摘要
目的对脑卒中患者发生血管性痴呆的情况进行调查并分析其危险因素。方法选取郑州大学第一附属医院2021年8月—2023年9月治疗的80例脑卒中患者作为研究对象,按照患者是否发生血管性痴呆分为研究组,即血管性痴呆组(44例)与非血管性痴呆组对照组(36例)。对两组患者一般资料进行单因素分析,再将单因素分析中具有统计学意义的指标使用SPSS21.0统计软件进行多因素logistic回归分析脑卒中患者发生血管性痴呆的危险因素。结果研究组中年龄>70岁、有糖尿病、有高血压、有吸烟史、有饮酒史、多发性病灶、基底节及额叶梗死患者的比例明显高于对照组,差异有统计学意义(P<0.05),研究组血浆同型半胱氨酸(ho-mocysteine,Hcy)水平(22.13±5.12)μmol/L均明显高于对照组(13.94±3.11)μmol/L;研究组血清脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平(221.24±18.22)ng/mL、(4.11±1.81)ng/mL,明显低于对照组,差异有统计学意义(P<0.05);多因素logistic回归分析显示,年龄>70岁、糖尿病、高血压、有吸烟史、有饮酒史、多发病灶、基底节及额叶梗死、血浆Hcy水平升高、血清BDNF、VEGF水平降低都是脑卒中患者发生血管性痴呆的独立危险因素(OR=7.264、4.677、8.532、3.356、3.526、2.226、2.946、10.352、3.124、13.154),差异具有统计学意义(P<0.05)。血浆Hcy、血清BDNF、血清VEGF以及联合检测对胰腺癌肝转移特异度分别为:90.6%、85.1%、91.1%、94.1%,敏感度分别为:63.3%、70.1%、69.2%、84.2%,三者联合预测效力显著提高,特异度为94.1%,敏感度为84.2%。结论脑卒中患者发生血管性痴呆的危险因素包括年龄>70岁、糖尿病、高血压、吸烟史、饮酒史、多发病灶、基底节及额叶梗死、血浆Hcy水平升高、血清BDNF、VEGF水平降低等,临床可根据患者年龄、生活习惯、基础疾病、临床特征等对脑卒中患者进行提前干预与治疗,并且密切关注患者的Hcy、BDNF及VEGF水平,预防或者减缓脑卒中向血管性痴呆的发展。
Objective To investigate the occurrence of vascular dementia in stroke patients and analyze its risk factors.Methods Totally 80 stroke patients treated in the First Affiliated Hospital of Zhengzhou University from August 2021 to September 2023 were selected as research objects,and were divided according to whether the patients had vascular dementia or not,into a study group i.e vascular dementia group(44 cases)and a control group i.e.non-vascular dementia group(36 cases).The general data of the two groups of patients were analyzed by single factor analysis,and the statistically significant indicators in the single factor analysis were analyzed by multi-factor logistic regression analysis using SPSS 21.0 statistical software to find out the risk factors of vascular dementia in stroke patients.Results The proportion of patients with age>70 years old,diabetes mellitus,hypertension,smoking history,drinking history,multiple foci,basal ganglia and frontal lobe infarction in the study group were significantly higher than that of the control group(P<0.05).Plasma levels of ho-mocysteine(Hcy)in the study group(22.13±5.12)μmol/L were significantly higher than those of the control group(13.94±3.11)μmol/L.In the study group,serum brain-derived neurotrophic factor(BDNF)and vascular endothelial growth factor(VEGF)were detected The levels of factor,VEGF(221.24±18.22)ng/mL and(4.11±1.81)ng/mL were significantly lower than those of control group(P<0.05).From the results of multi-factor logistic regression analysis,age>70 years,diabetes mellitus,hypertension,smoking history,drinking history,multiple lesions,basal segment and frontal lobe infarction,elevated plasma Hcy level,and decreased serum BDNF and VEGF levels were all independent risk factors for vascular dementia in stroke patients(OR=7.264,4.677,8.532,3.356,3.526,2.226,2.946,10.352,3.124,13.154),the difference was statistically significant(P<0.05).The specificity of plasma Hcy,serum BDNF,serum VEGF and combined detection for pancreatic cancer liver metastasis were 90.6%,85.1%,91.1%and 94.1%,respectively,and the sensitivity were:63.3%,70.1%,69.2%,84.2%.The combined prediction efficacy of the three was significantly improved,and the specificity was 94.1%,and the sensitivity was 84.2%.Conclusion The risk factors for vascular dementia in stroke patients include old age,diabetes,hypertension,smoking history,drinking history,multiple lesions,basal ganglia and frontal lobe infarction,elevated plasma Hcy level,decreased serum BDNF,VEGF level,etc.Clinical intervention and treatment of stroke patients can be carried out in advance according to the patient's age,lifestyle,underlying diseases and clinical characteristics,and close attention should be paid to the patient's biochemical indicators,such as the increase of plasma Hcy level,serum BDNF and VEGF level combined detection,etc.,so as to prevent or slow down the development of stroke to vascular dementia,which is worthy of clinical promotion.
作者
齐佳林
杨静
秦曼
QI Jia-lin;YANG Jing;QIN Man(Department of Geriatric Synthesis,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《医药论坛杂志》
2024年第11期1152-1156,1162,共6页
Journal of Medical Forum
关键词
脑卒中
血管性痴呆
危险因素
认知障碍
Stroke
Vascular dementia
Risk factors
Cognitive impairment
