高血压合并腔隙性脑梗死患者认知功能障碍的影响因素分析

Influencing factors of cognitive dysfunction in hypertension patients with lacunar cerebral infarction

目的探讨高血压合并腔隙性脑梗死患者认知功能障碍的影响因素。方法选择2018年1月~2021年1月衢州市人民医院神经内科收治的原发性高血压患者159例,依据是否并发腔隙性脑梗死分为单发组97例,并发组62例。并发组又根据认知功能情况分为认知正常组47例,认知障碍组15例。收集患者一般临床资料,行简易智能状态检查量表(MMSE)评价认知功能。分别行单因素分析和多因素logistic回归分析。结果并发组入院时MMSE评分明显低于单发组[(22.65±2.14)分vs(29.68±2.52)分,P<0.01],认知功能障碍比例明显高于单发组(24.2%vs 6.2%,P<0.01)。认知障碍组饮酒、高血压病程、冠心病、颈部血管斑块、脑动脉硬化、夜间平均收缩压、24 h脉压明显高于认知正常组,年龄、受教育年限、昼间平均舒张压、夜间平均舒张压和24 h平均舒张压明显低于认知正常组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,年龄、受教育年限、颈部血管斑块、夜间平均收缩压是高血压并发腔隙性脑梗死的独立影响因素(OR=3.597,95%CI:1.656~8.265,P=0.001;OR=0.462,95%CI:0.266~0.966,P=0.035;OR=3.792,95%CI:1.655~9.034,P=0.002;OR=2.257,95%CI:1.070~4.358,P=0.028)。结论年龄、受教育年限、冠心病、颈部血管斑块、夜间收缩压是高血压伴腔隙性脑梗死患者认知功能障碍的主要影响因素。

Objective To study the influencing factors of cognitive dysfunction in hypertension patients with lacunar cerebral infarction(LCI).Methods One hundred and fifty-nine primary hypertension patients admitted to our hospital from January 2018 to January 2021 were divided into single LCI group(n=97) and concurrent LCI group(n=62).The patients in concurrent LCI group were further divided into cognitive impairment group(n=15) and cognitive impairment-free group(n=47).Their general clinical data were recorded and their cognitive function was evaluated according to their MMSE scale score and analyzed by univariate logistic regression analysis and multivariate logistic regression analysis respectively.Results The MMSE scale score on admission was significantly lower while the incidence of cognitive dysfunction was significantly higher in concurrent LCI group than in single LCI group(22.65±2.14 vs 29.68±2.52,24.2% vs 6.2%,P<0.01).The history of alcohol consumption and the course of hypertension were significantly longer, the incidence of CHD,cervical vascular plaques and cerebral arteriosclerosis, nighttime average SBP and 24 h pulse pressure were significantly higher while the age was significantly younger, the education time was significantly shorter, the daytime, nighttime and 24 h average DBP were significantly lower in cognitive impairment group than in cognitive impairment-free group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that age, education time, cervical vascular plaques, and nighttime average SBP were independent influencing factors of cognitive impairment in hypertension patients with LCI(OR=3.597,95%CI:1.656-8.265,P=0.001;OR=0.462,95%CI:0.266-0.966,P=0.035;OR=3.792,95%CI:1.655-9.034,P=0.002;OR=2.257,95%CI:1.070-4.358,P=0.028).Conclusion Age, education time, CHD,cervical vascular plaques and nighttime SBP are the major influencing factors of cognitive impairment in hypertension patients with LCI.