缺血性卒中合并脑白质疏松症患者认知功能变化及影响因素研究

Cognitive function changes and their influential factors in patients with ischemic stroke and leukoaraiosis

目的探讨缺血性卒中合并脑白质疏松症患者认知功能的变化及其影响因素。方法选取义乌市中心医院2018年1月至2019年10月诊治的缺血性卒中患者500例为观察对象。其中单纯性卒中200例(单纯组)、合并脑白质疏松症300例(合并组),对合并组梗死部位与脑白质疏松程度进行分析,另选同期于该院进行认知功能测试的志愿者150例为对照组,采用简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)对研究对象认知功能进行评定,依照MoCA评分将合并组MoCA评分≥26分的患者纳入认知障碍组、MoCA评分<26分的患者纳入非认知功能障碍组,分析导致缺血性卒中合并脑白质疏松症患者认知功能发生的危险因素。结果对照组MMSE、MoCA、画钟试验(CDT)、词语流畅性试验(VFT)、数字广度测验(DST)评分分别为(28.93±2.70)分、(28.35±2.74)分、(4.69±1.14)分、(4.94±0.42)分、(14.33±1.66)分,单纯组分别为(26.92±2.18)分、(25.02±3.52)分、(3.61±1.60)分、(4.77±0.46)分、(11.73±1.16)分,合并组分别为(24.91±2.79)分、(20.70±3.06)分、(2.87±1.23)分、(4.07±0.85)分、(10.82±0.93)分,三组差异均有统计学意义(F=124.50、318.50、93.43、112.60、428.60,均P<0.001)。不同程度脑白质疏松症患者MMSE、MoCA、CDT、VFT、DST评分差异均有统计学意义(F=69.09、102.40、20.98、60.90、57.00,均P<0.001);Spearman相关性分析结果显示,MMSE、MoCA、CDT、VFT、DST评分与脑白质疏松程度均呈负相关(r=-0.61、-0.69、-0.43、-0.56、-0.44,均P<0.05);logisitic回归分析显示年龄、烟酒史、糖尿病史、脑卒中史、梗死部位为是缺血性卒中合并脑白质疏松症患者认知功能障碍发生的独立危险因素,受教育程度是保护因素。结论缺血性卒中合并脑白质疏松症患者认知功能下降,其下降程度与脑白质疏松程度有关,年龄、烟酒史、糖尿病史、脑卒中史、梗死部位、受教育程度均是认知功能障碍发生的影响因素。

Objective To investigate cognitive function changes and their influential factors in patients with ischemic stroke and leukoaraiosis.Methods A total of 500 patients with ischemic stroke who received treatment in Yiwu Central Hospital from January 2018 to October 2019 were included in this study.They were divided into simple ischemic stroke group(n=200)and ischemic stroke complicated by leukoaraiosis group(combination group,n=300).The infarct location and the degree of leukoaraiosis in the combination group were analyzed.An additional 150 volunteers who concurrently underwent the Cognitive Function Test in the same hospital were selected as controls.Cognitive function was evaluated using the Mini-Mental State Examination(MMSE)and the Montreal Cognitive Assessment(MoCA).Patients in the combination group were divided into cognitive impairment group(MoCA score≥26 points)and non-cognitive impairment group(MoCA score<26 points)according to MoCA score.The risk factors of cognitive impairment in patients with ischemic stroke and leukoaraiosis were analyzed.Results The scores of the MMSE,MoCA,Clock Drawing Test(CDT),Verbal Fluency Test(VFT),and Digit Span Test(DST)in the control group were(28.93±2.70)points,(28.35±2.74)points,(4.69±1.14)points,(4.94±0.42)points,and(14.33±1.66)points respectively.They were(26.92±2.18)points,(25.02±3.52)points,(3.61±1.60)points,(4.77±0.46)points,and(11.73±1.16)points,respectively in the simple ischemic stroke group and(24.91±2.79)points,(20.70±3.06)points,(2.87±1.23)points,(4.07±0.85)points,and(10.82±0.93)points respectively in the combination group.There were significant differences in the scores of the MMSE,MoCA,CDT,VFT,and DST among the three groups(F=124.50,318.50,93.43,112.60,428.60,all P<0.001).Significant differences in the scores of the MMSE,MoCA,CDT,VFT,and DST were observed between patients with different degrees of leukoaraiosis(F=69.09,102.40,20.98,60.90,57.00,all P<0.001).Spearman correlation analysis results showed that the scores of the MMSE,MoCA,CDT,VFT,and DST were negatively correlated with the degree of leukoaraiosis(r=-0.61,-0.69,-0.43,-0.56,-0.44,all P<0.05).Logistic regression analysis results showed that age,history of smoking and drinking,history of diabetes,history of stroke,and infarct location were the independent risk factors for cognitive impairment in patients with ischemic stroke and leukoaraiosis.Education level was a protective factor against ischemic stroke and leukoaraiosis.Conclusion The degree of cognitive impairment in patients with ischemic stroke and leukoaraiosis is related to the degree of leukoaraiosis.Age,history of smoking and drinking,history of diabetes,history of stroke,infarction location,and education level are the influential factors of cognitive impairment.