缺血性脑卒中后早期发生血管性认知功能障碍的相关因素分析

Analysis of related factors of early vascular cognitive impairment after ischemic stroke

目的 研究缺血性脑卒中后血管性认知功能障碍（VCI）的发生率及相关因素。方法 采用美国国立卫生研究院脑卒中量表（NIHSS）、蒙特利尔认知评估量表（MoCA）对213例缺血性脑卒中患者评定神经系统损害程度及早期血管性认知功能障碍,采用单因素分析和多因素非条件Logistic回归分析评估VCI发生的危险因素。结果本组患者VCI发生率为41.78%。年龄、教育程度、饮酒、吸烟、高血压、血脂异常、冠心病、高糖化血红蛋白、心房颤动、NIHSS评分、同型半胱氨酸、超敏C反应蛋白与缺血性脑卒中后早期发生VCI有关（P〈0.05）,应激性高血糖与无糖尿病缺血性脑卒中患者发生VCI有关（P〈0.05）。多因素非条件Logistic回归分析结果显示,高糖化血红蛋白（OR=2.394,95%CI：1.546~5.261）、高血压（OR=2.185,95%CI：1.413~4.898）、同型半胱氨酸（OR=1.768,95%CI：1.176~3.651）及超敏C反应蛋白（OR=1.964,95%CI：1.164~3.968）是缺血性脑卒中后早期发生VCI的独立危险因素（P〈0.05）,应激性高血糖是无糖尿病缺血性脑卒中患者发生VCI的独立危险因素（OR=1.829,95%CI：1.282~3.287,P〈0.05）。结论 缺血性脑卒中后早期VCI的发生率较高,对患者预后产生不良影响,急性期检测血糖、超敏C反应蛋白及同型半胱氨酸水平有助于预测缺血性脑卒中后早期VCI的发生,合并高血压的患者发生VCI的风险高。

Objective To analyze the incidence and related factors of vascular cognitive impairment （VCI） after ischemic stroke. Methods National Institute of health stroke scale （NIHSS）,Montreal cognitive assessment （MoCA） were used on 213 patients with ischemic stroke to assess the extent of damage to the nervous system and early vascular cognitive dysfunction,univariate analysis and multivariate Logistic regression analysis were used to assess risk factors for VCI. Results The incidence rate of VCI was 41.78%.Age,education level,alcohol consumption,smoking,hypertension,dyslipi- demia,coronary heart disease,high glycated hemoglobin,atrial fibrillation,NIHSS,homocysteine,high-sensitivity C-reac tive protein were related with early VCI after ischemic stroke （P〈0.05）,stress hyperglycemia was related with VCI in pa- tients with non-diabetic ischemic stroke （P〈0.05）.Multivariate Logistic regression analysis showed that,high glycated hemoglobin （OR=2.394,95%CI：1.546-5.261）,hypertension （OR=2.185,95%CI：1.413-4.898）,homocysteine （0R=1.768,95% CI： 1.176-3.651） and high-sensitivity CRP （OR= 1.964,95%CI： 1.164-3.968） were independent risk factors for early VCI after ischemic stroke （P〈0.05）,stress hyperglycemia was the independent risk factor for VCI in patients with non-dia- betes ischemic stroke （OR=1.829,95%CI：1.282-3.287,P〈0.05）. Conclusion The incidence of early VCI after ischemic stroke is higher,has adverse effects on the prognosis of patients,detection of blood glucose,high-sensitivity CRP and ho- mocysteine at acute phase is helpful to predict the early incidence of VCI after ischemic stroke,and the risk of VCI occurrenc is high in patients with hypertension.