脑卒中后早期血管性认知功能障碍发生的危险因素分析

Risk factors of vascular cognitive impairment in patients after stroke at early stage

目的探讨脑卒中后早期血管性认知功能障碍发生的相关危险因素。方法分析徐州市中心医院神经内科自2008年至2010年收治的300例新发脑卒中患者的年龄、性别、血压、血脂、糖化血红蛋白、超敏C反应蛋白、同型半胱氨酸、房颤、烟酒嗜好、病灶部位等相关临床资料，并于发病30d后评估蒙特利尔认知量表得分以确认有无血管性认知功能障碍发生．应用单因素和多因素Logistic回归分析显示影响其发生的危险因素。结果单因素分析显示：年龄、糖化血红蛋白、房颤、收缩压、关键部位病灶、超敏C反应蛋白、同型半胱氨酸与脑卒中后早期血管性认知功能障碍显著相关。进一步Logistic回归分析显示：糖化血红蛋白、收缩压、关键部位病灶、超敏C反应蛋白、同型半胱氨酸是其独立危险因素（OR=1．489，P=0．021，95％CI：1．054～1．956；OR=1．134，P=0．027，95％CI：1．011-1．130；OR=3．124，P=0．028，95％CI：1．167-3．012；OR=2．476，P=-0．029，95％CI：1．897～2．245：OR=2．132，P=0．032，95％CI：1．097-2．323）。结论糖化血红蛋白、收缩压、关键部位病灶、超敏C反应蛋白、同型半胱氨酸等资料可以作为脑卒中后早期血管性认知功能障碍发生的预测指标。

Objective To analyze the risk factors of vascular cognitive impairment in patients after stroke at early stage. Methods Three hundred patients with stroke at early stage were chosen in our study; their age, gender, levels of blood pressure, lipids and HbAlc, homocysteine （Hcy）, and high-sensitivity C-reactive protein （HS-CRP）, atrial fibrillation, smoking, drinking and lesion sites were detected. Based on the scores in Montreal Cognitive Scale 30 d after the onset, statistical analysis was performed on the above factors. Results Univariate analysis showed that age, atrial fibrillation, levels of HbAlc and blood pressure, lesion sites, HS-CRP level, and Hey level were significantly associated with the vascular cognitive impairment. Further logistic regression analysis indicated that levels of HbA1 c and blood pressure, and lesion sites, and HS-CRP and Hcy levels were the independent risk factors （OR=1.489, P=0.021, 95%CI： 1.054-1.956; OR=1.134, P=0.027, 95%CI： 1.011-1.130; OR=3.124, P=- 0.028, 95%CI： 1.167-3.012; OR=2.476, P=0.029, 95%CI： 1.897-2.245; OR=2.132, P=0.032, 95%CI： 1.097-2.323）. Conclusion Levels of HbAlc and blood pressure, and lesion sites, and HS-CRP and Hcy levels can serve as the predictive indexes of vascular cognitive impairment in patients after stroke at early stage.