老年轻型缺血性卒中患者认知障碍和卒中复发的危险因素分析

目的评估老年轻型缺血性卒中患者的认知障碍情况,并分析卒中复发的危险因素。方法回顾性病例对照研究,入选2016年1月至2017年1月聊城第二人民医院神经内科的老年急性缺血性脑卒中患者95例,依据美国国立卫生研究院卒中量表(NIHSS)评分分为轻型卒中组(NIHSS≤3分,62例)和中重型卒中组(NIHSS>3分,33例)。随访12个月,评估两组NIHSS评分、改良Rankin量表(mRS)、蒙特利尔认知评估量表(MoCA)。应用Cox回归比例风险模型分析影响卒中复发的危险因素。结果95例患者中男性62例(65.3%),平均年龄(68.3±6.7)岁。两组患者年龄、性别、急性卒中分型、既往病史等差异无统计学意义(均P>0.05),但两组患者的静脉重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗率差异有统计学意义(P<0.01)。轻型组患者NIHSS(1.0±0.5)分和mRS(1.6±0.7)分,低于中重型组患者(3.2±1.1)分、(2.4±1.1)分(均P<0.01)。平均随访(12.6±1.9)个月,两组患者卒中后认知障碍发生率差异无统计学意义(P>0.05),但卒中后抑郁发生率差异有统计学意义(P<0.05);病死率0.0%比21.0%(10例)、再发卒中率20.9%(13例)比42.4%(14例),差异有统计学意义(P<0.01、P<0.05)。Cox回归比例风险模型显示,基线NIHSS评分、糖尿病和卒中病史是影响轻型脑卒中复发的危险因素(均P<0.05)。结论老年轻型卒中患者的静脉rt-PA溶栓治疗率低,病死率和卒中再发率低于中重型卒中患者,卒中后认知障碍发病率高。基线NIHSS评分、糖尿病和卒中病史是影响轻型脑卒中复发的危险因素。

The evaluation of cognitive impairment and analysis of risk factors for stroke recurrence in elderly patients with minor ischemic stroke

Objective To evaluate the cognitive impairment in elderly patients with minor ischemic stroke and to analyze risk factors for stroke recurrence.Methods This was a retrospective case-control study.Ninety-five elderly patients with acute ischemic stroke hospitalized in the neurology department of Second People's Hospital of Liaocheng were enrolled from January 2016 to January 2017.Based on the National Institutes of Health Stroke Scale(NIHSS),all cases were divided into the minor stroke group(NIHSS score≤3,n=62)and the medium-severe stroke group(NIHSS score>3,n=33).After 12-month follow-up,the NIHSS,modified Rankin scale(mRS)and Montreal cognitive assessment(MoCA)were used to evaluate the study subjects.Results Of the 95 patients,there were 62 males(65.3%)and 33 females(34.7%),with age of(68.3±6.7)years.No significant differences were found in baseline characteristics of age,male ratio,subtypes and history between two groups(all P>0.05).But,the treatment rate of intravenous thrombolysis was lower in minor stroke group than in medium-severe stroke group6.5%(4 cases)vs.42.4%(14 cases)(P<0.01)].The scores of NIHSS(1.0±0.5)vs.(3.2±1.1),P<0.01],mRS(1.6±0.7)vs.(2.4±1.1),P<0.01]were lower in the minor stroke group than in the medium-severe group.After a mean follow-up of(12.6±1.9)months,the rate of cognitive impairment was comparable between the two groups(P>0.05),while the rate of post stroke depression had a significant difference between two groups(P<0.05).Furthermore,there was lower rate of mortality and stroke recurrence in the minor stroke group than in the medium-severe group(0.0%or 0/62 vs.30.3%or 10/33,and 21.0%or 13/62 vs.42.4%or 14/33,P<0.05).Cox proportional hazard model showed that baseline NIHSS score,diabetes and stroke history were the risk factors for stroke recurrence in patients with minor stroke(P<0.05).Conclusions The treatment rate of intravenous thrombolysis with rt-PA,mortality rate and stroke recurrence rate are lower in patients with minor stroke than in patients with medium-severe stroke,while the incidence of post stroke cognitive impairment is high.High score of baseline NIHSS,diabetes and stroke history are risk factors for stroke recurrence in elderly patients with minor stroke.