急性脑梗死后认知功能障碍危险因素分析

The Risk Factors of Cognitive Function Impairment after Cerebral Infarction

目的对脑梗死后血管性认知功能障碍(VCI)相关危险因素进行探讨。方法选取急性脑梗死患者143例,记录患者性别、年龄、受教育年限、抽烟、饮酒情况及是否有高血脂、高血压、糖尿病病史,通过CT或者MRI明确其病灶部位、病灶多少及大小。于发病后3个月采用MoCA和ADL评价患者的认知功能和日常生活活动能力,根据相应标准将其分为无认知功能障碍(N-VCI)组和VCI组,探讨脑梗死后VCI发生与以上各因素的关系。结果①通过MoCA量表筛查,脑梗死后3个月VCI的发生率为51.05%;②VCI组额叶、颞叶、基底节区、丘脑梗死明显多于N-VCI组(P<0.01);③高龄、低教育程度、高血压、糖尿病、多次梗死、多发病灶、大病灶、左侧梗死、脑萎缩及白质病变者VCI组明显多于N-VCI组(P<0.05或P<0.01);④高血压、多次梗死、多梗死灶、左侧梗死、脑萎缩及脑白质病变进入多因素Logistic回归方程,其OR值分别为4.889、3.604、4.693、2.974、3.765和2.828。结论脑梗死后VCI的发生率高;额叶、颞叶、丘脑及基底节区梗死易引起VCI的发生;高龄、低教育水平、左侧梗死、梗死次数、多发病灶、大病灶、高血压、糖尿病、脑萎缩及白质病变是脑梗死后VCI发生的危险因素。

Objective To investigate the correlative risk factors of cognitive function impairment after cerebral infarction. Methods 143 cases with acute stroke were elected and their common and clinical information were recorded. The sites, size and infarction were confirmed by CT or MRI. cognition was evaluated by MoCA, ADL scale after 3 months of cerebral infarction. Results （1） The occurrence of cognition impairment was 51.05% after 3 months of cerebral infarction. （2）There were significantly statistical difference between VCI group and N - VCI group in frontal lobe,temporal lobe, hemorrhage of basal ganglion area and thalamencephalon （P 〈 0.01 ）. （3）There were significantly statistical difference between VCI group and N- VCI group in age, education level, hypertension, diabetes, multiple infarction, multiple lesions, big lesion, left infarction, Cerebral atrophy and Cerebral white matter lesions （ P 〈 0.01 ）. （4）Multi - factor logistic regression analysis showed that hypertension （ 4. 889 ）, multiple infarction （ 3. 604 ）, multiple lesions （ 4. 693 ）, left infarction （2. 974 ） , Cerebral atrophy （ 3. 765 ） and cerebral white matter lesions （2. 828 ） were positively correlated with post - stroke cognitive mpairment （P 〈 0.05 ）. Conclusion Cognitive dysfunction is a common complication of cerebral infarction, infarction of frontal lobe, temporal lobe, hemorrhage of basal ganglion area and thalamencephalon are liable to cause VCI, old age ,low education level, hypertension, diabetes, multiple infarction, multiple lesions, big lesion, left infarction, cerebral atrophy and cerebral white matter lesions are the risk factors of VCI.