轻型急性缺血性脑卒中早期认知损害的特点和危险因素分析  

Characteristics of early cognitive impairment in patients with mild acute ischemic stroke and the analysis of risk factors

作　　者：马翠红 方建伟 李爱芹[1] 程飞 戈洪国 朱海暴[1] MA Cuihong;FANG Jianwei;LI Aiqin;CHENG Fei;GE Hongguo;ZHU Haibao(不详;Department of Neurology,Chengde Central Hospital,Chengde Hebei 067000,China)

机构地区：[1]承德市中心医院神经内科,067000

出　　处：《中国神经免疫学和神经病学杂志》2022年第2期93-97,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：承德市科学技术研究与发展计划资助项目(201903A009)。

摘　　要：目的分析轻型急性缺血性脑卒中早期认知损害的特点和危险因素。方法连续纳入发病48 h内的轻型急性缺血性脑卒中患者(均为前循环梗死)118例,采用蒙特利尔认知评估量表(MoCA)筛选认知损害的患者,分析认知损害的特点及认知损害的危险因素。结果认知损害患者69例(58.47%),认知损害组在视空间与执行功能、命名、注意力、语言、抽象、延迟回忆和定向力认知域得分均显著低于非认知损害组(P<0.01)。与非认知损害组患者比较,认知损害组平均年龄较大〔(61.9±7.96)岁比(55.0±8.94)岁,t=-4.41,P<0.01〕、平均血尿酸水平较低〔(262.54±74.33)μmmol/L比(295.88±88.31)μmmol/L,t=2.22,P=0.03〕,侧脑室旁白质高信号得分较高〔中位数1.5分比1.0分,Z=-2.94,P<0.01〕。多因素Logistic回归分析显示:侧脑室旁脑白质病变(OR=2.318,95%CI为1.135~4.734,P=0.021)及低血尿酸水平(OR=0.992,95%CI为0.986~0.999,P=0.024)是认知损害的独立危险因素。结论轻型缺血性脑卒中早期认知损害发生率高且患者表现为多认知域受损。侧脑室旁脑白质病变及低血尿酸水平可能是其认知损害发生的独立危险因素。Objective To analyse the characteristics and risk factors of early cognitive impairment of mild acute ischemic stroke(anterior circulatory infarction).Methods A total of 118 patients with mild acute ischemic stroke within 48 hours of onset were included.The Montreal Cognitive Assessment(MoCA)was used to evaluate cognitive function,we analyze the characteristics and risk factors of patients with cognitive impairment.Results Sixty-nine(58.47%)patients had cognitive impairment,the scores of visual space and executive function,naming,attention,language,abstraction,delayed recall and orientation in cognitive impairment group were significantly lower than those in non-cognitive impairment group(P<0.01).Compared with the non-cognitive impairment group,the patients with cognitive impairment had older age[(61.9±7.96)years old vs.(55.0±8.94)years old,t=-4.41,P<0.01],lower mean serum uric acid level[(262.54±74.33)μmmol/L vs.(295.88±88.31)μmmol/L,t=2.22,P=0.03],and higher scores of periventricular hyperintensities[median:1.5 score vs.1.0 score,Z=-2.94,P<0.01].Multivariate logistic regression analysis indicated that high score of periventricular hyperintensities(OR=2.318,95%CI 1.135-4.734,P=0.021)and low serum uric acid level(OR=0.992,95%CI 0.986-0.999,P=0.024)were independent risk factors for cognitive impairment.Conclusions The prevalence of cognitive impairment in patients with mild acute ischemic stroke is high in early stage,and multiple cognitive domains could be involved.Periventricular hyperintensities and low serum uric acid level may be independent risk factors of cognitive impairment.

关 键 词：轻型急性缺血性卒中 认知损害 尿酸 脑白质病变 

分 类 号：R743.3[医药卫生—神经病学与精神病学]