首发脑梗死患者危险因素对认知功能障碍程度的影响

Effects of cerebral infarction risk factors on the degree of cognitive impairment in patients with first cerebral infarction

目的探讨首发脑梗死患者危险因素对认知功能障碍程度的影响。方法纳入我院于2013年12月至2015年12月期间收治的102例首发脑梗死患者为观察组,同期随机抽取年龄相匹配的55例体检人群为对照组。两组受检者均采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(Mo CA)、Addenbrooke改良认知评估量表(ACE-R)评估认知功能,并测定血压、血糖、颈动脉粥样硬化性斑块等脑梗死相关危险因素。比较两组受检者的血压、血糖、颈动脉粥样硬化性斑块情况,并分析各项危险因素对认知功能障碍程度的影响。结果与对照组比较,观察组患者合并有高血压、糖尿病、颈动脉粥样硬化斑块人数的比例明显增加(21.81%vs 86.27%;14.54%vs25.49%;36.36%vs 90.20%),差异均有统计学意义(P<0.05),观察组患者的MMSE、Mo CA和ACE-R量表评分降低[(27.55±2.10)分vs(23.96±3.54)分;(27.29±2.31)分vs(24.33±3.4)分;(86.41±4.69)分vs(60.23±14.18)分],差异均有统计学意义(P<0.05)。观察组患者的血压水平越高,认知功能水平越差,差异有统计学意义(P<0.05),三种量表均较敏感;观察组患者血糖控制情况越差,认知功能水平越差,差异有统计学意义(P<0.05),以MMSE及Mo CA量表敏感;观察组患者的颈动脉狭窄程度越重,认知功能水平越差,差异有统计学意义(P<0.05),以MMSE、Mo CA量表敏感;脑梗死患者合并危险因素越多,认知功能水平越差,三种量表均较敏感。结论首发脑梗死患者,其认知功能较正常人群存在不同程度的下降,血压、血糖水平和颈动脉粥样硬化狭窄程度以及合并上述危险因素数量均可加重其认知功能障碍程度。

Objective To investigate the effects of cerebral infarction risk factors on the degree of cognitive impairment in patients with first cerebral infarction. Methods A total of 102 patients with first cerebral infarction, who admitted to our hospital from December 2013 to December 2015, were selected as the experimental group.At the same time, 55 age-matched subjects for health examination were randomly selected as the control group. The cognitive function was assessed by Mini-mental State Examination(MMSE), Montreal Cognitive Assessment(MoCA), Addenbrooke Cognitive Examination-revised(ACE-R), and blood pressure, blood glucose and carotid artery atherosclerotic plaque in both groups was measured. The blood pressure, blood glucose and carotid artery atherosclerotic plaque of the two groups were compared, and the influence of various risk factors on the degree of cognitive dysfunction was analyzed. Results Compared with the control group, the incidence of hypertension, diabetes mellitus and carotid artery atherosclerotic plaque in the experimental group significantly increased(21.81% vs 86.27%,14.54% vs 25.49%, 36.36% vs 90.20%, respectively, all P<0.05), and MMSE, Mo CA, ACE-R scale scores in the experimental group significantly decreased,(27.55±2.10) vs(23.96±3.54),(27.29±2.31) vs(24.33±3.4),(86.41±4.69) vs(60.23±14.18), respectively, all P<0.05. In the experimental group, the higher the blood pressure level, the worse the cognitive function(P<0.05), and the three scales were all sensitive. In the observation group, the worse the blood glucose control,the worse the cognitive function, with statistically significant difference(P<0.05), and MMSE and Mo CA scale were sensitive. In the observation group, the more severe the carotid stenosis, the worse the cognitive function, with statistically significant difference(P<0.05), and MMSE and Mo CA scale were sensitive. The more the merger risk factors of cerebral infarction, the lower level of cognitive function(P<0.05), in which three scale were sensitive. Conclusion The cognitive function of the patients with first cerebral infarction is lower than that of the normal people. The levels of blood pressure and blood glucose, carotid atherosclerotic stenosis and the number of the merged risk factors can exacerbate the degree of cognitive dysfunction.