缺血性卒中后认知功能障碍危险因素分析

Study on the risk factors of the cognitive dysfunction after ischemic stroke

目的探讨缺血性卒中后认知障碍的危险因素。方法共收集535例发病24h内入院的缺血性卒中患者,根据简易精神状态检查量表(MMSE)评分分为正常组(435例)和异常组(100例),对所有患者均在24h内进行MMSE评分、美国国立卫生研究院卒中量表(NIHSS)评分、脑CT和(或)磁共振成像检查,并完成血清尿酸、血糖、血脂、肝功能、肾功能、血常规等的测定,同时收集患者的基本信息。结果由按α=0.05引入水准,进行逐步logistic回归分析可见,NIHSS评分、血小板(PLT)异常,低密度脂蛋白(LDL)异常,血尿酸异常,年龄>60岁以上是影响患者MMSE评分异常的主要因素,尤其是PLT异常和NIHSS评分异常。患者年龄>60岁是年龄≤60岁患者MMSE出现异常风险的2.196倍,血尿酸异常的患者出现MMSE异常的风险是正常范围内患者的1.600倍;PLT异常的患者出现MMSE异常的风险是血小板在正常范围内患者的7.397倍;NIHSS评分异常的患者出现MMSE异常的风险是NIHSS评分正常患者的2.860倍;LDL异常的患者出现MMSE异常的风险是LDL正常范围内患者的2.189倍。结论血尿酸异常、年龄偏大、NIHSS评分异常、PLT异常、LDL异常均与MMSE评分密切相关,血尿酸、NIHSS评分结果等因素可以作为早期预测患者发生缺血性卒中后认知障碍的重要因素,为临床较早地对卒中患者进行干预提供了很好的理论基础。

Objective To investigate the risk factors of cognitive dysfunctions after ischemic stroke.Methods According to the mini-mental state examination（MMSE）scores,a total of 535 patients collected within 24 hours from onset of ischemic stroke were divided into 2groups：normal group（435cases）and abnormal group（100cases）.In 24 h,all patients underwent MMSE score,NIHSS（national institutes of health stroke scale score）,brain CT and/or MRI examination,then took the determination of their serum uric acid,blood glucose,blood lipid,liver function,renal function and routine blood test etc.Results Through the logistic regression analysis based onα= 0.05,it was showed that NIHSS score,platelet（PLT）abnormality,low-density lipoprotein（LDL）abnormality and blood uric acid abnormality,the age over 60 years old were the mainly effective factor,for MMSE score,particularly PLT and NIHSS score abnormalities appeared more obvious.The risk of MMSE abnormalities was 2.196 times higher in those patients aged over 60 years old than that in the patients aged below 60 years old,and the risk of MMSE abnormalities was 1.600 times higher in those patients with blood uric acid abnormality than that in the patients whose blood uric acid were in normal range;the risk of MMSE abnormalities was 7.397 times higher in those patients with PLT abnormality than that in the patients whose PLT were in normal range;the risk of MMSE abnormalities was 2.860 times higher in those patients with NIHSS score abnormalities than that in the patients with NIHSS score normality;the risk of MMSE abnormalities was 2.189 times higher in those patients with LDL abnormality than that in the patients whose LDL were in normal range.Conclusion All these abnormalities such as serum uric acid abnormality,age-older,NIHSS score abnormality,PLT and LDL abnormalities were closely related with MMSE score,blood uric acid,NIHSS score and other factors which could be considered as main factors for early predicting the cognitive dysfunction after ischemic stroke.It could provide theoretical basis for early clinical intervention of stroke patients.