 3 days after the onset of ischemic stroke.The patients were divided into either a cognitive impairment group or a non-cognitive impairment group according to the MMSE scores.Demographics,vascular risk factors,and clinical data were compared in both groups.The independent risks factor for cognitive impairment after ischemic stroke were analyzed by using multivariate logistic regression analysis.Results A total of 202 patients with ischemic stroke were included in the study,in which 48 （23.8%） were in the cognitive impairment group.The proportions of age （66 ± 6 years vs.57 ± 5 years; t =2.231,P =0.038）,previous diabetes （39.6% vs. 18.2% ; x2 =9.388,P =0.003 ）,history of stroke or transient ischemic attack （39.6% vs.20.8%;x2 =6.856,P=0.007）,and the baseline National Institutes of Health Scale scores （11.8 ±2.4 vs,8.1 ± 1.9; t =2.046,P =0.043）,as well as serum homocysteine （29.2± 7.8 μmol/L vs.19.9 ±6.5 μmol/L; t =2.781,P =0.008）,uric acid （401.5 ± 51.1 μmol/L vs.312.4 ± 60.7 μmol/L; t =3.042,P=0.003）,and C-reactive protein （18.4 ±5.2 μmol/L vs.11.3±4.2 μmol/L;t=2.903,P=0.004）levels in the cognitive impairment group were significantly higher than those in the non-cognitive impairment group.Multivariate logistic regression analysis showed that tha age （odds ratio [OR] 1.812,95% confidence interval [CI] 1.138 -3.205; P =0.039）,history of diabetes （OR 2.520,95% CI 1.854 -4.111; P =0.025）,history of stroke or transient ischemic attack （OR 4.232,95% CI 1.905 - 8.582; P =0.014）,as well as the increased levels of serum homocysteine （OR 3.618,95% CI 2.061 -6.312; P =0.018）,uric acid （OR 2.179,95% CI 1.654 - 3.836; P =0.031）,and C-reactive protein （OR 2.716,95% CI 1.507 - 5.552; P =0.022）were the independent risk factors for cognitive impairment

关 键 词：认知障碍 卒中 脑缺血 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]