急性部分前循环脑梗死后血管性认知功能障碍的危险因素研究

Study on risk factors of vascular cognitive impairment after acute partial anterior circulation cerebral infarction

目的探讨急性部分前循环脑梗死后6-12个月患者出现血管性认知功能障碍(VCI)的危险因素,并由此建立一个诊断预测模型。方法前瞻性地收集158名急性部分前循环脑梗死患者的人口生物学资料、血管性危险因素和影像学资料,并随访6-12个月,采用美国国立卫生研究院脑卒中量表(NIHSS)评估神经功能缺损程度、蒙特利尔认知评估量表(MoCA)评价患者认知功能,用Logistic逐步回归分析筛选与VCI相关的危险因素,用危险因素建立诊断预测模型,使用受试者工作特征曲线(ROC曲线)评价模型的预测能力。结果共有133名患者完成随访,急性部分前循环脑梗死后6-12个月VCI患病率为38.35%(51/133)。多因素Logistic回归分析发现高NIHSS评分(β=0.264,OR=1.302,95%CI=1.097-1.546)、高同型半胱氨酸(β=0.080,OR=1.083,95%CI=1.001-1.172)、高超敏C反应蛋白(β=0.030,OR=1.031,95%CI=1.008-1.054)、急性非腔隙性病灶(β=1.032,OR=2.806,95%CI=1.098-7.172)、高脑白质病变FAZEKAS评分(β=0.515,OR=1.674,95%CI=1.098-2.553)是急性部分前循环脑梗死后6-12个月出现VCI的独立危险因素(P<0.05)。诊断预测模型曲线下面积(AUC)为0.843(95%CI=0.777-0.908)。结论高NIHSS评分、高同型半胱氨酸、高超敏C反应蛋白、急性非腔隙性病灶、脑白质病变高FAZEKAS评分为急性部分前循环脑梗死后6-12个月发生VCI的独立危险因素,其建立的诊断预测模型可用于预测急性部分前循环脑梗死后6-12个月VCI的发生,有助于筛查脑梗死后发生VCI高危的患者。

Objective To explore the risk factors of vascular cognitive impairment(VCI)in patients 6-12 months after the onset of acute partial anterior circulation cerebral infarction,and to establish a diagnostic predictive model.Methods A total of 158 patients diagnosed with acute partial anterior circulation cerebral infarction were enrolled and followed up for 6-12 months in this study.Data were analyzed based on demographic characteristics,vascular risk factors and imaging data.The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the degree of neurological impairment,and the Montreal Cognitive Assessment Scale(MoCA)was used to evaluate the cognitive function of patients.Logistic stepwise regression analysis was used to screen risk factors related to VCI,and the risk factors were used to establish a diagnostic predictive model.The receiver operating characteristic curve(ROC curve)was used to evaluate the predictive ability of the model.Results 133 subjects completed the 6-12 months follow-up visit,the prevalence of VCI 6-12 months after acute partial anterior circulation cerebral infarction was 38.35%(51/133).Multivariate logistic regression analysis found that high NIHSS score(β=0.264,OR=1.302,95%CI=1.097-1.546),high homocysteine(Hcy)(β=0.080,OR=1.083,95%CI=1.001-1.172),Hypersensitivity C-reactive protein(Hs-CRP)(β=0.030,OR=1.031,95%CI=1.008-1.054),acute non-lacunar lesions(β=1.032,OR=2.806,95%CI=1.098-7.172)and High FAZEKAS score of white matter lesions(β=0.515,OR=1.674,95%CI=1.098-2.553)were independent risk factors for VCI 6-12 months after acute partial anterior circulation cerebral infarction(P<0.05).The area under the curve(AUC)of the diagnostic predictive model was 0.843(95%CI=0.777-0.908).Conclusion High NIHSS score,high homocysteine,high-sensitivity C-reactive protein,acute non-lacunar lesions and High FAZEKAS score of white matter lesions are independent risk factors for VCI 6-12 months after acute partial anterior circulation cerebral infarction.The diagnosis predictive model established by them can be used to predict the occurrence of VCI,and help screen patients with high risk of VCI 6-12 months after acute partial anterior circulation cerebral infarction.