摘要
目的探讨急性脑梗死后认知功能障碍的影响因素。方法以急性脑梗死患者为研究对象,共收集60例符合纳入标准的患者(所有患者均为右利手)。收集患者的一般资料、急性期炎症指标、凝血功能检查结果,并用美国国立卫生院神经功能缺损评分(NIHSS量表)对患者急性期神经功能缺失程度进行评价。于发病90天后,采集患者中风证候要素,使用蒙特利尔认知评估(MoCA)量表对患者认知功能进行评价,参照急性脑梗死后认知功能障碍的诊断标准,将患者分为认知功能障碍组(MoCA<26分)和认知功能正常组(MoCA≥26分),对2组患者进行比较,分析急性脑梗死后认知功能障碍的影响因素。结果认知功能障碍组中既往有高血压病史、糖尿病病史及脑卒中病史的患者比例高于认知功能正常组(P<0.05);认知功能障碍组患者的血同型半胱氨酸(HCY)、超敏C反应蛋白(hs-CRP)和血浆纤维蛋白原(FIB)均高于认知功能正常组(P<0.05);通过K-均值聚类分析将每一时点的NIHSS评分聚为3类,每一类按NIHSS平均得分升序排列,对应为类中心1、2、3,其中类中心3的MoCA得分低于类中心1和类中心2(P<0.05)。Logistic回归分析结果显示,痰证对急性脑梗死后认知功能障碍的发病有显著影响(P<0.05)。结论高血压病史、糖尿病病史、卒中病史、急性期血HCY、hs-CRP、FIB水平与急性脑梗死后认知功能障碍的发生有关;脑梗死急性期神经功能损伤越重,脑梗死后认知功能损伤越重;痰证与急性脑梗死后认知功能障碍发病的关系最密切。
Objective To discuss the influential factors of cognitive impairment after acute cerebral infarction （ACI）. Methods Sixty cases of ACI patients （all patients were right-handed） following inclusion criteria were selected for collecting general information, inflammatory markers of acute stage, and results of blood coagulation function test, meanwhile, evaluating the degree of neurologic deficit of patients at acute phase with National Institutes of Health Stroke Scale （NIHSS）. 90 days after the attack, the syndrome elements were collected and Montreal Cognitive Assessment （MoCA） scale was used to evaluate cognitive function. And the patients were divided into a cognitive impairment group （Group A, MoCA〈26） and a normal group （Group N, MoCA ≥ 26） by referring to the diagnostic criteria of cognitive impairment after ACI. The influential factors of cognitive impairment after ACI were investigated by comparing the two groups. Results The proportion of patients with previous history of hypertension, diabetes and stroke in the Group A was higher than that in the Group N （P〈0.05）; the level of blood homocysteine （HCY）, high-sensitivity C-reactive protein （hs-CRP） and plasma fibrinogen （FIB） in the Group N was higher than that in the Group N （P〈0.05）; K-means Cluster Analysis clustered NIHSS scores at each time point into three categories, and each category was in ascending sort according to the average NIHSS score, corresponding to class center 1, 2 and 3. Of which, MoCA score of the class center 3 was lower than that of the class center 1 and 2 （P〈0.05）. Logistic regression analysis showed that phlegm syndrome had a significant effect on the incidence of cognitive impairment after ACI （P〈0.05）. Conclusion The cognitive impairment after ACI is associated with the history of hypertension, diabetes, stroke, and the level of blood HCY, hs-CRP and FIB of acute phase; the severer the neurologie deficit of the ACI is, the severer the cognitive impairment after cerebral infarction is; the phlegm syndrome is the most closely related with the cognitive impairment after ACI.
出处
《北京中医药》
2013年第7期501-505,共5页
Beijing Journal of Traditional Chinese Medicine
基金
2010年度中医药行业科研专项(201007002)
北京中医药大学科研创新团队项目(2011-CXTD-23)
北京中医药大学中青年教师资助项目(JYB22-JS034)
关键词
急性脑梗死
认知功能障碍
影响因素
acute cerebral infarction
neurologie defiet
cognitive impairment
influential factors
