缺血性卒中后认知障碍与脑梗死分型及相关危险因素的关系

目的探讨缺血性卒中后认知障碍与脑梗死牛津郡社区脑卒中项目(OCSP)分型及相关实验室指标的关系特点。方法选取2016年6月至2018年6月于我院神经内科住院的急性脑梗死患者152例为观察对象。根据OCSP分型,分为完全前循环梗死(TACI)、部分前循环梗死(PACI)、后循环梗死(POCI)和腔隙性梗死(LACI)4组。研究对象于入院时采用NIHSS量表评估神经功能缺损情况,随访至发病90d时完成蒙特利尔认知评估(Montreal Cognitive Assessment,MoCA)量表评分,评估其认知功能。根据MoCA评分分为认知功能障碍组(PSCI组)及单纯脑梗死组,对MoCA评分及相关实验室指标进行统计学分析。结果(1)急性脑梗死发生后,其OCSP分型不同亚型均可导致PSCI,其发生率由高到低排列依次为PACI(45.37%)、LACI(33.33%)、POCI(11.11%)、TACI(10.19%),差异有显著性(χ~2=20.417,P=0.000)。组间两两比较,PACI亚型PSCI的发生率较POCI亚型高(P<0.05)。(2)脑梗死OCSP分型4种亚型比较,发病90d时MoCA评分不同,由高到低排列依次为LACI亚型、POCI亚型、PACI亚型、TACI亚型(H=27.747,P=0.000)。TACI亚型认知功能损害较重,认知域损害较全面,以命名、语言、抽象思维、延迟回忆能力受损显著;LACI亚型认知功能损害较轻,仅部分认知域受累,以视空间与执行功能、注意力受损为主。(3)与单纯脑梗死组比较,PSCI组患者入院时NIHSS评分较高、发病30d时BI评分较低,差异有显著性(t=-9.725、6.311,P<0.001);PSCI组患者血清Hcy、hs-CRP、Cys-C、CHOL水平升高,差异有显著性(t=-4.296、-5.158、-2.942、-2.166,P<0.05)。(4)急性脑梗死患者发病90d时的MoCA评分与入院时NIHSS评分、血清Hcy、hs-CRP及Cys-C水平呈负相关(rs’=-0.813、-0.385、-0.600、-0.268,P<0.01);与发病30d时BI评分呈正相关(rs’=0.638,P<0.01)。(5)经Logistic回归分析显示,急性脑梗死发病90d时发生PSCI的影响因素有入院NIHSS评分、发病30d时BI评分、血清Hcy水平和脑梗死分型。结论对于LACI亚型脑梗死、病情相对较重的患者,以及入院后血清Hcy、hs-CRP或Cys-C水平升高、发病30d时BI评分较低的患者,应格外注意其发病3个月时PSCI的发生。早期识别、早期积极干预PSCI相应危险因素,将对临床防治缺血性PSCI、延缓其进展带来重大意义。

Relationship between cognitive impairment after ischemic stroke and cerebral infarction types and related risk factors

Objective The study was to analyze the relationship between cognitive impairment after ischemic stroke and OCSP classification of acute cerebral infarction and related laboratory indexes.Methods 152 patients with acute cerebral infarction admitted to the department of neurology of our hospital from June 2016 to June 2018 were selected as the research objects.According to OCSP classification,the patients were divided into four groups:total anterior circulation infarcts(TACI),partial anterior circulation infarcts(PACI),posterior circulation infarcts(POCI),and lacunar infarcts(LACI).The NIHSS was used to assess neurological deficits at admission,the Montreal Cognitive Assessment(MoCA)scale was used to assess the Cognitive function of the patients at the 90 dfollow-up.According to the MoCA score,the patients were divided into the post-stroke cognitive impairment group(PSCI group)and the simple cerebral infarction group(SCI group).Statistical analysis was carried out on the MoCA score and related laboratory parameters.Results(1)After acute cerebral infarction,different OCSP subtypes could lead to PSCI,and the incidence rates were successively PACI(45.37%),LACI(33.33%),POCI(11.11%),TACI(10.19%),with statistically significant difference(χ~2=20.417,P=0.000).(2)Comparison of the four subtypes of OCSP classification showed different MoCA scores on the 90 th day of onset,which ranged from high to low:LACI subtype,POCI subtype,PACI subtype,TACI subtype(H=27.747,P=0.000).TACI subtype of cognitive function was significantly impaired,including naming,language,abstract thinking and delayed recall.The LACI subtypes showed mild cognitive impairment,mainly in visual space,executive function and attention.(3)Compared with the SCI group,patients in the PSCI group had higher NIHSS score at admission and lower BI score at 30 dof onset,and the serum Hcy,hs-CRP,Cys-C and CHOL levels were increased,with statistically significant differences(P<0.05).(4)MoCA score of patients with acute cerebral infarction at90 dwas negatively correlated with NIHSS score,serum Hcy,hs-CRP and Cys-C levels at admission(rs’=-0.813,-0.385,-0.600,-0.268,P<0.01).It was positively correlated with BI score at 30 dafter onset(rs’=0.638,P<0.01).(5)Logistic regression analysis showed that the influencing factors of PSCI at 90 dof onset of acute cerebral infarction included admission NIHSS score,BI score at 30 dof onset,serum Hcy level and cerebral infarction classification.Conclusion For patients with LACI subtype cerebral infarction,with relatively severe disease,as well as patients with elevated serum Hcy,hs-CRP,Cys-C levels after admission and low BI score at 30 dof onset,special attention should be paid to the occurrence of PSCI at 3 months of onset.Early identification and early active intervention of PSCI risk factors will be of great significance to the clinical prevention and treatment of ischemic PSCI and delay its progress.