老年首发轻型急性期脑梗死患者认知功能障碍的危险因素分析  

Risk factors for cognitive impairment in elderly first-ever acute mild cerebral infarction patients

作　　者：王颖[1] 董凯生[1] 陶香君 李悦[1] 胡文立[1] Wang Ying;Dong Kaisheng;Tao Xiangjun;Li Yue;Hu Wenli(Department of Neurology,Affiliated Beijing Chaoyang Hospital of Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院神经内科,100020

出　　处：《中华老年心脑血管病杂志》2021年第2期120-123,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81271309)。

摘　　要：目的探讨老年首发轻型急性期脑梗死患者发生认知功能障碍(CI)的影响因素。方法选取老年首发轻型急性期脑梗死患者227例,经过文化程度矫正后根据蒙特利尔认知评估量表(MoCA)评分分为CI组(MoCA评分≤26分)169例和非CI组58例,收集一般资料,采用脑梗死患者健康行为量表(HBS-SP)评分,采用ROC曲线分析,计算曲线下面积(AUC),进行多因素logistic回归分析。结果本研究CI发生率为74.4%。CI组年龄、TG水平和女性比例明显高于非CI组(P<0.05,P<0.01),2组文化程度比较,差异有统计学意义(P<0.01)。CI组HBS-SP评分及规律运动评分明显低于非CI组(P<0.05)。老年首发轻型急性期脑梗死患者年龄、HBS-SP评分和TG预测CI的最佳临界值分别为60.5岁(AUC=0.648,95%CI:0.555~0.740),55分(AUC=0.387,95%CI:0.291~0.483)和2.16 mmol/L(AUC=0.514,95%CI:0.411~0.618)。logistic回归分析显示,女性、HBS-SP评分≤55分为老年首发轻型急性期脑梗死患者发生CI的独立危险因素(P<0.01),而大专及以上文化程度是发生CI的保护因素(P=0.002)。结论老年首发轻型急性期脑梗死患者CI发生率较高。特别关注绝经期后女性脑梗死、低文化和生活方式不健康患者,及时识别CI危险因素,对其进行健康指导,以预防和减缓CI发生。Objective To study the risk factors for cognitive impairment in elderly first-ever acute mild cerebral infarction(MCI)patients.Methods Two hundred and twenty-seven first-ever acute MCI patients were divided into cognitive impairment group(n=169)and cognitive impairmentfree group(n=58)according to their MoCA Scale score.Their general data were recorded.The patients were assessed according to their Health Behavior Scale(HBS)score and analyzed by ROC curve analysis.The AUC for HBS in diagnosis of acute MCI was measured and analyzed by multivariate logistic regression analysis.Results The incidence of cognitive impairment was 74.4%in first-ever acute MCI patients included in this study.The age was significantly older,the serum level of TG and the ratio of female patients were significantly higher in cognitive impairment group than in cognitive impairment-free group(P<0.05,P<0.01).The education level was significantly different between the two groups(P<0.01).The HBS score and regular exercise score were significantly lower in cognitive impairment group than in cognitive impairmentfree group(P<0.05).The optimal cut-off value of age,HBS score and serum TG level in predicting cognitive impairment in acute MCI patients were 60.5 years(AUC=0.648,95%CI:0.555-0.740),55(AUC=0.387,95%CI:0.291-0.483)and 2.16 mmol/L(AUC=0.514,95%CI:0.411-0.618)respectively.Multivariate logistic regression analysis showed that female sex and HBS score≤55 were the independent risk factors for cognitive impairment while college education level was the protective factor for cognitive impairment in elderly first-ever acute MCI patients(P<0.01).Conclusion The incidence of cognitive impairment is relatively high in firstever acute MCI patients.Close attention should be paid to postmenopausal cerebral infarction patients and those with a low education level and unhealthy living style.The risk factors for cognitive impairment should be timely identified in order to prevent or delay it.

关 键 词：脑梗死 认知功能障碍 绝经期 生活方式 健康行为 

分 类 号：R743.33[医药卫生—神经病学与精神病学]