急性脑梗死后认知障碍与血尿酸相关性的多因素分析

Correlation between cognitive disorder after acute cerebral infarction with serum uric acid by multivariate analysis

目的前瞻性研究评估血尿酸(uric acid,UA)与急性脑梗死后认知障碍的相关性。方法 400例连续纳入的急性脑梗死患者根据蒙特利尔认知评估量表(Montreal cognitive assessment,Mo CA)评估分为无认知障碍组及认知障碍组,依据两组患者年龄、性别、吸烟、酗酒、高血压病、糖尿病、脂代谢紊乱、教育程度、关键部位梗死、心房纤颤、血UA、血同型半胱氨酸等认知障碍的潜在危险因素进行单因素分析,将单因素分析有统计学意义的指标作为自变量,以Mo CA评分为因变量进行多元线性回归分析,并依据血UA水平、性别、年龄、TOAST分型等分层进行脑梗死后认知障碍的发生风险比较。结果血UA升高是急性脑梗死后认知障碍的独立影响因素,高UA血症患者相比无高UA血症患者发生脑梗死后认知障碍的风险显著增加(P=0.007),相对危险度是1.350,95%CI(1.098,1.660),尤其对其中的男性、中青年或小动脉闭塞型脑梗死患者,其风险进一步增加,相对危险度分别为1.513,95%CI(1.092,2.096)及1.412,95%CI(1.125,1.771)及1.464,95%CI(1.128,1.900)。结论血UA水平升高是急性脑梗死后认知障碍的独立影响因素,男性患者、中青年患者或、小动脉闭塞型脑梗死患者,脑梗死后认知障碍的风险进一步增加。

Objective To evaluate the correlation between serum uric acid with cognitive disorder after acute cere-bral infarction by prospective study. Methods Four hundred consecutively enrolled patients of acute cerebral infarction were divided into no cognitive impairment group and cognitive impairment group according to the assess of Montreal Cog-nitive Assessment （MoCA）. Univariate analysises were conducted in the potential risk factors of cognitive impairment in-cluding age, sex, smoking, alcohol, hypertension, diabetes, dyslipidemia, level of education, infarction in key parts, atrial fibrillation, serum uric acid, blood homocysteine between two groups. The statistically significant indicators in univariate analysises were used as independent variables and the scores of MoCA were used as the dependent variable to conduct multiple linear regression analysis. The assessment on the risk of cognitive impairment after cerebral infarction were con-ducted according to serum uric acid, sex, age and TOAST classification further. Results Serum uric acid was indepen-dent risk factors of cognitive disorder after acute cerebral infarction. The risk of cognitive disorder after acute cerebral in-farction was significantly increased in patients with high level of serum uric acid than with normal level and the relative risk was 1.35,95%CI（1.098,1.660）. Especially for the young, male or patients with cerebral infarction in classification of small artery occlusion, the risk increased further, and the relative risk was 1.513, 95%CI（1.092, 2.096）1.412, 95%CI （1.125, 1.771）and 1.464, 95%CI（1.128, 1.900）respectively. Conclusion Exaltation of Serum uric acid was indepen-dent risk factor of cognitive disorder after acute cerebral infarction. The risk of cognitive disorder after acute cerebral in-farction was significantly increased in patients with high level of serum uric acid than with normal level, and especially for the young, male and patients with cerebral infarction in classification of small artery occlusion, the risk increased fur-ther.