北京市社区缺血性卒中患者认知功能障碍及危险因素调查

Cognitive impairment and risk factor survey in patients with ischemic stroke in Beijing communities

目的 探讨社区就诊的缺血性卒中患者认知功能障碍（PSCI）患病情况及其危险因素。方法在北京市5个城区各选一家二级医院所管辖的社区卫生服务站，对在此就诊的2003年1月-2004年12月首发或二次复发的缺廊性卒中患者进行横断面调查。应用简易智能状态检测量表（MMSE）评估患者的认知功能，同时收集了卒中发病情况、PSCI危险因素等资料。结果共有993例患者完成MMSE评估，PSCI为7．9％（78／993）。卒中后6个月内、6个月〈卒中〈12个月、12～24个月的PSCI患病率分别为8．5％、10．1％和4．9％。〈60岁者的PSCI患病率为3．9％，60～、65～、≥70岁患者的患病率分别为5．1％、8．1％和11．4％，趋势检验，，=12．521，P〈0．0001。大专学历以上者PSCI患病率为3．6％，中学、小学和文盲卒中患者PSCI的患病危险分别是大专以上者的1．72、3．94、4．04倍（趋势检验，X^2=13．694，P〈0．0001）。影响PSCI的因素有多病灶卒中（OR=4．53，95％CI：2．26～9．06）、抑郁状态（OR=9．13，95％CI：3．35～24．83）、日常生活能力障碍（OR=2．53，95％CI：1．73～3．71）和非腔隙性梗死，其中前三项为PSCI患病的独立危险因素。结论社区就诊的缺血性卒中患者的PSCI与病程、文化程度、患病年龄等多种因素有关，多病灶卒中、抑郁状态和日常生活能力障碍为PSCI患病的独立危险因素。

Objective To investigate the prevalence and risk factors of post-stroke cognitive impairment （PSCI） in patients with ischemic stroke at community health service stations. Methods Five community health service stations were selected from 5 urban areas of Beijing, and a study was performed in patients with first or recurrent attack of ischemic stroke at the community health service stations from January 2003 to December 2004. The mini mental state examination （MMSE） was used to assess the cognitive function of the patients, and the data about the onset of stroke and the risk factors of stroke were collected. Results A total of 993 patients were completed the MMSE evaluation, the incidence of PSCI was 7.9% （78/993）. The prevalence of PSCI within 6 months, 7 - 12 months, and 12 months after onset of stroke were 8. 5% , 10. 1% , and 4. 9% , respectively. The prevalence of PSCI in patients under 60 years of age was 3.9%, and the prevalence in 60 -65, 65 -70, and ≥70 year groups were 5. 1%, 8.1%, and 11.4% respectively （X^2 trend test = 12. 521 ,P 〈 0. 0001 ）. The prevalence of PSCI was varied with the educational level of the patients, in patients with college graduates was 3.6% ,in patients with middle, primary school education and illiterate were 1.72, 3.94, and 4.04 times of the college graduates （x^2 trend test = 13. 694, P 〈 0. 0001 ）. The impact factors of PSCI were the multi - focal stroke, depressive state, activities of daily living handicap, and non - lacunar infarction of which, the first three were the independent risk factors for PSCI. Conclusion PSCI in patients with ischemic stroke is associated with a variety of factors, such as the course of disease, educational level, age of disease onset etc. The multi - focus stroke, depressive state, and activities of daily living handicap are the independent risk factors for PSCI.