缺血性脑卒中脑白质病变对认知功能及预后影响的研究

The relationship between cognitive impairment,prognosis and white matter lesions in ischemic stroke patients

目的:探讨缺血性脑卒中脑白质病变(WML)对认知功能及预后的影响。方法:选取2015年1月至2016年1月本院神经内科收治的缺血性脑卒中伴WML患者80例作为观察组,同期选取在本院神经内科就诊的缺血性脑卒中不伴WML患者80例作为对照组。两组患者均给予抗血小板聚集(阿司匹林肠溶片100mg/d或氯吡格雷片75mg/d)及他汀类药物治疗。随访1年后,采用蒙特利尔认知评估量表(MoCA)和改良Rankin量表评分(mRs)对两组患者的认知功能和神经功能进行评估。结果:观察组患者认知障碍发生率为72.50%,显著高于对照组的32.50%(P<0.05);与对照组相比,观察组在MoCA总分、视空间与执行能力、注意力与计算力、抽象理解、延迟记忆、定向力等方面显著降低,差异有统计学意义(P<0.05);观察组病死率、预后不良(mRs≥2分)的比例明显高于对照组(P<0.05)。结论:缺血性脑卒中患者脑白质受损与认知功能障碍密切相关,且预后较差。

Objective:To study the relationship between cognitive impairment and prognosis of ischemic stroke patients with white matter lesions(WML).Methods:80 ischemic stroke patients with WML treated in our hospital from January 2015 to January 2016 were selected as an observation group.80 ischemic stroke patients without WML were selected as a control group.After one year,the Montreal Cognitive Assessment Scale(MoCA)score and the modified Rankin scale(mRs)score were assessed.Results:The incidence of cognitive impairment in the observation group(72.50%)was significantly higher than that in the control group(32.50%)(P<0.05).The total score of MoCA and the scores of visual space execution ability,attention and computational power,abstract understanding,delayed memory,orientation etc.in the observation group were significantly lower than those in the control group(P<0.05).The mortality rate and the proportion of poor prognosis(mRs score≥2)in the observation group was notably higher than that in the control group(P<0.05).Conclusion:The WML in patients with ischemic stroke was closely related to cognitive impairment,and the prognosis was poor.