轻型急性缺血性卒中患者认知障碍的危险因素研究

Study on risk factors of cognitive disorder in patients with mild acute ischemic stroke

目的探讨轻型急性缺血性卒中患者出现认知障碍的危险因素。方法选取2015年1月—2018年9月北京中医药大学东方医院脑病科住院的84例轻型急性缺血性卒中患者为研究对象,收集其一般临床资料及生化指标,于发病后第10~14天测评蒙特利尔认知评估(MoCA)量表,按测评结果将其分为无认知障碍组30例(MoCA评分≥26分)和认知障碍组54例(MoCA评分<26分),对两组进行统计分析并探讨。结果认知障碍组年龄、血清同型半胱氨酸(Hcy)水平高于无认知障碍组,而文化程度低于无认知障碍组,差异均有统计学意义(均P<0.05)。两组在性别、既往史、吸烟、饮酒、脑白质脱髓鞘、梗死位置及数目、总胆固醇、低密度脂蛋白、高密度脂蛋白、三酰甘油、空腹血糖等方面比较差异无统计学意义(P>0.05)。多因素logistic回归分析显示,年龄升高[OR=1.071,95%CI(1.010~1.137),P=0.022]、血清Hcy升高[OR=1.102,95%CI(1.002~1.213),P=0.046]是轻型急性缺血性卒中后出现认知障碍的独立危险因素(P<0.05),高文化程度[OR=0.487,95%CI(0.268~0.884),P=0.018]是其独立保护因素(P<0.05)。结论高龄、低文化程度及血清Hcy水平升高与轻型急性缺血性卒中患者发生认知障碍密切相关,而血清Hcy作为可改变的理化因素,如在急性期早期监测并控制其水平可能有助于预防卒中后认知障碍的发生。

Objective To explore risk factors of cognitive disorder in patients with mild acute ischemic stroke.Methods A total of 84 patients with mild acute ischemic stroke admitted to the Department of Encephalopathy,Dongfang Hospital,Beijing University of Chinese Medicine from January 2015 to September 2018 were selected as subjects.Their general clinical data and biochemical indicators were collected.On the 10th to 14th day after stroke,they were evaluated by the Montreal cognitive assessment(MOCA)scale.According to the evaluation results,the patients were divided into the non-cognitive disorder group(30 cases)(MOCA scores≥26 points)and the cognitive disorder group(54 cases)(MOCA scores<26 points).The two groups were statistically analyzed and discussed.Results The age and serum homocysteine(Hcy)level of the cognitive disorder group were higher than those of the non-cognitive disorder group,and the standard of culture was lower than that of the non-cognitive disorder group,the differences were statistically significant(all P<0.05).There were no significant differences between the two groups in gender,previous history,smoking,alcohol consumption,white matter demyelination,infarct location and number,total cholesterol,low density lipoprotein,high density lipoprotein,triglyceride,fasting blood glucose,etc.(P>0.05).Multivariate logistic regression analysis showed that increased age(OR=1.071,95%CI[1.010-1.137],P=0.022)and serum Hcy level(OR=1.102,95%CI[1.002-1.213],P=0.046)were the independent risk factors for cognitive disorder in patients with mild acute ischemic stroke(P<0.05).While the highe standard of culture(OR=0.487,95%CI[0.268-0.884],P=0.018)was its independent protective factor(P<0.05).Conclusion Advanced age,low standavd of culture level and elevated serum Hcy level are closely related to cognitive disorder in patients with mild acute ischemic stroke.As a modifiable physical and chemical factor,monitoring and controlling serum Hcy level in the early acute phase may be helpful to prevent the occurrence of cognitive disorder after stroke.