急性缺血性脑卒中患者认知损害的危险因素分析

目的探讨急性缺血性脑卒中患者出现认知损害的危险因素,为预防脑卒中后认知损害提供依据。方法回顾性分析2015年1月至2018年9月住院的103例急性缺血性脑卒中患者的临床资料,所有入组病例均在入院第2天空腹采集肘静脉血测定血脂、同型半胱氨酸、空腹血糖及糖化血红蛋白。参照2019年美国糖尿病学会发布的"糖尿病医学诊疗标准"制定血糖控制标准(空腹血糖4.4~7.2mmol·L-1,糖化血红蛋白<6.5%)。发病第10~14天(病情稳定排除谵妄等情况)进行北京版蒙特利尔认知评估(MoCA)量表测评,将MoCA评分<26分为认知损害组(64例)和MoCA≥26分为无认知损害组(39例),通过统计学分析探讨急性缺血性脑卒中出现认知损害的危险因素。结果与无认知损害组比较,认知损害患者年龄偏大(P=0.013)、美国国立卫生研究院卒中量表(NIHSS)评分较高(P=0.016);认知损害组空腹血糖、糖化血红蛋白水平高于无认知损害组,且血糖控制达标情况较无认知损害组差(分别P=0.001,P=0.045,P=0.006,P=0.001)。结论高龄、NIHSS评分高、空腹血糖升高及血糖水平控制达标差是急性缺血性脑卒中患者出现认知损害的危险因素之一,血糖作为可控因素,严格控制血糖可能有助于预防急性缺血性脑卒中后认知损害的发生。

Risk Factors of Cognitive Impairment in Patients with Acute Ischemic Stroke

Aim To explore the correlation between cognitive impairment and blood glucose levels in patients with acute ischemic stroke,and to provide evidence for prevention of post-stroke cognitive impairment.Methods The clinical data of 103 patients with acute ischemic stroke admitted to the department of encephalopathy,Dongfang Hospital,Beijing University of Chinese Medicine from January 2015 to September 2018 were retrospectively analyzed.Fasting elbow venous blood was collected on the second day of admission for determination of serum lipids,homocysteine,fasting blood glucose and glycosylated hemoglobin;the blood glucose control standard of this study was established with reference to the Diabetes Medical Diagnostic Standard issued by the American Diabetes Association in 2019.The fasting plasma glucose was controlled at 4.4-7.2 mmol·L^-1,and the glycated hemoglobin<6.5%was considered as standard.The Beijing version of the Montreal Cognitive Assessment(MoCA)was evaluated on the 10th to 14th day of the disease(stable conditional exclusion,etc.),divided into cognitive impairment group(MoCA<26 points)and no cognitive impairment group(MoCA≥26 points),through statistical analysis,to the risk factors of cognitive impairment in patients with acute ischemic stroke.Results Compared with the group without cognitive impairment,the age of the cognitive impairment group was older and the N1HSS score was higher(P=0.013,P=0.016).The levels of fasting plasma glucose and glycosylated hemoglobin in the cognitive impairment group were higher than those in the non-cognitive disorder group,and the blood glucose control compliance was worse than that in the noncognitive disorder group(P=0.001,P=0.045,P=0.006,P=0.001).Conclusion Advanced age,higher NIHSS scores,elevated fasting plasma glucose and poor control of blood glucose level are among the risk factors for cognitive impairment in patients with acute ischemic stroke.As a modifiable factor,strict control of blood glucose may help prevent cognitive impairment after acute ischemic stroke.