高血压脑出血患者的认知功能障碍与白质缺血性病变的关系

Relationship between cognitive dysfunction and white matter ischemic lesions in patients with hypertensive intracerebral hemorrhage

目的探讨高血压脑出血(HCH)认知功能障碍(MCI)与白质缺血性病变的关系。方法本研究对象为2020年2月~2022年2月我院100例HCH患者,采用蒙特利尔认知评估量表(MoCA)评估患者的认知功能,并设为MCI组以及非MCI组,比较两组患者性别、年龄、神经功能障碍程度等病历资料,MRI检查评估白质缺血性病变程度、位置、评分等,采用单因素、多因素分析HCH MCI与病历资料及白质缺血性病变的关系。结果100例HCH患者发生MCI45例;MCI组与非MCI组在年龄、受教育年限、Barthel指数评定量表(MBI)、美国国立卫生研究院卒中量表(NIHSS)、血肿体积、同型半胱氨酸(hcy)水平方面差异具有统计学意义(P<0.05);两组性别、体质指数差异无统计学意义(P>0.05);MCI组与非MCI组白质缺血性病变评分、部位以及严重程度差异具有统计学意义(P<0.05);二元Logistic回归分析显示,年龄、MBI评分、NIHSS评分、血肿体积、hcy水平、白质缺血性病变评分、室周病变、重度病变是HCH MCI的独立危险因素。结论HCH患者MCI发生率较高,与神经功能以及白质缺血性病变等有关。

Objective To investigate the relationship between cognitive impairment(MCI)and white matter ischemic lesions in patients with hypertensive intracerebral hemorrhage(HCH).Methods A total of 100 HCH patients in our hospital from February 2020 to February 2022 were selected as the study subjects.The Montreal Cognitive Assessment(MoCA)scale were used to assess patient cognitive function,and they were set as the MCI group and non-MCI group.The medical records such as gender,age,and degree of neurological dysfunction between the two groups of patients were compared.The MRI examination were used to evaluate degree,location and score of white matter ischemic lesions.Univariate and multivariate analysis were used to evaluate the risk factors of MCI in HCH patients.Results Forty-five cases of MCI in 100 HCH patients.There were difference between MCI group and non-MCI group in terms of age,years of education,Barthel Index(MBI),National Institutes of Health Stroke Scale(NIHSS),hematoma volume,homocysteine(hcy)level and other medical records(P<0.05).There was no significant difference in gender and body mass index between the two groups(P>0.05).There were statistically significant differences in the score,location and severity of white matter ischemic lesions between the MCI group and the non-MCI group(P<0.05).Binary Logistic regression analysis showed that age,MBI score,NIHSS score,hematoma volume,hcy level,grade 3 white matter ischemic lesions,periventricular lesions,and severe lesions were independent risk factors of MCI in HCH patients.Conclusion The higher incidence of MCI in HCH patients is related to motor function,neurological function,and white matter ischemic lesions.