首次发病的老年轻型急性缺血性卒中患者肌少症与卒中后认知障碍相关性研究

Association between sarcopenia and post-stroke cognitive impairment in elderly patients with first-time acute minor ischemic stroke

目的:探讨肌少症与首次发病的老年轻型急性缺血性脑卒中患者卒中后认知障碍(PSCI)的相关性。方法:采用前瞻性研究的方法,连续收集2018年10月至2019年6月在西部战区总医院神经内科住院治疗的首次发病的年龄60岁以上的轻型急性缺血性脑卒中患者。入院后24 h(急性期)内行简明肌少症量表(SARC-F)评定,并据此将患者分为非肌少症组(SARC-F<4)和肌少症组(SARC-F≥4)。患者发病24 h内及3个月随访时,采用简易智能状态检查量表(MMSE)评估其认知功能状况。结果:共纳入211例患者,其中肌少症组31例(31/211,14.69%),非肌少症组180例(180/211,85.31%),肌少症组的PSCI发病率高于非肌少症组(83.87%和26/31比55.56%和100/180,χ^(2)=8.814,P=0.003)。评估两组认知域情况发现,肌少症组MMSE总分、定向力、记忆、注意力和计算力、语言能力方面均下降(均P<0.05)。Logistic回归分析显示,在首次发病的老年轻型急性缺血性脑卒中患者中,肌少症是发生PSCI的独立危险因素(OR=3.657,95%CI:1.077~12.411,P=0.038)。结论:肌少症是PSCI发病的独立危险因素,在卒中急性期评估患者肌少症情况可能有助于在临床上判断卒中患者发生PSCI的风险,降低PSCI的发病率。

Objective To investigate the correlation between sarcopenia and post-stroke cognitive impairment(PSCI)in elderly patients with first-time acute minor ischemic stroke.Methods This was a prospective study.Elderly patients over 60 years of age with first-time acute minor ischemic stroke admitted to the Department of Neurology of the General Hospital of Western Theater Command from October 2018 to June 2019 were continuously enrolled.Patients received the SARC-F score assessment within 24h after admission and were divided into two groups according to their SARC-F scores:the non-sarcopenia group(SARC-F score<4)and the sarcopenia group(SARC-F score≥4).Cognitive function was assessed by using the Mini-Mental State Examination(MMSE)within 24 h of admission and at 3-month follow-up.Results A total of 211 patients were enrolled in this study,including 31 patients(31/211,14.69%)in the sarcopenia group and 180 patients(180/211,85.31%)in the non-sarcopenia group.The incidence of PSCI was higher in the sarcopenia group than in the non-sarcopenia group(83.87%or 26/31 vs.55.56%or 100/180,χ^(2)=8.814,P=0.003).The total MMSE score,orientation,immediate memory,attention,calculation and language functions were lower in the sarcopenia group compared with non-sarcopenia group(P<0.05).Logistic regression analysis showed that sarcopenia was an independent risk factor for PSCI(OR=3.478,95%CI:1.039-11.642,P=0.043)in the elderly with first-time acute minor ischemic stroke.Conclusions Sarcopenia is an independent risk factor for PSCI in elderly patients with first-time acute minor ischemic stroke.Sarcopenia assessment in the acute phase of stroke might help doctors to assess the risk of PSCI and reduce the incidence of PSCI in stroke patients.