青年卒中后认知障碍的危险因素分析

Analysis of Risk Factors of Post-stroke Cognitive Impairment in Young Stroke Patients

目的探讨青年卒中后认知障碍(post-stroke cognitive impairment,PSCI)的危险因素。方法连续收集2016年12月-2017年12月在天津市环湖医院神经内科住院的18～45岁的缺血性卒中患者165例,记录患者人口学资料、血管危险因素、实验室检查资料,所有患者于发病14 d内行蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)测评,根据MoCA评分<26分认为认知功能障碍,分为PSCI组和认知功能正常组,采用多因素Logistic回归分析青年PSCI的独立危险因素。结果研究共纳入165例青年卒中患者,其中男性128例(77.6%),平均年龄(40.02±5.20)岁。青年卒中发病14 d内出现PSCI的比例为64.8%(107例)。多因素Logistics回归分析显示较低受教育程度[比值比(oddsratio,OR)6.752,95%可信区间(confidenceinterval,CI)1.385～32.906,P=0.018]、入院时NIHSS评分较高(OR 1.660,95%CI 1.372～2.009,P<0.001)、既往缺血性卒中(OR 3.728,95%CI1.376～10.104,P=0.010)是青年PSCI的独立危险因素。结论青年PSCI的患病率仍较高,较低受教育程度、入院时NIHSS评分较高、既往缺血性卒中的患者PSCI风险更高。

Objective To investigate the risk factors of post-stroke cognitive impairment(PSCI)in young ischemic stroke patients.Methods Young patients(age 18-45 years)with ischemic stroke in neurology department of Tianjin Huanhu hospital from December 2016 to December 2017 were enrolled consecutively.Demographic information,vascular risk factors,laboratory test results were collected.All of the patients were assessed by Montreal cognitive assessment(MoCA)scale within 14 days from onset.According to the MoCA score,all patients were divided into PSCI(MoCA score<26)group and normal cognitive function group.Multivariate Logistic regression analysis was used to analyze the independent risk factors of young PSCI.Results A total of 165 young patients(mean age 40.02±5.20;77.6% male)were identified,and 64.8%(n=107)had PSCI within 14 days from onset.Multivariate Logistic regression analysis showed that the lower level of education [odds ratio(OR)6.752,95% confidence interval(CI)1.385-32.906,P=0.018],higher NIHSS score on admission(OR 1.660,95%CI 1.372-2.009,P<0.001),previous ischemic stroke(OR 3.728,95%CI 1.376-10.104,P=0.010)were independent risk factors of PSCI in young adult stroke patients.Conclusions The prevalence of PSCI in young people is still high,especially those with lower level of education,higher NIHSS score on admission and previous ischemic stroke,should be paid more attention to screen PSCI.