基于混合增长模型分析老年脑卒中后认知损害动态变化及其相关因素分析

Dynamic Changes and Related Factors of Post-stroke Cognitive Impairment in the Elderly Based on Mixed Growth Model

目的基于混合增长模型分析老年脑卒中后认知损害(PSCI)动态变化情况及其相关因素。方法采用随机抽样法中的分层抽样法抽取2021年3月至2022年2月新疆地区5所综合性医院1321例老年PSCI患者为研究对象,分别在患者入组时(首次确诊为PSCI时)、入组后1个月、入组后3个月、入组后6个月及入组后12个月时间点对患者进行认知功能评估;使用Mplus8.3软件构建老年PSCI变化的混合增长模型,采用Logistic回归分析老年PSCI不同变化轨迹患者的相关影响因素。结果1321例患者在为期12个月的随访中,具备完整老年认知损害知情者问卷量表评分随访数据的共1075例,最终纳入1075例为研究对象。混合增长模型分析显示老年PSCI的发展趋势分为3个类型组:缓解组、平稳组和恶化组。3个组别PSCI的发展均有时间效应,缓解组PSCI评分随时间显著降低,平稳组随时间缓慢降低,恶化组随时间显著升高。Logistic回归分析年龄,吸烟史,合并糖尿病、高血压病,缺血性脑卒中,神经功能损害是影响老年PSCI发展轨迹的影响因素(均P<0.05)。结论老年PSCI发展轨迹具异质性,存在不同类别的发展趋势,其中年龄,吸烟史,合并糖尿病、高血压病,缺血性脑卒中,神经功能损害是其影响因素。

Aim To analyze the dynamic changes and related factors of post-stroke cognitive impairment(PSCI)in the elderly based on mixed growth model.Methods A total of 1321 elderly patients with PSCI were randomly selected from five comprehensive hospitals in Xinjiang from March 2021 to February 2022.The cognitive function of the patients was evaluated at baseline,1 month after enrollment,3 months after enrollment,6 months after enrollment and 12 months after enrollment,respectively.The mixed growth model of the changes of PSCI in the elderly was constructed by using software Mplus 8.3.Logistic regression was used to analyze the related influencing factors of diferent elderly patients with PSCI change trajectory.Results During the 12-month follow-up of 1321 patients,there were 1075 patients with complete follow-up data of IQCODE scale,and finally 1075 patients were included.The mixed growth model analysis showed that the development trend of elderly PSCI can be divided into three types,namely remission group,stable group and deterioration group.The development of PSCI in the three groups has time effect.The PSCI scores of the remission group decreased significantly with time,the stable group decreased slowly with time,and the deterioration group increased significantly with time.Logistic regression analysis showed that age,smoking,diabetes,hypertension,ischemic stroke and neurological function are the influencing factors for the development of senile PSCI(P<0.05).Conclusion The development track of senile PSCI is heterogeneous and there are different types of development trends,among which age,smoking,diabetes,hypertension,ischemic stroke and neurological function are the influencing factors.