颅脑损伤患者损伤部位与继发血管性痴呆的相关性研究

Study on the correlation between brain injury portions with secondary vascular dementia in patients with brain injury patients

目的探讨颅脑损伤患者脑组织损伤部位与继发血管性痴呆(VaD)的相关性。方法收集51例颅脑损伤患者入院后的影像学检查结果,采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(Mo CA)、Addenbrooke改良认知评估量表(ACE-R)评估患者脑卒中后6个月的认知功能,以患者是否继发VaD为因变量,脑组织损伤部位、损伤程度等因素为自变量,采用单因素和多因素Logistic回归分析研究不同损伤部位对于患者继发认知功能障碍的影响。结果 51例颅脑损伤患者中5例失访。依据随访结果,最终35例患者继发VaD,11例患者认知功能正常。单因素Logistic回归分析显示,左半球额叶、左半球颞叶、左半球枕叶、下丘脑、后丘脑、弥漫性轴索损伤、多发病灶对颅脑损伤患者继发VaD产生影响(P均<0.05),多因素Logistic回归分析显示,左半球额叶、左半球枕叶、弥漫性轴索损伤、多发病灶进入回归模型(P均<0.05)。结论左半球额叶、左半球枕叶及弥漫性轴索损伤、多发病灶损伤是颅脑损伤患者继发VaD的危险因素,应及时予以临床干预。

Objective It is to investigate the correlation between severe brain injury portions with secondary vascular dementia（ VaD） in brain injury patients. Methods Imaging findings of 51 brain injury patients after admission were collected,Mini- Mental State Examination（ MMSE）,Montreal Cognitive Assessment（ Mo CA）,Addenbrooke improved cognitive assessment（ ACE- R） were used to assess the cognitive function of the patients in six months after stroke,whether with secondary VaD as the dependent variable,brain tissue injury site as independent variables,using univariate and multivariate logistic regression analysis to study the effect of different lesion on cognitive dysfunction of the patients. Results Five patients were lost to follow-up. Based on the results of following-up,there were 35 patients with secondary final VaD,11 patients with normal cognitive function. Univariate logistic regression analysis showed that： the frontal lobe（ left）,temporal lobe（ left）,occipital（ left）,hypothalamus,metathalamus,diffuse axonal injury,multiple lesions were related with severe head injury secondary impact VaD（ P 0. 05）. Multivariate logistic regression analysis showed that： the left hemisphere frontal,occipital lobe of the left hemisphere,diffuse axonal injury,multiple lesions entered the regression model（ P 0. 05）. Conclusion Located in the left hemisphere frontal,occipital and left hemisphere diffuse axonal injury,multiple lesions in patients with severe traumatic brain injury are injury secondary VaD risk factors,clinical interventions should be timely used.