脑微出血与非关键部位脑梗死患者认知功能的相关性  

Correlation between cerebral microbleeds and cognitive function in patients with cerebral infarction in non-critical regions

作　　者：桂千 侯晓夏 徐勤荣 冯红选[1] 吴冠会[1] 卢艳丽[2] 程庆璋[1] GUI Qian;HOU Xiaoxia;XU Qinrong;FENG Hongxuan;WU Guanhui;LU Yanli;CHENG Qingzhang(Department of Neurology,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu,215002;Department of Imaging,Headquarter of Suzhou Municipal Hospital of Jiangsu Province,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu,215002)

机构地区：[1]江苏省苏州市立医院本部/南京医科大学附属苏州医院神经内科,江苏苏州215002 [2]江苏省苏州市立医院本部/南京医科大学附属苏州医院影像科,江苏苏州215002

出　　处：《实用临床医药杂志》2023年第13期43-47,52,共6页Journal of Clinical Medicine in Practice

基　　金：江苏省南京医科大学科技发展基金项目(NMUB2018227);江苏省苏州市医疗卫生科技创新项目(SKJY2021121)。

摘　　要：目的探讨脑微出血(CMBs)与脑梗死后认知功能的相关性。方法依据3.0T头颅磁共振成像(MRI)磁敏感成像检查结果,选取2018年4月—2020年7月苏州市立医院本部神经内科住院的急性首发非关键部位脑梗死患者119例,收集CMBs等基本资料。根据CMBs灶数量分为0级(无CMBs)、1级(1~5个)和2级(≥6个)。根据CMBs部位分为单纯脑叶组、单纯深部组和混合组。3个月后,采用蒙特利尔认知评估量表(MoCA)评定患者认知功能;比较不同程度CMBs组患者认知功能的差异,以及单纯脑叶组、单纯深部组患者认知功能的差异;比较认知障碍组与认知正常组各因素的差异,并进一步分析非关键部位脑梗死患者发生认知障碍的影响因素。结果0级、1级、2级CMBs患者的MoCA总分依次降低,视空间与执行功能领域评分依次降低,注意领域评分依次降低,差异均有统计学意义(P<0.001)。单纯脑叶组MoCA总分、视空间与执行功能领域评分低于单纯深部组,差异有统计学意义(P=0.014、0.007)。与认知正常组比较,认知障碍组年龄较大、受教育时间较短、脑白质疏松(LA)程度较重、CMBs阳性率较高、CMBs灶数量较多、发生在脑叶区CMBs比率较高,差异均有统计学意义(P<0.05)。以是否发生认知障碍为因变量,将单因素分析有意义的指标纳入多因素分析,结果显示LA程度(OR=2.050,P=0.005)、CMBs阳性(OR=34.476,P=0.008)、CMBs灶数量(OR=1.594,P=0.045)是非关键部位脑梗死患者认知功能的独立影响因素。结论CMBs及其程度与非关键部位脑梗死患者认知功能密切相关。Objective To explore the correlation between cerebral microbleeds(CMBs)and cognitive function after cerebral infarction.Methods Based on the results of susceptibility imaging of 3.0 T cranial magnetic resonance imaging(MRI),119 hospitalized patients with acute primary cerebral infarction in non-critical regions in the Department of Neurology of Suzhou Municipal Hospital from April 2018 to July 2020 were selected,and the basic materials such as CMBs were collected.According to the number of CMBs lesions,the patients were divided into groups with grade 0(no CMBs),grade 1(1 lesion to 5 lesions of CMBs),and grade 2(≥6 lesions of CMBs).According to the location of CMBs,the patients were divided into pure cerebral lobe group,pure deep group and mixed group.After 3 months,the Montreal Cognitive Assessment(MoCA)was used to evaluate the cognitive function of the patients;the differences in cognitive function among different degrees of CMBs groups as well as between pure cerebral lobe group and pure deep group were compared;the differences in various factors between the cognitive impairment group and the cognitive normal group were compared,and the influencing factors of cognitive impairment in patients with cerebral infarction in non-critical regions were further analyzed.Results The total score of MoCA,the scores in the domains of visuospatial and executive function as well as and attention in CMBs patients with grade 0,grade 1 and grade 2 decreased successively,and the differences were statistically significant(P<0.001).The total score of MoCA and the scores in the domain of visuospatial and executive function in the pure cerebral lobe group were significantly lower than those in the pure deep group(P=0.014,0.007).Compared with the cognitive normal group,the cognitive impairment group had older age,shorter education time,higher severity degree of leukopenia(LA),higher positivity rate of CMBs,more CMBs lesions,and higher ratio of CMBs in cerebral lobes,and all the differences were statistically significant(P<0.05).Usin

关 键 词：脑微出血 非关键部位 脑梗死 认知功能 蒙特利尔认知评估量表 

分 类 号：R749.1[医药卫生—神经病学与精神病学] R743.3[医药卫生—临床医学]