老年缺血性卒中后轻度认知障碍患者眼-视功能障碍与认知功能的关系研究  

Relationship between Visual Impairment and Cognitive Function in Elderly Patients with Post-Stroke Mild Cognitive Impairment

作　　者：傅春玲 宋碧英 杨大会 FU Chunling;SONG Biying;YANG Dahui(Department of Ophthalmology,Chongqing University Three Gorges Hospital,Chongqing 404000,China;Department of Ophthalmology,Army Medical Centre of PLA,Army Medical University,Chongqing 404000,China)

机构地区：[1]重庆大学附属三峡医院眼科,重庆404000 [2]陆军军医大学陆军特色医学中心眼科

出　　处：《中国卒中杂志》2024年第2期167-172,共6页Chinese Journal of Stroke

摘　　要：目的 探讨老年卒中后轻度认知障碍(post-stroke mild cognitive impairment,PSMCI)患者眼-视功能障碍与认知功能的关系。方法 前瞻性连续纳入2020年2月—2022年2月重庆大学附属三峡医院收治的急性缺血性卒中患者资料。采用MMSE、MoCA量表评估患者的认知功能,并检测双眼视力、眼球转动运动、视野、视觉感知和视觉注意力。根据6个月随访是否发生PSMCI将患者分为PSMCI组和无PSMCI组。收集患者的临床资料,采用多因素logistic回归分析急性缺血性卒中患者发生PSMCI的危险因素。结果 共纳入157例患者,71例(45.22%)发生PSMCI,108例(68.79%)发生眼-视功能障碍,其中58例(53.70%)为中心视力受损,30例(27.78%)为视野丧失,41例(37.96%)为眼运动异常,30例(27.78%)为视觉知觉障碍。PSMCI组眼-视功能障碍总发生率以及中心视力受损、眼球运动异常、视野丧失、视觉知觉障碍发生率高于无PSMCI组,年龄高于无PSMCI组,差异有统计学意义(均P<0.05)。高龄(OR 1.919,95%CI 1.310~2.813,P<0.001)、入院时高NIHSS评分(OR 2.291,95%CI 1.423~3.689,P<0.001)、大体积梗死(OR 1.669,95%CI 1.203~2.315,P<0.001)、眼-视功能障碍(OR 1.998,95%CI 1.363~2.928,P<0.001)是急性缺血性卒中患者发生PSMCI的危险因素(均P<0.05)。结论 眼-视功能障碍与急性缺血性卒中患者PSMCI有关,眼-视功能障碍可能加重认知功能损伤。Objective To investigate the correlation between visual impairment and cognitive function in elderly patients with post-stroke mild cognitive impairment(PSMCI).Methods Patients with acute ischemic stroke admitted to Chongqing University Three Gorges Hospital from February 2020 to February 2022 were prospectively and continuously included.MMSE and MoCA were used to evaluate the cognitive function of the patients,and binocular visual acuity,eye movement,visual field,visual perception and visual attention were measured.According to the occurrence of PSMCI at 6 months follow-up,the patients were divided into PSMCI group and non-PSMCI group.Clinical data were collected and the risk factors of PSMCI in patients with acute ischemic stroke were analyzed by multivariate logistic regression.Results A total of 157 patients were included,of which 71 cases(45.22%)developed PSMCI,108 cases(68.79%)developed visual impairment,of which 58 cases(53.70%)had central visual impairment,30 cases(27.78%)had visual field loss,41 cases(37.96%)had abnormal eye movement,and 30 cases(27.78%)had visual perception deficit.The total incidence of visual impairment,the incidence of central visual impairment,abnormal eye movement,visual field loss and visual perception deficit in the PSMCI group were higher than those in the non-PSMCI group(P<0.05),the age was higher than that in the non-PSMCI group(P<0.05).The difference was statistically significant.Older age,(OR 1.919,95%CI 1.310-2.813,P<0.001)higher NIHSS score(OR2.291,95%CI1.423-3.689,P<0.001),large infarction(OR1.669,95%CI1.203-2.315,P<0.001)and visual impairment(OR1.998,95%CI1.363-2.928,P<0.001)were risk factors for PSMCI in patients with acute ischemic stroke(allP<0.05).Conclusions Visual impairment is associated with PSMCI in patients with acute ischemic stroke.Visual impairment may aggravate cognitive impairment.

关 键 词：卒中后轻度认知障碍 眼-视功能障碍 认知功能 危险因素 

分 类 号：R74[医药卫生—神经病学与精神病学]