急性缺血性卒中患者血管性认知障碍及其亚型的相关因素分析  

Correlation Factors Analysis of Vascular Cognitive Impairment and Its Subtypes of Acute Ischemic Stroke Patients

作　　者：曾瑞[1] 李春芳[1] 刘蕾[1] 杜宁[1] 张轩[1] 陈书丽[1] 薛蓉[1] 

机构地区：[1]天津医科大学总医院神经内科,天津300052

出　　处：《中国卒中杂志》2016年第4期255-261,共7页Chinese Journal of Stroke

基　　金：国家临床重点专科建设项目天津市卫生行业重点攻关项目(12KG132);天津市科技支撑项目资助(13ZCZDSY01900)

摘　　要：目的探讨急性缺血性卒中患者血管性认知障碍(vascular cognitive impairment,VCI)及其亚型非痴呆性血管性认知障碍(VCI-no dementia,VCIND)与血管性痴呆(vascular dementia,Va D)发生的主要相关因素。方法选择2014年6月至2015年6月就诊于天津医科大学总医院神经内科的491例急性缺血性卒中患者为研究对象,应用前期已建立的血管性认知障碍数据库记录患者的一般人口学信息、病史、体格检查、血管危险因素、生化及影像检查信息,对患者进行美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、Essen评分及低分子肝素治疗急性卒中试验(the Trial of Org 10172 in Acute Stroke Treatment,TOAST)分型,于发病(10±2)d进行蒙特利尔认知量表(Montreal Cognitive Assessment,Mo CA)、临床痴呆量表(Clinical Dementia Rating,CDR)、日常生活能力量表(Activities of Daily Living,ADL)评分,依据血管性认知障碍诊治指南中VCI的诊断及分类诊断标准将患者分为认知正常组(no cognitive impairment,NCI)和VCI组,VCI组包括VCIND组和Va D组,分析上述各项因素的组间差异及相关性。结果 491例急性缺血性卒中患者中VCI占69.86%,其中包括37.68%的VCIND和32.18%的Va D患者。1VCI组低受教育程度(P<0.001)、糖尿病(P=0.005)、心脏病(P=0.045)、卒中家族史(P=0.005)、幕上病变(P<0.001)的比例及卒中次数(P=0.014)、D-二聚体水平(P=0.001)、Essen评分(P=0.024)、NIHSS评分(P<0.001)显著高于NCI组,女性(P=0.004)、幕下病变(P<0.001)的比例及受教育年(P<0.001)显著低于NCI组,差异均有显著性;Logistic回归分析显示低受教育程度、糖尿病、幕上病变和高D-二聚体水平是VCI的独立危险因素。2与VCIND组比较,Va D组患者既往卒中史(P=0.013)、TOAST分型中大动脉粥样硬化型梗死(P<0.001)的比例及卒中次数(P=0.001)、Essen评分(P=0.032)、神经功能缺损程度(P=0.005)显著高于VCIND组,TOAST分型中小动脉闭�Objective To investigate the major correlation factors of vascular cognitive impairment（VCI） and its subtypes including VCI-no dementia（VCIND） and vascular dementia（Va D）.Methods A total of 491 patients with acute ischemic stroke admitted in Neurology Department of Tianjin Medical University General Hospital during June 2014 to June 2015 were recruited in this study. General demographic information, medical history, physical examination, vascular risk factors, laboratory and image data recorded in our previously established VCI database were used to assess. The National Institutes of Health Stroke Scale（NIHSS） scores, mechanism of ischemic stroke（the Trial of Org 10 172 in Acute Stroke Treatment, TOAST）, Essen scores, Montreal Cognitive Assessment（Mo CA）, Clinical Dementia Rating（CDR）, and Activities of Daily Living（ADL） after（10±2） days of stroke. Recruited patients were divided into VCI group and no cognitive impairment（NCI） group according to the Guide for Diagnosis and Treatment of VCI. Patients with VCI comprised of those with VCIND and Va D. Inter-group differences and correlations of factors mentioned above were analyzed.Results Among 491 cases of patients with acute ischemic stroke, VCI accounted for 69.86% which was composed of 37.68% of VCIND and 32.18% of Va D.（1） Comparing to NCI group, patients with VCI were more likely to have higher low-educational status（P 0.001）, diabetes（P =0.005）, heart disease（P =0.045）, family history of stroke（P =0.005）, supratentorial stroke（P 0.001）, stroke frequency（P =0.014）, higher Essen scores（P =0.024）, stroke severity（NIHSS） scores（P 0.001） and D-Dimer level（P =0.001）, lower proportion of female（P =0.004） and subtentorial stroke（P 0.001）, and less education year（P 0.001）, which had significant differences. Logistic regression analysis showed that lower educational status, diabetes, supratentorial stroke, higher D-Dimer level were independent risk factors for VCI.（2） I

关 键 词：血管性认知障碍 缺血性卒中 非痴呆性血管性认知障碍 血管性痴呆 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]