急性脑梗死伴脑白质疏松症对患者认知功能障碍的影响

Influence of leukoaraiosis on cognitive dysfunction in the patients with acute cerebral infarction

目的 探讨急性脑梗死患者伴脑白质病变对认知功能的影响,并对二者的相关性进行分析。方法 选取2014年1月-2015年4月收住海军总医院的首次发作的急性脑梗死患者,经头颅磁共振成像（MRI）T2加权像进行脑白质病变的判定,将有脑白质病变的患者设为脑白质病变组,共42例,无脑白质病变的患者设为无脑白质病变组,共34例。采用修订后的蒙特利尔认知评估（MoCA）量表进行认知功能的判定;采用胆碱能通路高信号量表（Chips量表）及改良的Scheltens量表对患者的脑白质损害情况进行判定;并对脑白质病变程度与认知功能的相关性进行分析。结果 ①脑白质病变组和无脑白质病变组认知功能评分结果显示,视空间与执行、注意与集中、记忆项目比较,差异均有统计学意义（Z=2.37,P〈0.05;Z=3.24,P〈0.01;Z=4.39,P〈0.01）;两组MoCA量表总分比较,差异有统计学意义（Z=2.97,P〈0.05）。②脑白质病变组中有认知功能障碍与无认知功能障碍患者Chips量表评分、改良Scheltens量表评分比较,差异均有高度统计学意义（t=2.85,P〈0.01;t=3.66,P〈0.01）。③急性脑梗死伴脑白质病变患者认知功能障碍与脑白质病变的相关性分析结果显示：视空间与执行（r=-0.392）、注意与集中（r=-0.487）、定向力（r=-0.438）及MoCA量表总分（r=-0.420）与Chips量表评分呈负相关（均P〈0.01）。注意与集中（r=-0.464）、定向力（r=-0.523）、MoCA量表总分（r=-0.518）与改良Scheltens量表评分呈负相关（均P〈0.01）。结论 急性脑梗死患者脑白质病变与认知功能有关,其严重程度影响着患者认知功能障碍的程度。

Objective To investigate the influence of leukoaraiosis on cognitive dysfunction in the patients with acute cerebral infarction, and to analyze the correlation between them. Methods From January 2014 to April 2015, the patients with the first episode of acute cerebral infarction admitted to Navy General Hospital were collected. Leukoencephalopathy was judged by cranial magnetic resonance imaging（MRI） T2-weighted images. 42 cases of patients with leukoencephalopathy were selected as leukoencephalopathy group and 34 cases of patients without leukoencephalopathy were selected as no-leukoencephalopathy group. Montreal cognitive assessment（MoCA） scale was used to assess cognitive function, cholinergic pathways high signal scale and improved Scheltens scale were used to assess leukoencephalopathy damage. And the correlation between leukoencephalopathy and cognitive function was analyzed. Results① The scores of cognitive function in leukoencephalopathy group and no-leukoencephalopathy group were compared：there were significant differences on items of space and execution, attention and concentration, memory（Z = 2.37, P〈0.05; Z = 3.24, P〈0.01; Z = 4.39, P〈0.01）. MoCA total score in the two groups was compared, the difference was statistically significant（Z = 2.97, P〈0.05）. ② In the leukoencephalopathy group, there were significant differences about the scores of cholinergic pathways high signal scale and improved Scheltens scale in the patients with cognitive dysfunction and without cognitive dysfunction（t = 2.85, P〈0.01; t = 3.66, P〈0.01）.③The correlation of cognitive dysfunction and leukoencephalopathy in the acute cerebral infarction patients with leukoencephalopathy： visuospatial and execution（r =-0.392）, attention and concentration（r =-0.487）, orientation（r =-0.438） and MoCA total score（r =-0.420） were negatively correlated with Chips scale scores（P〈0.01）; attention and concentration（r =-0.464）,orientation（r =-0.523）, MoCA total score（r =-0.518） were negatively correlated with modified Scheltens scale scores（P〈0.01）. Conclusion Leukoencephalopathy is related with cognitive function in the patients with acute cerebral infarction, and the degree of leukoencephalopathy affects the degree of cognitive dysfunction.