拉萨地区小动脉闭塞性脑卒中发生认知功能障碍的危险因素分析

Risk factors for cognitive impairment in patients with acute cerebral infarction due to small artery occlusion

目的探索拉萨地区小动脉闭塞性脑卒中发生认知功能障碍患者的危险因素。方法收取2016年1月到2019年12月在西藏自治区人民医院收治的急性小动脉闭塞性脑卒中患者126例,记录临床资料、影像学资料、化验结果和神经心理学评分等。按蒙特利尔认知评估量表(MoCA)的检查结果是否大于26分,分为认知障碍组(48例)和认知功能正常组(78例)。结果2组患者在发病年龄、性别、藏族患者的比例、文化程度、高血压比例、高血脂比例、冠心病比例、同型半胱氨酸增高比例、尿酸增高比例无显著性差异。认知功能障碍组患者糖尿病比例高于认知功能正常组(31.25%vs 14.10%,χ2=5.335,P=0.021)、高原红细胞增多症比例高于认知功能正常组(22.92%vs 8.97%,χ2=4.717,P=0.030)、脑白质病变比例高于认知功能正常组(47.92%vs 24.36%,χ2=7.421,P=0.006),差异均有统计学意义。结论拉萨地区小动脉闭塞性脑卒中的患者并不少见,其中影响认知障碍的因素包括糖尿病,高原红细胞增多症和比较严重的颅内白质病变。

Objective To identify the risk factors for mild cognitive impairment in patients with acute cerebral infarction caused by small artery occlusion in Lhasa,a plateau region.Methods From January 2016 to December 2019,126 patients with acute cerebral infarction caused by small artery occlusion were enrolled at Tibet Autonomous Region People’s Hospital.Clinical data,imaging data,laboratory results,and neuropsychological scores were recorded.According to the evaluation results using the Montreal Cognitve Assessment scale,the patients were divided into a cognitive impairment group(Group 1;n=48)and a normal cognitive function group(Group 2;n=48).Results There was no significant difference between the two groups in age,gender,proportion of Tibetan patients,education level,hypertension,hyperlipidemia,coronary heart disease,HCY,or uric acid.The proportion of patients with diabetes mellitus in Group 1 was significantly higher than that in Group 2(31.25%vs 14.10%,χ2=5.335,P=0.021).The proportion of patients with high altitude polycythemia in Group 1 was 22.92%,and that in Group 2 was only 8.97%;there was a significant difference between the two groups(χ2=4.717,P=0.030).The proportion of patients with intracranial demyelination was significantly higher in Group 1 than in Group 2(47.92%vs 24.36%,χ2=7.421,P=0.006).Conclusion Patients with acute cerebral infarction caused by small artery occlusion are not uncommon in Lhasa area.The risk factors for cognitive impairment include diabetes mellitus,high altitude erythrocytosis,and severe intracranial demyelination.