急性脑卒中早期认知功能恶化的相关危险因素分析

Analysis of Risk Factors for Early-stage Cognitive Function Deterioration in Patients with Acute Stroke

目的探讨急性脑卒中早期认知功能恶化的相关危险因素,为早期诊断、预防及治疗提供依据。方法选择2018年3月—2018年12月上海交通大学医学院附属新华医院崇明分院收治的急性脑卒中病人100例,采用蒙特利尔认知评估量表(MoCA-B)、简易精神状态量表(MMSE)、临床痴呆量表(CDR)评估早期卒中后认知功能障碍(PSCI)发生情况,收集人口社会学、既往史、各项检查结果及住院期间治疗情况,采用多因素Logistic回归分析早期(脑卒中后3个月)认知功能恶化的危险因素。结果急性脑卒中病人脑卒中后3个月PSCI发生率高于急性期(发病<14 d),差异有统计学意义(P<0.05)。恶化组(n=24)与非恶化组(n=76)年龄、性别、文化程度、既往脑卒中史、糖尿病、糖化血红蛋白(HbA1c)、急性期MMSE、MoCA-B、CDR评分比较,差异均有统计学意义(P<0.05)。年龄、既往脑卒中病史、HbA1c、CDR评分是急性脑卒中病人早期认知功能恶化的独立危险因素(P<0.05);而文化程度是保护性因素(P<0.05)。结论急性脑卒中病人早期PSCI发生率较高,且高龄、文化程度低、既往脑卒中病史、高HbA1c、高CDR评分更易发生早期认知功能恶化,应加强病人认知功能随访,并给予针对性的干预治疗。

Objective To analysis of risk factors for early-stage cognitive function deterioration in patients with acute stroke.Methods One hundred patients with acute stroke were selected.Montreal Cognitive Assessment-B(MoCA-B),Min-i Mental State Examination(MMSE),Clinical Dementia Rating Scale(CDR)were performed to evaluate post-stroke cognitive impairment(PSCI)in early stage.The data of the population sociology,past history,examination results and treatment during hospitalization were collected,and the multiple logistic regression was used to analyze the risk factors of cognitive function deterioration in early stage.Results The incidence of PSCI in patients with acute stroke at 3 months after stroke was significantly higher than that in the acute stage(<14 d,P<0.05).There were significant differences between deterioration group(n=24)and non deterioration group(n=76)in age,gender,cultural degree,history of previous stroke,diabetes,glycosylated hemoglobin(HbA1c),MMSE,MoCA-B,CDR scores in acute phase(P<0.05).Multiple logistic regression analysis results showed that age,previous stroke history,HbA1c,CDR score were the independence of early stage cognitive function deterioration in patients with acute stroke,and cultural degree was the protective factor(P<0.05).Conclusion The incidence of PSCI in the early stage of acute stroke was not low,and early follow-up of cognitive function and targeted intervention should be given to patients of advanced age,low cultural degree,previous history of stroke,high HbA1c,and high CDR score were more likely to contribute early cognitive function deterioration.