多发腔隙性脑梗死患者发生认知障碍的影响因素研究

Influencing Factors of Cognitive Impairment in Patients with Multiple Lacunar Infarction

背景多发腔隙性脑梗死(MLI)患者常以认知功能损伤就诊,若不及时干预则可能导致痴呆,进而影响患者的生活质量。因此,寻找MLI患者发生认知障碍的影响因素具有重要的临床意义。目的探讨MLI患者发生认知障碍的影响因素。方法连续选取2021年1—6月华北理工大学附属开滦总医院神经内科收治的MLI患者198例,根据简易智力状态检查量表(MMSE)评分将其分为认知障碍组(MMSE评分<27分,n=94)和无认知障碍组(MMSE评分为27~30分,n=104)。比较两组患者临床资料、梗死灶分布情况、呼吸暂停低通气指数(AHI)、昼夜节律类型量表(CTI)-灵活性/刚性分量表(FR)评分、CTI-困倦/活力分量表(LV)评分、抑郁程度、焦虑程度;MLI患者发生认知障碍的影响因素分析采用多因素Logistic回归分析。结果认知障碍组患者中有饮酒史、高同型半胱氨酸血症(HHcy)病史者所占比例高于无认知障碍组(P <0.05)。认知障碍组患者中额叶梗死、脑桥梗死及基底核梗死者所占比例高于无认知障碍组(P <0.05)。多因素Logistic回归分析结果显示,HHcy病史[OR=2.053,95%CI(1.080,3.900)]、额叶梗死[OR=2.262,95%CI(1.035,4.943)]、AHI[OR=1.030,95%CI(1.005,1.056)]及CTI-FR评分[OR=0.846,95%CI(0.757,0.945)]是MLI患者发生认知障碍的独立影响因素(P <0.05)。结论伴有HHcy、额叶梗死、AHI增加及睡眠生物节律灵活性减弱的MLI患者更易发生认知障碍,应引起临床重视。

Background Patients with multiple lacunar infarction(MLI)are often treated with cognitive impairment.If not intervened in time,it may lead to dementia and affect the quality of life of patients.Therefore,it is of great significance to find the influencing factors of cognitive impairment in patients with MLI.Objective To explore the influencing factors of cognitive impairment in patients with MLI.Methods A total of 198 patients with MLI treated in the Department of Neurology,Kailuan General Hospital,North China University of Science and Technology from January to June 2021 were selected.According to the Mini-Mental State Examination(MMSE)score,they were divided into cognitive impairment group(MMSE score<27,n=94)and non-cognitive impairment group(MMSE score was 27-30,n=104).The clinical data,infarct distribution,apneahypopnea index(AHI),Circadian Type Inventory(CTI)-Flexibility or Rigidity(FR)score,CTI-Lanfuid or Vigorous(LV)score,depression and anxiety were compared between the two groups;multivariate Logistic regression analysis was used to analyze the influencing factors of cognitive impairment in patients with MLI.Results The proportion of patients with drinking history and hyperhomocysteinemia(HHcy)history in the cognitive impairment group was higher than that in the non-cognitive impairment group(P<0.05).The proportion of patients with frontal lobe infarction,pontine infarction and basal ganglia infarction in the cognitive impairment group was higher than that in the non-cognitive impairment group (P < 0.05) . Multivariate Logistic regression analysis showed that HHcy history [OR =2.053, 95%CI (1.080, 3.900) ] , frontal lobe infarction [OR =2.262, 95%CI (1.035, 4.943) ] , AHI [OR =1.030, 95%CI (1.005, 1.056) ] and CTI-FR score [OR =0.846, 95%CI (0.757, 0.945) ] were the independent influencing factors for cognitive impairment in patients with MLI (P < 0.05) . Conclusion MLI patients with HHcy, frontal lobe infarction, increased AHI and decreased flexibility of sleep biological rhythm are more likely to have cognitive impairment, which should be paid more attention in clinical practice.