急性脑血管病合并代谢综合征患者的认知功能障碍特征

Characteristics of cognitive dysfunction in patients with acute cerebrovascular disease complicated by metabolic syndrome

目的:通过比较急性脑血管病(acutecerebrovasculardisease,ACVD)合并代谢综合征(metabolicsyndrome,MS)、单纯高血压,糖尿病时的认知功能变化,分别探讨其认知功能改变特征。方法:研究对象为1997-01/2002-12解放军第三军医大学大坪医院神经内科收治的脑出血和脑梗死患者共222例,分成MS,高血压,糖尿病和单纯ACVD组。纳入标准:符合第四届全国脑血管病会议制定的脑出血和脑梗死诊断标准的ACVD患者。排除标准:有听力、视力、语言、意识障碍,85岁以上和40岁以下,以及蛛网膜下腔出血和短暂脑缺血发作患者。用修订韦氏记忆量表(Wechslermemoryscale,WMS)、老年认知功能量表(scaleofelderlycognitivefunction,SECF)和简易精神状态量表(mini-mentalstateexamination,MMSE)检测222例ACVD患者的认知功能,并分别分析MS,高血压,糖尿病与ACVD患者认知功能损害间的关系。结果:ACVD患者各项认知检测的粗分、T分、量表分和记忆商(MQ)均明显低于对照组(t=6.309～145.585,P<0.05～0.0001);SECF检测仅单纯ACVD组的长记忆犤(8.20±2.40)分和动物粗分犤(6.12±2.55)分犦也明显高于MS组犤(6.8±3.47)分和(4.7±5.41)分(F=3.392,4.235,P<0.05,高血压组的长记忆和回忆1粗分犤(8.23±2.67)分和(5.28±3.19)分犦也明显高于MS组犤(6.

AIM:To compare the changes of cognitive function of patients with acute cerebrovascular disease(ACVD) combined by metabolic syndromes(MS), simple essential hypertension(EH) and diabetes mellitus(DM), so as to explore the characteristics of cognitive function changes. METHODS: A total of 222 inpatients with cerebral hemorrhage(CH) and cerebral infarction(CI),who were in the Department of Neurology,Daping Hospital of Third Military Medical University of Chinese PLA during January 1997 to December 2002,were divided into MS group,EH group,DM group and simple ACVD group.All the ACVD patients were in accordance with the diagnostic standard for CH and CI established in the Fourth National Academic Meeting for Cerebrovascular Disease,whereas those with hearing,visual,language and consciousness disorders,those older than 85 years old or younger than 40 years old,and those with subarachnoid hemorrhage and transient ischemia attack were excluded.The cognitive functions of the 222 ACVD patients were evaluated with Wechsler memory scale(WMS),the scale of elderly cognitive function(SECF) and the mini mental state examination(MMSE).The relationship of the impairment of cognitive function with MS,EH and DM was analyzed. RESULTS:The raw scores,T scores,the scale scores and the memory quotient(MQ) of the ACVA patients were significantly lower than those of the control group(t=6.309 to 145.585,P< 0.05 to 0.000 1).The results of SECF showed that the raw scores of the long term memory and animal of the simple ACVD patients[(8.20±2.40) and(6.12±2.55) points] were significantly higher than those of the MS group[(6.8±3.47) and(4.7±5.41)](F=3.392,4.235,P< 0.05).The raw scores of long term memory and recall 1 were significantly higher in the EH group[(8.23±2.67) and(5.28±3.19) points] than the MS group[(6.8±3.47) and(3.85 ±3.01) points](F =3.445,P< 0.05).In comparison of the abnormality rate among the groups, only the abnor mality rate of long term memory was lower in the simple ACVD patients than in the MS group(χ2=5.16,P< 0.05). The results of WMS showed that the raw scores in the simple ACVD patients were significantly higher than those in the MS group(F=2.684 to 24.006,P< 0.05 to 0.01);Significant higher scale scores were only identified in the simple AVCD patients than those in ACVD patients with MS based on the 1→100, accumulative addiction,card recall,regeneration,comprehension,and digit span, as well as the total scale scores(F=3.344 to 5.278,P< 0.05 to 0.01). CONCLUSION:The cognitive function is obviously impaired in ACVD patients.EH and DM have little effect on the cognitive function of ACVD patients,but EH and DM significantly contribute to the damage of memory in ACVA patients with MS,which includes immediate,short term and long term memories.