血管性认知功能障碍的危险因素及卒中 单元综合治疗的临床分析

目的:分析血管性认知功能障碍(VCI)的危险因素及卒中单元综合治疗VCI的疗效。方法:非痴呆性血管认知障碍(VCIND)患者50例,血管性痴呆(Va D)54例及认知正常的脑梗死患者50例分别纳入VCIND组、VaD组及认知正常对照(NCON)组。收集3组的一般资料;检测C反应蛋白(CRP)、血脂、血糖、同型半胱氨酸(Hcy)、总甲状腺素(TT4)等指标;完善头部MRI检查,并进行影像评分。3组均进行卒中单元综合治疗,VCIND组和VaD组患者均于治疗前和治疗6个月后进行简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估(MoCA)及日常生活活动能力(ADL)评估。结果:Va D和VCIND组吸烟、饮酒、高血压及糖尿病人数高于NCON组,CRP、低密度脂蛋白胆固醇(LDL-C)、空腹血糖、Hcy及TT4水平高于NCON组(均P0.05);Va D组患者年龄、CRP、Hcy及TT4水平高于VCIND组(均P0.05)。VaD和VCIND组颅脑各部位MRI的Fazekas分级均高于VCIND组,Va D组颅脑各部位MRI的Fazekas分级高于VCIND组(均P0.05)。VCIND组的MoCA评分和MMSE评分高于同组治疗前,ADL评分低于同组治疗前(均P0.05),VaD组的MMSE评分高于同组治疗前,ADL评分低于同组治疗前(均P0.05)。结论:高龄、吸烟、饮酒、高血压、糖尿病是VCI的危险因素;CRP、Hcy、TT4及MRI检查有助于提前评估患者的认知功能;卒中单元综合治疗VCI有效。

Clinical Analysis of Risk Factors of Vascular Cognitive Impairment and Effect of Stroke Unit Therapy

This research aimed to study the risk factors for patients with vascular cognitive impairment (VCI) and exam the therapy effects of stroke unit on those people. Methods: We included 50 non-dementia VCI (VCIND) patients, 54 vascular dementia (VaD) patients, and 50 normal cognition stroke patients into the VCIND group, VaD group, and NCON group, respectively. We collected general data from all groups and examined various indicators including levels of C-reactive protein (CRP), blood lipid, blood glucose, homocysteine (Hcy), and total serum thyroxine (TT4); we completed cranial MRI for all the patients and evaluated the results. All 3 groups underwent stroke unit therapy. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Activities of Daily Living (ADL) assessment were performed on VCIND and VaD group patients. Results: Compared with the NCON group, there were significantly more subjects who smoke, drank, had high blood pressure, and had diabetes in the VaD and VCIND groups (P<0.05). Moreover, the levels of CRP, LDL-C, fasting blood glucose, Hcy, and TT4 were significantly higher in the VaD and VCIND groups than those in the NCON group (all P<0.05). Patient age and levels of CRP, Hcy, and TT4 were higher in the VaD group compared to the VCIND group (all P<0.05). In the VaD and VCIND groups, MRI of various brain regions showed higher Fazekas grades compared to those in the NCON group, and furthermore, Fazekas grades of the VaD group were higher than that of the VCIND group (all P<0.05). After treatment, the VCIND group showed an increase in MoCA score and MMSE score and a decrease in ADL score compared to before treatment (all P<0.05). The VaD group showed an increase in MMSE score and a decrease in ADL after treatment compared to before (all P<0.05). Conclusion: A higher age, smoking, drinking, hypertension, and diabetes are potential risk factors for VCI. Appropriate testing such as CRP, Hcy, TT4, and MRI is helpful for the assessment of cognitive function in patients for early detection. Comprehensive stroke unit therapy is effective in the treatment of VCI.