老年缺血性脑卒中患者早发型卒中后认知障碍发生情况及其影响因素分析  

Analysis of early concurrent cognitive impairment in elderly ischaemic stroke patients and its influencing factors

作　　者：吴婷婷 张薇[1] 何雅琪 沈海清[1] 路敬叶[2] 张艳 Wu Tingting;ZhangWei;He Yaqi;Shen Haiqing;LuJingye;Zhang Yan(Department of Neurology,Rugao People's Hospital,Rugao 226500,China;Department of Neurology,Taixing People's Hospital,Taixing 225400,China;Department of Intensive Care,Haian People's Hospital,Hai'an 226600,China)

机构地区：[1]如皋市人民医院神经内科,江苏如皋226500 [2]泰兴市人民医院神经内科,江苏泰兴225400 [3]海安市人民医院重症监护室,江苏海安226600

出　　处：《中华脑血管病杂志(电子版)》2024年第6期573-579,共7页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：2022年如皋市指令性科技攻关计划项目(SRG(22)1072)。

摘　　要：目的调查老年缺血性脑卒中患者早发型卒中后认知障碍(PSCI)的发生情况并探讨其影响因素。方法采用横断面研究方式,随机抽取于2021年8月至2023年3月在如皋市人民医院和泰兴市人民医院神经内科住院治疗,且在发病后3~6个月内完成临床随访的745例患者为研究对象。采用问卷形式收集患者人口学基本情况,从医院病例系统收集患者疾病相关信息,包括临床资料、实验室检查指标及影像学资料;采用美国国立卫生研究院卒中量表(NIHSS)对患者卒中严重程度进行测定,采用简易智力状态检查量表对患者的认知功能进行评定。采用Logistic多元回归分析老年缺血性脑卒中患者早期并发认知障碍的影响因素。结果745例老年缺血性脑卒中患者中,早发型PSCI患病率为37.99%(283/745)。年龄≥70岁(OR=2.152,95%CI:1.074~5.738)、发病至就诊时间长(OR=2.481,95%CI:1.204~4.708)、卒中部位为颞叶(OR=2.746,95%CI:1.097~7.058)、梗死体积≥1.5 cm^(3)(OR=1.992,95%CI:1.126~3.523)、颈动脉斑块积分高(OR=2.083,95%CI:1.201~3.613)、血清C反应蛋白水平高(OR=2.893,95%CI:1.382~5.739)、血清同型半胱氨酸水平高(OR=2.847,95%CI:1.482~6.382)及NIHSS评分高(OR=2.501,95%CI:1.592~5.937)是老年脑卒中患者发生早发型PSCI的危险因素。结论老年脑卒中患者早发型PSCI发生率高,年龄、发病至就诊时间、卒中部位、梗死体积、颈动脉斑块积分、血清C反应蛋白、血清同型半胱氨酸水平及NIHSS评分均是其影响因素。Objective To investigate the prevalence of early-onset post-stroke cognitive impairment(PSCI)in elderly ischaemic stroke patients and to identifying the influencing factors.Methods A crosssectional study was used to randomly include 745 patients admitted the Department of Neurology of Rugao People's Hospital and Taixing People's Hospital from August 2021 to March 2023,who had completed the clinical follow-ups within 3-6 months post-stroke onset.A questionnaire was used to collect basic patient demographics,and disease-related information was collected from the hospital case system,including clinical data,laboratory indicators and imaging data.The National Institute of Health stroke scale(NIHSS)was used to determine the severity of stroke,and the mini-mental state examination(MMSE)was used to assess the cognitive function.Logistic multiple regression analysis was employed to identify factors influencing early concurrent cognitive deficits in elderly ischemic stroke patients.Results The prevalence of post-stroke cognitive impairment was 37.99%(283/745)in elderly stroke patients.Risk factors for earlyonset PSCI included Age≥70 years(OR=2.152,95%CI:1.074-5.738),delayed time from onset to clinic visit(OR=2.481,95%CI:1.204-4.708),temporal lobe stroke location(OR=2.746,95%CI:1.097-7.058),infarct volume≥1.5 cm^(3)(OR=1.992,95%CI:1.126-3.523),high carotid plaque score(OR=2.083,95%CI:1.201-3.613),elevated serum C-reactive protein level(OR=2.893,95%CI:1.382-5.739),increased serum homocysteine level(OR=2.847,95%CI:1.482-6.382),and high NIHSS score(OR=2.501,95%CI:1.592-5.937).Conclusion Early-onset PSCI is highly prevalent among elderly stroke patients,with age,time to consultation post-stroke onset,stroke location,infarct volume,carotid plaque score,serum C-reactive protein,serum homocysteine level and NIHSS score identified as significant influential factors.

关 键 词：老年人 缺血性脑卒中 卒中后认知障碍 患病率 危险因素 

分 类 号：R749.1[医药卫生—神经病学与精神病学]