急性脑梗死后继发认知功能障碍的危险因素及预后探讨

Risk Factors and Prognosis of Patients with Secondary VCI after ACI

目的探讨急性脑梗死后继发认知功能障碍(VCI)的危险因素及其对预后的影响。方法根据认知功能受损情况将105例急性脑梗死患者分为VCI组(47例)和非VCI组(58例),回顾性分析其临床资料,以logistic回归分析筛选VCI的危险因素,对比两组发病1、3个月后的日常生活能力。结果两组空腹血糖受损、糖尿病、高血压、饮酒、抑郁、梗死灶、美国国立卫生研究院卒中量表(NIHSS)评分、血清高密度脂蛋白胆固醇(HDLC)和超敏C反应蛋白(hs-CRP)水平差异显著(P<0.05或P<0.01),其中糖尿病、高血压、梗死灶、NIHSS评分、血清HDL-C和hs-CRP水平为VCI的独立危险因素(P<0.05);两组治疗3个月后Barthel评分显著高于治疗1个月的评分(P<0.01),组间比较,非VCI组评分均显著高于VCI组(P<0.01)。结论糖尿病、高血压、梗死灶、NIHSS评分、血清HDL-C和hs-CRP水平为急性脑梗死继发VCI的独立危险因素,且发生VCI的患者预后显著差于未发生VCI的患者,临床应积极干预相关因素,预防VCI发生,改善患者预后。

Objective To explore the risk factors of secondary VCI（vascular cognitive impairment） after ACI （acute cerebral infarction） and their influence on prognosis. Methods A total of 105 ACI patients were divided into VCI group （n= 47） and non-VCI group （n= 58） according to their cognitive impairment condition. The clinical data of both groups were retrospectively analyzed and the risk factors of VCI were screened by logistic regression analysis and ADL （activities of daily living） was compared between the two groups after 1 and 3 months of onset respectively. Results There were significant differences between two groups in terms of impairment of fasting blood glucose, diabetes, hypertension, drinking, depression, infarction nidi and NIHSS（National Institutes of Health Stroke Scale） as well as serum HDL-C（high density lipoprotein cholesterol） and hs-CRP （hypersensitive c reactive protein） （P〈0. 05 or P〈0.01） among which diabetes, hypertension, infarction nidi, NIHSS score as well as serum HDL-C and hs-CRP levels were the independent risk factors for VCI （P〈 0. 05）. Barthel scores were evidently higher in both groups after 3 monthsr treatment than 1 monthrs treatment （P〈0.01） and those of non- VCI group were markedly higher than VCI group （P〈0. 01）. Conclusion Diabetes, hypertension, infarction nidi, NIHSS score as well as serum HDL-C and hs-CRP levels are the independent risk factors for VCI and the prognosis of VCI patientsr is prominently poorer than that of non-VCI patients. Positive interventions on relevant factors should be implemented in clinic to prevent the development of VCI and improve patients＇ prognosis.