基于倾向性评分匹配的轻型缺血性脑卒中危险因素对认知衰弱的影响

The effects of risk factors on cognitive decline in mild ischemic stroke based on propensity score matching

目的探讨轻型缺血性脑卒中(MIS)相关危险因素对老年人发生认知衰弱(CF)的影响,为临床预防以及干预认知衰弱提供科学指导。方法以2021年6月至2022年5月华北理工大学附属医院与唐山南湖医院收治的971例老年轻型缺血性脑卒中患者为研究对象,根据出院后3个月随访是否发生认知衰弱分为认知衰弱组(271例)和无认知衰弱组(700例)。采用倾向性评分匹配的方法对混杂因素进行匹配,使用R 4.2.1软件进行χ^(2)检验和多因素logistic回归分析。结果成功匹配190对研究对象。多因素logistic回归分析结果显示,睡眠时长≤6 h(OR=2.54,95%CI:1.030~4.929)、预后营养指数≤46.3(OR=1.962,95%CI:1.141~3.373)、脑血管病发生次数为1次(OR=2.130,95%CI:1.252~3.624)、脑血管病发生次数≥2次(OR=3.193,95%CI:1.639~6.221)、椎动脉阻力指数>0.67(OR=1.938,95%CI:1.1.233~3.047)、脑白质病变为中或重度(OR=2.091,95%CI:1.276~3.425)是老年轻型脑卒中患者认知衰弱的危险因素。结论轻型缺血性脑卒中相关危险因素促进了老年患者认知衰弱的发生,应重点关注睡眠时间短、预后营养状况较差、有脑血管病病史、椎动脉阻力指数增大和有脑白质病变等脑卒中老年患者的认知衰弱情况。

Objective To explore the effects of relative risk factors of mild ischemic stroke(MIS)in the elderly on cognitive decline(CD),and provide the guidance for clinical prevention and intervention of CD.Methods A cohort of 971 elderly patients with MIS collected from June 2021 to May 2022 was established and divided into the cognitive decline group(271 cases)and no cognitive decline group(700 cases)according to whether cognitive frailty occurred after following-up for 3 months.Confounding factors were matched using propensity score matching,theχ^(2) test and multivariate logistic regression were used to analyze the data,the used software was R 4.2.1.Results The subjects of 190 pairs were successfully matched,the multivariate logistic regression showed that the sleeping duration≤6 h(OR=2.54,95%CI:1.030-4.929),prognostic nutritional index≤46.3(OR=1.962,95%CI:1.414-3.373),cerebrovascular disease with 1 occurrence(OR=2.130,95%CI:1.252-3.624),cerebrovascular disease with≥2 occurrences(OR=3.193,95%CI:1.639-6.221),vertebral artery resistance index>0.67(OR=1.938,95%CI:1.233-3.047),and cerebral white matter lesions with moderate/severe severity(OR=2.091,95%CI:1.276-3.425)were the risk factors of CD in elderly MIS patients.Conclusion The risk factors related to MIS promote the occurrence of CD in elderly patients.It should pay attention to CD in stroke residents with short sleeping duration,poor prognostic nutrition,cerebrovascular disease history,high vertebral artery resistance index and cerebral white matter lesions.