脑微出血对急性脑梗死患者认知功能的影响：前瞻性病例系列研究  

Effect of cerebral nicrobleeds on cognitive function in patients with acute cerebral infarction： a retrospective case series study

作　　者：王国珍[1] 汪国宏[1] 王小强[2] 张持[2] 岳宏[2] 吴君仓[2] 

机构地区：[1]安徽医科大学,230011 [2]安徽医科大学附属合肥医院,合肥市第二人民医院神经内科,230011

出　　处：《国际脑血管病杂志》2013年第2期86-90,共5页International Journal of Cerebrovascular Diseases

基　　金：合肥市重大科技项目（合科[2011]25号）

摘　　要：目的探讨急性脑梗死患者认知功能与脑微出血（cerebral microbleed，CMB）的相关性。方法前瞻性分析急性脑梗死患者的临床和影像学资料，根据MRI结果对CMB进行计数，详细记录患者的一般情况、CMB部位和脑白质疏松严重程度，在入院次日应用蒙特利尔评估量表（Montreal Assessment Scale，MoCA）对患者进行认知功能评估，在3、6和9个月时进行MoCA评估随访。分析急性脑梗死患者的认知功能变化及其与CMB的关系。结果共纳入82例缺血性卒中患者，其中33例伴有CBM，49例无CBM。CMB组收缩压[（155．03±19．68）IninHg对（142．20±21．22）mmHg（1mmHg=0．133kPa）；t=2．762，P=0．007]和美国国立卫生研究院卒中量表（National Institutes of Health Strokescale，NIHSS）评分[（6．21±4．57）分对（4．00±3．98）分；t=2．322，P=0．023]均显著性高于非CMB组。多变量logistic回归分析显示，收缩压水平[优势比（odds ratio，OR）1．032，95％可信区间（confidence interval，C1）1．008～1．057；P=0．009I和NIHSS评分（OR1．163，95％CI1．013～1．311：P=0．014）是急性脑梗死患者存在CMB的独立预测因素。CMB与MoCA量表评分密切相关，且随访时间越长，相关性越强。在CMB患者中，执行功能（rs=-0．318，P=0．004）、视空间功能（rs=-0．403，P=0．000）和计算功能（rs=-0．362，P=0．001）均显著受损，CMB越严重，这3个认知域评分越低，损害也越严重。结论CMB与急性脑梗死患者认知功能损害密切相关，CMB越严重，认知功能损害越明显，且CMB患者的认知功能损害随着时间的推移而加重。Objective To investigate the correlation between cognitive function and cerebral microbleeds （CMBs） in patients with acute cerebral infarction. Methods The clinical and imaging findings in patients with acute stroke were analyzed retrospective. CMBs were counted according to the findings of MRI. The general conditions, CMB site and leukoaraiosis severity of the patients were recorded in detail. The cognitive function of the patients was assessed with the Montreal cognitive assessment scale （MoCA） the next day in the hospital. MoCA assessment follow-up was conducted at 3, 6 and 9 months. The changes in cognitive function of the patients with acute cerebral infarction and its relationship with CBMs were analyzed. Results A total of 82 patients with ischemic stroke were enrolled in the study, 33 of them had CBMs and 49 had no CBMs. The systolic blood pressure （155.03 ± 19. 68 mm Hgvs. 142. 20 ± 21.22 mm Hg;t - 2. 762, P = 0. 007） and the National Institutes of Health Stroke Scale （NIHSS） score （6. 21 ± 4. 57 vs. 4. 00 ± 3.98; t =2. 322, P = 0. 023） in the CBM group were significantly higher than those in the non-CBM group. Multivariate logistic regression analysis showed that the systolic blood pressure level （odds ratio [ OR] 1. 032, 95% confidence interval [ CI] 1. 008 -1. 057; P=0. 009） and the NIHSS score （OR 1. 163, 95% CI 1. 013 - 1. 311; P=0. 014） were the independent predictors of CBMs in patients with acute cerebral infarction. CMBs were closely associated with MoCA scores, and the longer follow-up time, the correlation would stronger. The executive function （rs = 0. 318, P = 0. 004）, visual space ftmction （rs = 0. 403, P = 0. 000） and calculation function （rs = 0. 362, P = 0. 001 ） in patients with CMBs were significantly impaired. The more serious of CMBs, the lower of the scores in above 3 cognitive domains, and the damage would be more serious. Conclusions CMBs are closely associated with cognitive function impairment in patients with acute cerebral infarction

关 键 词：卒中 脑缺血 微出血 认知障碍 磁共振成像 

分 类 号：R74[医药卫生—神经病学与精神病学]