脑梗死后血管性痴呆发病危险因素研究

Risk Factors of Vascular Dementia after Cerebral Infarction

目的:探讨影响脑梗死后血管性痴呆(VD)发病的危险因素。方法:对392例急性脑梗死患者进行随访研究,于发病第10天及第90天进行2次神经心理学测试,根据测试结果及美国国立神经系统疾病与卒中研究所和瑞士神经科学研究国际协会(NINDS-AIREN)VD诊断标准,将研究对象分为VD组和脑梗死后非痴呆组。分析患者的临床特征、血脂水平及影像学特征。采用多因素Logistic回归分析脑梗死后VD发病的危险因素。结果:84例患者诊断为VD(21.4%)。单因素分析中,VD组与非痴呆组病灶的数目、部位、脑萎缩及脑白质病变(WMLs)差异有统计学意义,多因素分析中发现有左侧或双侧大脑半球病变、病灶的数目多和有脑萎缩为VD发病的独立危险因素,OR值分别为8.958、1.375和2.297。2组间年龄、性别、文化程度、高血压病史、糖尿病病史、冠心病病史、吸烟及饮酒史及血脂水平差异无统计学意义(P>0.05)。结论:脑梗死后VD很常见,小血管病变是VD的主要类型,应早期进行针对性的预防和治疗,以减少和延缓VD的发生。

Objective： To investigate risk factors of vascular dementia （VD）after cerebral infarction. Methods： A total of 392 patients with acute cerebral infarction were enrolled in this study. Patients underwent a neuropsychological examination on 10 days and 3 months after stroke. The vascular dementia was diagnosed according to Association Internationale pour la Recher- che et 1＇ Enseignement en Neurologie （NINDS-AIREN）. Clinical data, lipid levels and CT/MRI features were analyzed in VD group and Non-VD group. Risk factors for VD were determined by multiple Logistic regression analysis. Results： Eighty-four participants were diagnosed as VD（21.4%）. Results of univariate analysis found that VD was associated with the number of lesions, location of lesions, leukoaraiosis and cerebral atrophy. The multivariate Logistic regression showed that left hemisphere or bilateral lesions （OR = 8.958）, number of lesions （OR = 1.375） and cerebral atrophy （OR = 2.297） were inde- pendent risk factors of VD. There were no significant differences in age, gender, education level, history of hypertension, histo- ry of diabetes, history of coronary heart disease, smoking, drinking and lipid levels between two groups （P 〉 0.05）. Conclu- sions： Vascular dementia is very common after ischemic stroke. The cerebral small vessel disease （SVD） is a major cause of VD. Better understanding of the risk factors for VD should be emphasized to reduce and delay the occurrence of vascular de- mentia.