缺血性脑卒中急性期认知损伤的危险因素及其交互作用研究

Research on the risk factors for cognitive impairment and their interactions in acuteischemic stroke patients

目的 探讨缺血性脑卒中(ischemic stroke, IS)急性期认知损伤的危险因素及相互之间的交互作用。方法 选取绵阳市人民医院神经内科在2019年1月—2022年1月期间连续收住院的IS患者。将纳入患者分为认知损伤和认知正常组。收集研究对象人口学特征和临床资料。采用多因素logistic回归方法和多因子降维法分析IS急性期认知损伤的传统危险因素以及之间的交互效应。结果 共纳入患者255例。其中,认知损伤88例(34.5%),认知正常167例(65.5%)。多因素logistic回归分析结果显示,调整协变量后,结果显示认知损伤组更多见大中面积梗死、非轻型脑卒中、颈动脉中重度狭窄和高超敏C反应蛋白(hypersensitive C-reactive protein, hsCRP)值(P<0.05)。有大中面积梗死和非轻型脑卒中的高hs-CRP的IS患者,发生认知损伤的机率为22.632倍[比值比为22.632,95%置信区间(5.980,85.652),P<0.001]。结论 IS急性期认知损伤发生率较高。大中面积梗死、非轻型脑卒中、颈动脉狭窄、高hs-CRP及非右侧梗死患者易发生认知损伤,且这些风危险因素间有复杂的交互作用。

Objective To evaluate the risk factors for cognitive impairment and their interactions in acute ischemic stroke(IS)patients.Methods IS patients admitted to the Department of Neurology,the People’s Hospital of Mianyang between January 2019 and January 2022 were selected.Patients were divided into a cognitive impairment group and a cognitive normal group.The demographic characteristics and clinical data of the subjects were collected,and the traditional risk factors for cognitive impairment were determined by univariate and multivariate logistic regression analysis.The multifactor dimensionality reduction test was used to detect the possible interactions between risk factors.Results A total of 255 patients were included.Among them,88 cases(34.5%)in the cognitive impairment group and 167 cases(65.5%)in the cognitive normal group.The results of factor logistic regression analysis showed that after adjusting for covariates,big and medium infarction volume,severe IS,moderate to severe carotid artery stenosis as well as high hypersensitive C-reactive protein(hs-CRP)were associated with post-IS cognitive impairment(P<0.05).The cognitive impairment increased by 22.632 times[odds ratio=22.632,95%confidence interval(5.980,85.652),P<0.001]in patients with big and medium infarction volume,severe IS and high hs-CRP.Conclusions The cognitive impairment is common in acute IS.Patients with big and medium infarction volume,nonmild stroke,carotid artery stenosis,high hs-CRP,and non-right sided infarction are prone to cognitive impairment,and there are complex interactions among these risk factors.