脑梗死发病后6个月内淡漠变化及其预测因素的研究  

Study on the Changes of Post-Stroke Apathy Within Six Months and Predictors of Post-Stroke Apathy

作　　者：王君[1,2] 王正则[2] 高连波[2] 曹云鹏[1] 

机构地区：[1]中国医科大学附属第一医院神经内科,辽宁沈阳110001 [2]中国医科大学附属第四医院神经内科,辽宁沈阳110032

出　　处：《医学临床研究》2016年第5期833-837,共5页Journal of Clinical Research

基　　金：国家自然科学基金（No：81371227）

摘　　要：【目的】探讨脑梗死6个月内卒中后淡漠（PSA）变化及PSA预测因素。【方法】收集急性脑梗死患者220例并完成急性期及6个月随访。根据急性期及6个月淡漠情况，将患者分为Ⅰ组（急性期淡漠，6个月淡漠组）、Ⅱ组（急性期淡漠，6个月非淡漠组）、Ⅲ组（急性期非淡漠，6个月淡漠组）、Ⅳ组（急性期非淡漠，6个月非淡漠组）。应用淡漠量表评估PSA，简易智力状态检查表（MMSE）评估认知功能、美国国立卫生研究院卒中量表（NIHSS）评定卒中严重程度、修正Rankin评分（mRS）评估功能结局、Barthel指数评分（gI）评估日常生活能力。急性期和6个月两个时间点抽血检测血浆同型半胱氨酸（Hcy）、血尿酸（UA）、超敏c反应蛋白（hs-CRP）、糖化血红蛋白（HbAlc）、纤维蛋白原。【结果】发病6个月淡漠组年龄、NIHSS、mRS、hs-CRP、Hcy高于非淡漠组，受教育程度、MMSE、BI、HbAlC、UA低于非淡漠组。与I组比较，MMSE、HbAlC低于Ⅱ、Ⅲ、Ⅳ组，hs-CRP高于Ⅱ、Ⅲ、Ⅳ组（P〈0．05）。【结论】脑梗死6个月时年龄、受教育程度、NIHSS、MMSE、mRS、BI、HbAlC、hs-CRP、Hcy、UA与PSA密切相关，较低MMSE，较低HbAlC，较高hs-CRP预测PSA发生。[Objective]The aim of this study was to clarify the changes of post-stroke apathy （PSA） within six months and to examine the predictors for post-stroke apathy （PSA）. [Methods]220 patients with acute cerebral infarction were recruited for the study and divided into group Ⅰ （acute and 6-months apathy）, Ⅱ （a- cute apathy but 6-months non-apathy）, Ⅲ （acute non-apathy but 6-months apathy） and Ⅳ （acute and 6-mo- mths non-apathy） . They completed assessments at the acute stage and after six months follow-up. The Apa- thy Scale （AS） was used to assess PSA. Mini-Mental State Examination （MMSE） was used to assess cognitive function and the National Institutes of Health Stroke Scale （NIHSS） was used to assess stroke severity. Func- tional outcome was assessed with the modified Rankin Scale （mRS）. Functional outcome in daily living activi- ties was assessed with the Barthel Index（BI）at acute stage and six months follow-up. The serum levels of ho- mocysteine （Hcy）, uric acid （UA）, highly-sensitive C-reactive protein （hs-CRP）, lipid spectrum, glycated hemoglobin （HbAlc）, and fibrinogen of patients were determined at admission and six months follow up. [Results]At the six months follow up： age, NIHSS score, mRS score, hs-CRP level, and Hey levels in Group A were significant higher than in other groups. Education, MMSE score,BI score, HbAlc level, and UA lev- els, however, were significant lower than in other groups. The comparison of clinical data in the four groups of patients at the acute stage were as follows., compared with group Ⅰ , MMSE score, HbAlc level in group Ⅱ , Ⅳ and Ⅳ were lower than in group Ⅳ . However, hs-CRP levels in the ]] ,Ⅳ and IV groups were higher than in group I （P 〈0.05）. [Conclusion]The study found independent associations of age, education, NIHSS score, MMSE score, mRS score, BI score, HbAle level, hs-CRP level, Hcy level, and UA levels with PSA at six months follow up. Furthermore, MMSE score, HbAlc level, and hs

关 键 词：脑梗死/并发症 半胱氨酸 尿酸 C反应蛋白质 

分 类 号：R743.33[医药卫生—神经病学与精神病学]