脑梗死部位对患者认知功能的影响及意义

The effect and significance of cerebral infarction location on cognitive function

目的分析脑梗死患者临床资料和认知障碍的变化,评估梗死部位对认知功能的影响及意义。方法本研究为前瞻性观察性研究,纳入2020年1月—2021年1月郑州大学人民医院收治的急性脑梗死患者316例,在发病后2周、发病后6个月、发病后12个月时评估患者认知功能,根据评估结果分为卒中后认知功能下降组(PSCI组,44例)和未下降组(NPSCI组,272例),评估患者认知功能变化情况。结果PSCI组梗死部位累及额叶(15.91%,7/44)、基底节区(13.64%,6/44)、丘脑(18.18%,8/44)的比例高于NPSCI组[额叶(4.78%,13/272)、基底节区(5.51%,15/272)、丘脑(6.62%,18/272)],2组差异有统计学意义(均P<0.05)。对2组认知功能评分进行重复测量方差分析发现,2组患者的认知功能差异有统计学意义(P<0.001),发病后2周与发病后6个月、12个月之间的认知功能差异均有统计学意义(均P<0.001)。广义估计方程显示,认知功能的影响因素为梗死灶累及额叶、基底节区、丘脑(P<0.05);同时发现发病后12个月与发病后2周、发病后6个月的认知功能差异有统计学意义(P<0.05),即时间也是认知功能的影响因素。结论当梗死部位为额叶、基底节区、丘脑时,可能更易出现远期认知障碍。

Objective To analyze the changes of clinical data and cognitive impairment in patients with cerebral infarction,and to evaluate the effect and significance of infarction location on cognitive function.Methods A total of 316 patients with acute cerebral infarction admitted to People's Hospital of Zhengzhou University from January 2020 to January 2021 were enrolled in this prospective observational study.Cognitive function was evaluated at 2 weeks,6 months,and 12 months after the onset of stroke.According to the evaluation,the patients were divided into a post-stroke cognitive decline group(PSCI group,44 cases)and a non-decline group(NPSCI group,272 cases),and the changes of cognitive function were evaluated.Results The proportion of infarction sites involving frontal lobe(15.91%,7/44),basal ganglia(13.64%,6/44)and thalamus(18.18%,8/44)in PSCI group were higher than those in NPSCI group[frontal lobe(4.78%,13/272),basal ganglia(5.51%,15/272)and thalamus(6.62%,18/272)],the differences between the two groups were statistically significant(all P<0.05).Repeated measures analysis of variance showed that the cognitive function scores of the two groups were significantly different(P<0.001).Pairwise comparison showed that there were statistically significant differences between 2 weeks after onset and 6 and 12 months after onset(P<0.001).Further generalized estimating equation showed that there were significant differences in the frontal lobe,basal ganglia and thalamus when the infarction was involved(P<0.05).At the same time,it was found that the difference of cognitive function between 12 months and 2 weeks,6 months after onset was statistically significant(P<0.05),that was,time was also an influencing factor of cognitive function.Conclusion Long-term cognitive impairment is more likely to occur in patients with infarcts located in frontal lobe,basal ganglia and thalamus.