急性脑梗死后认知障碍与缺血性脑卒中复发相关  

Cognitive impairment is associated with recurrence of ischemic stroke after acute cerebral infarction

作　　者：李陈芳 洪音 殷梦媚 陶带花 张盛楠 徐俊 Li Chenfang;Hong Yin;Yin Mengmei;Tao Daihua;Zhang Shengnan;Xu Jun(Dalian Medical University Postraduate School,Dalian 116044,Liaoning Province,China)

机构地区：[1]大连医科大学研究生院,116044 [2]首都医科大学附属北京天坛医院神经病学中心认知障碍科国家神经系统疾病临床医学研究中心 [3]江苏省苏北人民医院神经内科

出　　处：《中华老年心脑血管病杂志》2020年第9期947-950,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81870821,81471215,81271211);江苏省社会发展项目(BE2015665);江苏省自然科学基金(BK20151592)。

摘　　要：目的探讨急性脑梗死后认知障碍与缺血性脑卒中复发事件的关系。方法纳入江苏省苏北人民医院急性脑梗死患者164例进行前瞻性分析,分别在急性脑梗死发生2周内(基线)及出院6个月时,用蒙特利尔认知评估量表(MoCA)和阿登布鲁克认知功能检查(ACE-Ⅲ)评分评估患者认知功能,入选者以6个月时MoCA评分分为脑卒中后认知障碍(PSCI)组68例(MoCA评分<26分),脑卒中后非认知障碍(PSNCI)组96例(MoCA评分≥26分)。之后,电话随访入选者脑卒中复发情况。Cox比例风险模型分析PSCI与脑梗死复发的关系。结果基线和6个月时,PSCI发生率分别为51.22%和41.46%,随访期间,脑卒中复发25例,其中PSCI组19例,PSNCI组6例,PSCI组脑卒中复发率高于PSNCI组(27.9%vs 6.3%,P<0.05)。与基线比较,6个月时MoCA、ACE-Ⅲ总分、语言和记忆力评分明显升高,语言流畅和视空间能力评分明显降低,有统计学差异(P<0.01)。对混杂因素进行调整后,Cox比例风险模型分析仍显示,MoCA评分<26分和ACE-Ⅲ评分≤62.5分患者脑梗死复发风险升高,PSCI与缺血性脑卒中复发独立相关(HR=4.760,95%CI:1.495~15.151,P=0.008;HR=4.902,95%CI:1.640~14.649,P=0.004)。结论 PSCI与缺血性脑卒中复发相关。重视对PSCI的干预,可能成为脑梗死复发的二级预防策略之一。Objective To study the association between cognitive impairment and recurrence of ischemic stroke after acute cerebral infarction(ACI).Methods One hundred and sixty-four ACI patients admitted to North Jiangsu People’s Hospital were included in this study.Their cognitive function was assessed according to their MoCA scale score and ACE-Ⅲ scale score within 2 weeks after ACI and at month 6 after discharge.The patients were divided into poststroke cognitive impairement(PSCI) group or MoCA scale score <26 group(n=68) and poststroke non-cognitive impairement(PSNCI) group or MoCA scale score ≥26 group(n=96).The patients were followed up for 6 months,during which the reccurrence of ischemic stroke was recorded by telephone.The association between PSCI and recurrence of ischemic stroke after ACI was analyzed by Cox proportional harzards model analysis.Results The incidence of PSCI was 51.22% and 41.46% respectively within 2 weeks after ACI and at month 6 after discharge.Recurrence of ischemic stroke occurred in 19 patients of PSCI group and in 6 patients of PSNCI group out of the 25 patients during the follow-up period(27.9% vs 6.3%,P<0.05).Compared with the baseline,the total scores of MoCA and ACE-Ⅲ,language and memory scores were significantly increased at 6 months,while the scores of language fluency and visual spatial ability decreased(P<0.01).Cox proportional harzards model analysis showed that MoCA scale score <26 and ACE-Ⅲ scale score ≤62.5 were the risk factors for the recurrence of ischemic stroke and PSCI was independently associated with the recurrence of ischemic stroke after adjustment for confounding factors(HR=4.760,95%CI:1.495-15.151,P=0.008;HR=4.902,95%CI:1.640-14.649,P=0.004).Conclusion PSCI is associa-ted with the recurrence of ischemic stroke.Intervention of PSCI may become one of the secondary prevention strategies for the recurrence of ischemic stroke after ACI.

关 键 词：脑梗死 认知障碍 卒中 复发 

分 类 号：R743.3[医药卫生—神经病学与精神病学]