脑卒中患者认知功能情况及血管性认知障碍的影响因素

Cognitive function and the influencing factors of vascular cognitive impairment in stroke patients

目的探讨脑卒中患者认知功能情况及血管性认知障碍(VCI)的影响因素。方法选取122例脑卒中患者,采用蒙特利尔认知评估(MoCA)量表评估患者认知功能并分组。MoCA评分24~30分的患者为认知功能正常组(正常组),20~23分的患者为非痴呆型血管性认知障碍组(VCIND组),0~19分的患者为血管性痴呆组(VaD组)。采集患者外周血进行同型半胱氨酸(Hcy)、超敏C反应蛋白(hsCRP)、IL-6、TNF-α检测。结果根据MoCA评分,122例患者分为正常组(30例)、VCIND组(30例)、VaD组(62例)。三组间文化程度、Hcy、IL-6、TNF-α的差异有统计学意义(均P<0.05)。MoCA评分与hsCRP、Hcy、IL-6、TNF-α呈负相关(r=-0.179,P=0.049;r=-0.258,P=0.004;r=-0.644,P<0.001;r=-0.723,P<0.001)。Logistic回归分析结果显示,文化程度是VCI的保护因素(OR=0.270,P=0.006),IL-6、TNF-α是VCI的危险因素(OR=7.756,P=0.002;OR=10.020,P=0.042)。结论脑卒中患者hsCRP、Hcy、IL-6、TNF-α水平越高,MoCA评分越低。文化程度是VCI的保护因素,IL-6、TNF-α是VCI的危险因素。

Objective To investigate the cognitive function of stroke patients and the influencing factors of vascular cognitive impairment(VCI). Methods The cognitive function of 122 patients with stroke was evaluated by the Montreal cognitive assessment(MoCA) scale. Patients with MoCA score of 24 to 30 minutes were in the normal cognitive function group(normal group), patients with 20 to 23 points were in the non-dementia vascular cognitive impairment group(VCIND group), and patients with 0 to 19 points were in the vascular dementia group(VaD group). The peripheral blood was collected for the detection of homocysteine(Hcy), hypersensitive C reactive protein(hsCRP), IL-6 and TNF-α. Results According to the MoCA score, 122 patients were divided into normal groups(30 cases), VCIND group(30 cases), and VaD group(62 cases). There were significant differences among the three groups in literacy, Hcy, IL-6 and TNF-α(all P<0.05). MoCA score was negatively correlated with hsCRP, Hcy, IL-6, TNF-α(r=-0.179, P=0.049;r=-0.258, P=0.004;r=-0.644, P<0.001;r=-0.723, P<0.001). The results of Logitic regression analysis showed that the degree of education was a protective factor for VCI(OR=0.270, P=0.006), and IL-6, TNF-α were risk factors for VCI(OR=7.756, P=0.002;OR=10.020, P=0.042). Conclusions The higher the hsCRP, Hcy, IL-6, TNF-α levels in stroke patients, the lower the MoCA score. Literacy is a protective factor for VCI, and IL-6 and TNF-α are risk factors for VCI.