初发腔隙性脑梗死的病灶数量和部位对患者认知功能的影响

目的探讨初次发病的腔隙性脯梗死的痫灶数量和部位对患者从知功能的影响。方法选择初次发病的腔隙性脑梗死患者91例，其中单发病灶56例（位于左侧25例，打侧31例），多发病灶35例（左侧21例，有侧14例）。于发病1例内进行神经心理学测验，包括简易精神状态检查量表、汉化的韦氏成人智力量表（数字广度、图片排列、数字符号和积木测验）、世界卫生组织-加利福尼亚洛杉矶大学听觉词语学习测验、简化的Rey复杂图形测验、Stroop测验、语义分类流畅性测验、加利福尼亚卡片分类测验和阃钟测验。评估患者的认知功能情况。结果①单发病灶与多发病灶患者的神经心理学洲验结果显示，病灶位于左侧大脑半球者，差异有统计学意义的指标是反映执行能力中的语义分类流畅性（动物）、WAIS-RC罔片排列及加利福尼亚卡片分类积分，单发痫灶者分别为17±5、11±4、5.8±1.5，多发病灶者为13±4、7±5、4.7±2.0，均P〈0.05。病灶化于有恼者，差异有统计学意义的指标亦是反映执行能力中的WAIS-RC图片排列的积分，单发病灶者为11±4、多发病灶者为8±4，P〈0.05。②左、右侧单发病灶患者比较，右侧认知功能评分低于左侧，且差异有统计学意义的项目为MMSE和执行能力中的语义分类流畅性（动物）、加利福尼亚卡片分类积分，均P〈0.05；而左、右侧多发病灶患者的认知功能评分，差异均无统计学意义。结论双侧多发病灶的初发腔隙性脑梗死患者的认知障碍均较单发病灶更值得早期重视和干预。

Effect of the number and position of lesions on cognitive function in patients with first attack of lacunar infarction

Objective To investigate the effect nf the number and position of lesions on cognilive func- tion in patients with first attack of lacunar infarction. Methods A total of 91 patients with first attack of lacunar infarction were enrolled, among them, 56 had single lesion （25 in the left and 31 in the right side of brain）, and 35 had multiple lesions （21 in the left and 14 in the right side of brain）. Neuropsychological tests were performed within one week after onset of symptoms, including the mini-mental state examination （MMSE） , Chinese version of Wechsler adult intelligence scale （digit span, picture arrangement, digit symbol test and block test） , World Health Organization-University of California-Los Angeles auditory verbal learning test, Rey complex figure test, Stroop test, semantic category verbal fluency test, California card sorting test, and clock drawing test. The cognitive function of the patients was also assessed. Results①The results of neuropsychologieal test in patients with single and muhiple lesions showed that： in patients whose lesions in the left brain, the indexes of statistically significant difference were to reflect the category scores of the semantic category verbal fluency test （animal） , Weehsler adult intelligence scale （picture arrangement）,and California card sorting test in the executive ability. In patients with single lesions they were 17±5, 11±4, and 5.8±1.5, respectively, In patients with multiple lesions were 13±4, 7±5, and 4.7 ±2.0, respec-tively （P 〈0.05 all）. In patients whose lesions in the right brain, the index of statistically significant difference was also that to reflect the category score of the Wechsler adult intelligence scale （picture arrangement） in the executive ability. In patients with single lesions were 11±41, while in those with multiple lesions were 8±4 （P 〈 0.05 ）. ②As compared to the single lesions in left and right sides, the right side cognitive func- tion score was lower than that of the left and the items with statistically significant differences were the catego- ry scores of MMSE, semantic category verbal fluency test （animal）, and California card sorting test in the executive ability （P 〈0.05 all）, while there was no significant difference in those with multiple lesions in the left and right cognitive function scores. Conclusion Cognitive impairment in patients with firstattack of lacunar infarction with bilateral multiple lesions needs more attention and intervention than those with single lesion.