缺血性脑卒中继发血管性痴呆患者与头颅CT所示病变部位的相关性研究

目的 探讨缺血性脑卒中患者继发血管性痴呆(VaD)与头颅CT所示病变部位的相关性。方法 纳入2014年5月1日～2015年5月1日收治的缺血性脑卒中患者为研究对象。收集患者入院后的CT检查表现,采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、Addenbrooke改良认知评估量表(ACE-R)评估患者脑卒中后3个月的认知功能; 以患者是否继发VaD为因变量,脑组织病变部位为自变量,采用单因素和多因素logistic回归分析研究不同病变部位对于缺血性脑卒中患者继发认知功能障碍的相关性。结果 经随访,最终纳入66例缺血性脑卒中患者,其中36例继发VaD,30例认知功能正常,2组基线资料无显著差异性(P>0.05)。单因素logistic回归分析显示,下丘脑、丘脑后部、左额/颞/枕以及多发病灶、脑白质病变、脑萎缩对缺血性脑卒中患者继发认知功能障碍产生影响(P<0.05); 多因素logistic回归分析显示,5项自变量进入回归模型,包括下丘脑、左额、左枕、多发病灶、脑白质病变(P<0.05)。结论 下丘脑、左额、枕以及多发病灶和脑白质病变是缺血性脑卒中患者继发VaD的危险因素,临床上应及时予以干预。

Research on association of vascular dementia with lesion site by neuroimaging in patients with ischemic stroke

ObjectiveTo investigate the association of vascular dementia(VaD)with lesion site shown by neuroimaging in patients with ischemic stroke.Methods The consecutive patients with ischemic stroke during May 1, 2014 and May 1, 2015, were enrolled. Neuroimaging findings were registered after patient admission, and cognitive functions of 3 months after stroke were evaluated using mini-mental state examination(MMSE), Montreal cognitive assessment(MoCA)and Addenbrooke' cognitive examination- revised(ACE-R). Taking VaD as dependent variable, and lesion site on neuroimaging as independent variables, the effect of different lesion sites on secondary cognitive dysfunction in stroke patients was studied using univariate and multivariate logistic regression analysis.Results There were a total of 36 patients with secondary VaD and 30 patients with normal cognitive function with follow-up, with no significant differences of baseline data between the two groups(P>0.05). Univariate logistic regression analysis showed that lesion sites on hypothalamus, metathalamus, left frontal, temporal and occipital lobe, multiple foci, white matter lesion and cerebral atrophy had effect on cognitive dysfunction secondary to ischemic stroke(P<0.05); multivariate logistic regression analysis showed that 5 independent variables entered into regression model, including lesion sites on hypothalamus, left frontal, occipital lobe and multiple foci and white matter lesion(P<0.05).Conclusion Lesion sites on hypothalamus, left frontal, occipital lobe and multiple foci and white matter lesion are the risk factors of secondary VaD in patients with ischemic stroke, in which timely treatment should be given in clinical practice.