急性脑梗死患者发生卒中后认知障碍的危险因素分析

Risk factors of cognitive impairment after stroke in patients with acute cerebral infarction

目的分析急性脑梗死(ACI)患者发生卒中后认知障碍(PSCI)的危险因素。方法回顾性分析2017年9月至2019年8月在巴彦淖尔市医院治疗的94例ACI患者的临床资料,根据OCSP分型,将患者分为完全前循环梗死组(TACI组,23例)、部分前循环梗死组(PACI组,25例)、后循环梗死组(POCI组,24例)、腔隙性梗死组(LACI组,24例)。对所有患者进行随访,直至发病后90 d,使用蒙特利尔认知评估量表(MoCA量表)评价患者认知功能,MoCA评分<22分为PSCI组,MoCA评分≥22分为单纯ACI组。分析不同OCSP分型ACI患者PSCI的发生情况。比较PSCI组与单纯ACI组患者美国国立卫生研究院卒中量表(NIHSS)评分(入院时)、日常生活活动能力量表Barthel指数(BI)评分(发病30 d)、血清血清胱抑素C(Cys-c)水平(入院后次日)。分析MoCA评分与NIHSS评分、血清Cys-C水平、BI评分的相关性。结果94例患者PSCI发生率为71.28%,其中PACI组84%,LACI组77.27%,POCI组66.67%,TACI组56.52%。PSCI组患者的NIHSS评分、血清Cys-C水平高于对照组,BI评分低于对照组,差异有统计学意义(P<0.05)。相关分析显示,MoCA评分与NIHSS评分、血清Cys-C水平存在正相关(P<0.05),与BI评分存在负相关(P<0.05)。结论脑梗死OCSP分型与PSCI发生密切相关,NIHSS评分、血清Cys-C水平偏高且发病30 d时BI评分偏低的ACI患者发生PSCI的风险更高,应提高警惕。

Objective To analyze the risk factors of post-stroke cognitive impairment(PSCI)in patients with acute cerebral infarction(ACI).Methods The clinical data of 94 ACI patients treated in Bayannur Hospital from September 2017 to August 2019 were retrospectively analyzed.According to the OCSP classification,the patients were divided into complete anterior circulation infarction group(TACI group,n=23),partial anterior circulation infarction group(PACI group,n=25),posterior circulation infarction group(POCI group,n=24),lacunar infarction group(LACI group,n=24).All patients were followed up until 90 days after the onset of the disease.The Montreal Cognitive Assessment(MoCA)scale was used to evaluate the cognitive function of the patients.MoCA scores less than 22 were assigned to the PSCI group,and MoCA scores≥22 were assigned to the pure ACI group.The occurrence of PSCI in ACI patients with different OCSP classifications was analyzed.The National Institutes of Health Stroke Scale(NIHSS)score(at admission),activities of daily living scale Barthel index(BI)score(30 days after onset),and serum cystatin C(Cys-C)level(the day after admission)were compared between the PSCI group and the simple ACI group.The correlation between MoCA score and NIHSS score,serum Cys-C level and BI score was analyzed.Results The incidence of PSCI in 94 patients was 71.28%,of which 84%were in the PACI group,77.27%in the LACI group,66.67%in the POCI group,and 56.52%in the TACI group.The NIHSS score and serum Cys-C level of the PSCI group were significantly higher than those of the control group,and the BI score was significantly lower than that of the control group,the difference was significant(P<0.05).Correlation analysis showed that MoCA score was positively correlated with NIHSS score and serum Cys-C level(P<0.05),and negatively correlated with BI score(P<0.05).Conclusions The OCSP classification of cerebral infarction is closely related to the occurrence of PSCI.ACI patients with high NIHSS scores,serum Cys-C levels and low BI scores at 30 days after the onset are at higher risk of PSCI,and should be vigilant.