脑微出血对髋关节置换术后患者认知功能障碍的影响

Correlation between postoperative cognitive dysfunction and cerebral microbleeds in patients with hip arthroplasty

目的探讨脑微出血与髋关节置换术后患者认知功能障碍的相关性。方法选取择期行单侧髋关节置换术术前MRI检查提示有脑微出血分为脑微出血(脑微出血组)和无脑微出血的患者(对照组)各60例,比较两组患者的临床资料,应用蒙特利尔认知评价量表(Mo CA)进行认知评价,行常规序列MRI以及磁敏感加权成像(SWI)检测是否有新发脑微出血。术后3个月有新发脑微出血者再与无新发脑微出血者的临床资料再作比较。采用logistics回归分析术后发生认知功能障碍的危险因素。结果脑微出血组术后7d、3个月Mo CA总分[(22.98±3.43)、(22.12±3.15)分]低于对照组[(24.58±2.20)、(23.62±2.37)分],差异均有统计学意义(均P<0.01)。新发脑微出血组患者有糖尿病病史患者占比(64.4%)、糖化血红蛋白(Hb A1c)[(7.26±1.64)%]多于或高于无新发脑微出血组[26.7%、(6.44±1.41)%],术后3个月Mo CA总分[(21.18±2.24)分]低于无新发脑微出血组[(23.88±2.74)分],差异均有统计学意义(P<0.05或0.01)。既往有脑微出血和糖尿病病史、术前脑微出血病灶数均为发生术后认知功能障碍的危险因素(OR=45.694、63.877、3.762,P<0.05或0.01),术前脑微出血预测认知功能障碍阈值的ROC曲线提示最佳脑微出血病灶数阈值为5.5,灵敏度55.1%,特异度77.4%,Youden指数=0.325。结论脑微出血为发生术后认知功能障碍的危险因素之一,脑微出血病灶数及糖尿病病史均与术后认知功能障碍密切相关。

Objective To investigate the correlation between postoperative cognitive dysfunction （POCD） and cerebral microbleed（CMB） in patients with hip arthroplasty. Methods One hundred and twenty patients undergoing hip arthroplasty in our hospital were recruited, including 60 cases with CMB after surgery and 60 patients without CMB （control group）. The Montreal Cognitive Assessment（MoCA） was used to evaluate the cognitive status; conventional MRI sequences and susceptibility- weighted imaging （SWI） were used to detect CMBs. Results Compare with the control group, MoCA scores in CMB group 7 clays and 3 months after operation were significantly decreased. The proportion of patients with diabetes history and glycosylated hemoglobin levels in CMB group was higher than those in control group. The MoCA scores in CMB group significantly lower than those in control group 3 months after surgery. Logistic regression analysis showed that previous CMB history （OR=45.694, P〈 0.05）, diabetes history （OR=63.877, P 〈0.01）, preoperative CMB number （OR=3.762, P〈0.05） were the risk factors for postoperative cognitive dysfunction. ROC curve showed that with CMB 5.5 as cut-off value, the sensitivity, speciality and Youden＇s index for predicting cognitive dysfunction were 55.1%, 77.4% and 0.325. Conclusion CMB is a risk factor for the oc- currence of postoperative cognitive dysfunction. The numbers of CMBs and history of diabetes are closely associated with post- operative cognitive dysfunction.