应激性高血糖比率与前循环穿支动脉硬化性脑梗死早期认知功能障碍的相关性研究

  目的  探讨应激性高血糖比率对前循环穿支动脉硬化性脑梗死早期认知功能障碍发生的影响。  方法  选取2014年12月—2019年12月在华北理工大学附属医院神经内科住院治疗的前循环穿支动脉硬化性脑梗死患者为观察对象，根据发病90天MoCA评分对所有入组患者分组，将完成认知评定的332例患者分为认知功能障碍组(145例)和认知功能正常组(187例)，分析应激性高血糖比率SHR与90天MoCA评分、MMSE评分的相关性，并绘制ROC曲线评价应激性高血糖相关指标对预测认知障碍的效能。  结果  本研究中早期认知障碍发生率为43.67%，单因素分析示2组的年龄、高血压病史、糖尿病史、文化程度、入院NIHSS评分、入院随机血糖、SHR差异有统计学意义。多因素logistic回归分析示年龄(OR=1.144, 95%CI: 1.097~1.193, P＜0.001)、入院NIHSS评分(OR=2.455, 95%CI: 1.254~4.804, P=0.009)、SHR(OR=2.087, 95%CI: 1.053~4.137, P=0.035)、入院随机血糖(OR=1.008, 95%CI: 1.001~2.012, P=0.047)是前循环穿支动脉硬化性脑梗死后发生早期认知功能障碍的独立危险因素；相关性分析示SHR与患者发病90天MoCA评分、MMSE评分呈负相关。SHR、入院随机血糖对预测前循环穿支动脉硬化性脑梗死发生早期认知功能障碍的ROC曲线下面积分别为0.795、0.626，且2组ROC曲线下面积差异有统计学意义。  结论  SHR是前循环穿支动脉硬化性脑梗死早期认知功能障碍的独立危险因素，SHR可作为预测一种认知预后的重要参考指标。 

Correlation between stress hyperglycaemia ratio and early cognitive dysfunction in patients with anterior circulation perforator arteriosclerotic cerebral infarction

  Objective  To discuss the effects of high blood sugar stress ratio on early cognitive dysfunction of patients with Anterior circulation perforator arteriosclerotic cerebral infarction.  Methods  From December 2014 to December 2019, patients with anterior circulation perforator arteriosclerotic cerebral infarction who were hospitalised in neurology department of Affiliated Hospital of North China University of Science and Technology were selected as the observation objects. According to the 90-day Montreal Cognitive Assessment (MoCA) score, all the patients were divided into two groups: cognitive dysfunction group(145 cases) and normal cognitive function group(187 cases). Data were collected to analyse the correlation between stress hyperglycaemia rate (SHR) and 90 day MoCA and A Mini-Mental State Examination (MMSE) scores. Receiver Operator Characteristic (ROC) curve was used to evaluate the effectiveness of SHR-related indicators in predicting cognitive impairment.  Results  In this study, the incidence of early cognitive impairment was 43.67%. The single-factor analysis showed that the differences in age, hypertension, diabetes history, education level, The NIH Stroke Scale (NIHSS) score, random blood sugar and SHR in the two groups were statistically significant. The Multivariate logistic regression analysis showed that age (OR=1.144, 95%CI: 1.097-1.193, P < 0.001), NIHSS score (OR=2.455, 95%CI: 1.254-4.804, P=0.009), SHR (OR=2.087, 95%CI: 1.053-4.137, P=0.035)and random blood glucose (OR=1.008, 95%CI: 1.001-2.012, P=0.047)were independent risk factors for early cognitive impairment after anterior circulation perforator arteriosclerotic cerebral infarction. Correlation analysis showed a negative correlation between SHR and MoCA and MMSE scores for 90 days. The area under ROC curve of SHR and admission random blood glucose in predicting the early cognitive impairment of patients with anterior circulation perforator arteriosclerotic cerebral infarction was 0.795 and 0.626, respectively, and the difference in area under the two sets of ROC curves was statistically significant.  Conclusion  SHR is an independent risk factor of cognitive dysfunction in the early stage of patients with anterior circulation perforator arteriosclerotic cerebral infarction. SHR can be used as an important reference index to predict cognitive prognosis.