首发急性缺血性脑卒中患者认知功能变化及其与相关因素关系的分析
수발급성결혈성뇌졸중환자인지공능변화급기여상관인소관계적분석
Changes of cognitive function and its correlated factors in patients with first acute cerebral ischemic stroke
  • 万方数据
    中华神经医学杂志 중화신경의학잡지
    CHINESE JOURNAL OF NEUROMEDICINE
    2012年 11期 1098-1105 ,共8页

    袁大华%张虹桥%章成国%林碧清%曾桄伦%王玉凯%杜朴%彭伟英

    원대화%장홍교%장성국%림벽청%증광륜%왕옥개%두박%팽위영

    急性缺血性脑卒中%认知功能损害%神经心理学测验%危险因素 急性缺血性腦卒中%認知功能損害%神經心理學測驗%危險因素
    급성결혈성뇌졸중%인지공능손해%신경심이학측험%위험인소
    Cerebral ischemic stroke%Cognitive impairment%Neuropsychological test%Risk factor
    目的 探讨首发急性缺血性脑卒中患者认知功能障碍情况及其与相关因素的关系.方法 收集佛山市第一人民医院神经内科自2010年7月至2011年6月收治的符合首发急性缺血性脑卒中诊断标准的患者568例,入院1周内进行神经心理学测验,包括简易精神状态检查量表(MMSE)、Mattis痴呆量表、汉化的韦氏成人智力量表数字广度顺背分测验、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复杂图形记忆测验、简短Stroop测验干扰部分、语义分类流畅性测验、简短Stroop测验色块部分及简化的Rey复杂图形临摹和画钟测验等,涉及注意力、记忆力、执行功能、信息处理能力、视空间结构能力等认知域.同时记录患者性别、年龄、高血压、吸烟史等临床资料,检测患者血压、血脂[胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、血糖(空腹血糖、餐后2h血糖),并对未确诊糖尿病的患者进行葡萄糖耐量试验(OGTT)以判断糖代谢状况.应用统计学方法分析血糖、血脂水平与患者认知功能的关系.结果 (1)568例首发缺血性脑卒中患者中MMSE量表异常率为78.2％,Mattis痴呆量表异常率为72.5％；注意力障碍占26.5％；逻辑记忆即刻障碍占56.3％,逻辑记忆延迟障碍占60.9％,听觉记忆力即刻障碍占74.6％,听觉记忆力延迟障碍占98.2％,视觉记忆力障碍占83.8％；执行功能障碍占62.7％；信息处理能力障碍占4.9％；视空间结构能力障碍占77.7％.(2)不同血糖水平患者之间MMSE量表评分、Mattis痴呆量表评分、注意力评分比较差异均有统计学意义(P＜0.05),且空腹血糖受损组较其他组评分明显降低,差异有统计学意义(P＜0.05).(3)不同类型高脂血症水平患者之间各认知域评分比较差异无统计学意义(P＞0.05).不同HDL-C水平患者在执行功能、画钟测验方面比较差异存在统计学意义(P＜0.05),但在其他认知领域方面组别之间差异无统计学意义(P＞0.05).高水平HDL-C组视空间结构能力评分显著高于正常组,差异有统计学意义(P＜0.05),而高水平HDL-C组执行功能评分则低于正常组,差异也有统计学意义(P＜0.05).(4)Logistic回归分析发现发现MMSE总体评分与性别、年龄、空腹血糖、餐后2h血糖有关；而年龄、性别和HDL-C是执行功能独立危险因素；记忆力与年龄有关,其中即刻听觉记忆力还与HDL-C相关；空间结构能力与年龄、性别及改良Rankin量表(mRS)评分均呈显著相关关系；信息处理能力则仅与HDL-C水平相关.结论 (1)首发急性缺血性脑卒中患者中约75％可存在认知功能障碍,主要以记忆力、执行力、视空间结构能力损害为主.(2)血糖水平尤其空腹血糖受损状况对患者认知功能的损害最为明显.(3)高水平的HDL-C有助于提高患者认知功能.(4)年龄、性别、HDL-C与患者认知功能水平的关系最密切.
    목적 탐토수발급성결혈성뇌졸중환자인지공능장애정황급기여상관인소적관계.방법 수집불산시제일인민의원신경내과자2010년7월지2011년6월수치적부합수발급성결혈성뇌졸중진단표준적환자568례,입원1주내진행신경심이학측험,포괄간역정신상태검사량표(MMSE)、Mattis치태량표、한화적위씨성인지역량표수자엄도순배분측험、세계위생조직-가리복니아락삼기대학은각사어학습측험、간화적Rey복잡도형기억측험、간단Stroop측험간우부분、어의분류류창성측험、간단Stroop측험색괴부분급간화적Rey복잡도형림모화화종측험등,섭급주의력、기억력、집행공능、신식처리능력、시공간결구능력등인지역.동시기록환자성별、년령、고혈압、흡연사등림상자료,검측환자혈압、혈지[담고순、삼선감유、저밀도지단백담고순(LDL-C)、고밀도지단백담고순(HDL-C)]、혈당(공복혈당、찬후2h혈당),병대미학진당뇨병적환자진행포도당내량시험(OGTT)이판단당대사상황.응용통계학방법분석혈당、혈지수평여환자인지공능적관계.결과 (1)568례수발결혈성뇌졸중환자중MMSE량표이상솔위78.2％,Mattis치태량표이상솔위72.5％；주의력장애점26.5％；라집기억즉각장애점56.3％,라집기억연지장애점60.9％,은각기억력즉각장애점74.6％,은각기억력연지장애점98.2％,시각기억력장애점83.8％；집행공능장애점62.7％；신식처리능력장애점4.9％；시공간결구능력장애점77.7％.(2)불동혈당수평환자지간MMSE량표평분、Mattis치태량표평분、주의력평분비교차이균유통계학의의(P＜0.05),차공복혈당수손조교기타조평분명현강저,차이유통계학의의(P＜0.05).(3)불동류형고지혈증수평환자지간각인지역평분비교차이무통계학의의(P＞0.05).불동HDL-C수평환자재집행공능、화종측험방면비교차이존재통계학의의(P＜0.05),단재기타인지영역방면조별지간차이무통계학의의(P＞0.05).고수평HDL-C조시공간결구능력평분현저고우정상조,차이유통계학의의(P＜0.05),이고수평HDL-C조집행공능평분칙저우정상조,차이야유통계학의의(P＜0.05).(4)Logistic회귀분석발현발현MMSE총체평분여성별、년령、공복혈당、찬후2h혈당유관；이년령、성별화HDL-C시집행공능독립위험인소；기억력여년령유관,기중즉각은각기억력환여HDL-C상관；공간결구능력여년령、성별급개량Rankin량표(mRS)평분균정현저상관관계；신식처리능력칙부여HDL-C수평상관.결론 (1)수발급성결혈성뇌졸중환자중약75％가존재인지공능장애,주요이기억력、집행력、시공간결구능력손해위주.(2)혈당수평우기공복혈당수손상황대환자인지공능적손해최위명현.(3)고수평적HDL-C유조우제고환자인지공능.(4)년령、성별、HDL-C여환자인지공능수평적관계최밀절.
    Objective To investigate the changes of cognitive impairment and its correlated factors in patients with first acute cerebral ischemic stroke.Methods Five hundred and sixty-eighty patients,admitted to our hospital from July 2010 to June 2011 and met the diagnostic criteria of first acute cerebral ischemic stroke,were chosen in our study; neuropsychological evaluation was conducted within 1 week of acute cerebral ischemic stroke.The comprehensive neuropsychological evaluation battery included mini-mental state examination (MMSE),Digit span,Mattis dementia scale,Rey complex figure test,stroop test,World Health Organization and University of California-Los Angeles auditory verbal learning test,semantic category verbal fluency test and clock drawing test,which contained tests for memory,attention,executive function,information processing capability,visuospatial and visuo constructive functions.Gender,age,histories of hypertension and smoking,and levels of blood pressure,random blood glucose,fasting blood glucose and 2-hour postprandial blood glucose,cholesterin,triglyceride,low density lipoprotein-C (LDL-C) and high density lipoprotein-C (HDL-C) were noted and the relations between cognitive function and both blood sugar and blood lipid levels were analyzed.Results (1) The abnormal rates of these patients in MMSE,Mattis dementia scale,attention deficit disorder,immediate logical memory disorder,delayed logical memory disorder,instant auditory memory disorder,delayed auditory memory disorder,visual memory disorder,executive function disorder,information processing disorder,and visuospatial and visuo constructive disorder were 78.2％,72.5％,26.5％,56.3％,60.9％,74.6％,98.2％,83.8％,62.7％,4.9％ and 77.7％,respectively.In patients with different blood glucose levels,significant differences were found on scores of MMSE,Mattis dementia scale,attention scale (P＜ 0.05); furthermore,the scores ofMMSE,Mattis dementia scale,attention scale in patients with impaired fasting glucose were obviously lower as compared with those in other groups (P＜0.05).The scale of above cognitive domains showed no significant difference in patients with different types of hyperlipidemias (P＞0.05); the scores of execution ability and visual space structure capability in patients with HDL-C were higher than those in normal density lipoprotein-C and LDL-C (P＜0.05),and the higher level of density lipoprotein-C,the higher scores of visual space structure capability (P＜0.05).Logistic regression analysis found that the total MMSE scores were associated with gender,age,and levels of fasting blood glucose and 2-hour postprandial blood glucose; the independent risk factors of executive function were gender,age and HDL-C level; the ability of memory was correlated with age and HDL-C level.Visuospatial and visuo constructive function was associated with gender,age and mRS scores; the information processing ability was only correlated with HDL-C level.Conclusion In patients with acute cerebral ischemic stroke,the cognitive impairment is extensive and severe,with a prevalence of about 75％,mainly having disorders in memory,executive ability,spatial structure; glucose levels,especially impaired fasting glucose level show most obvious influence in cognitive impairment;HDL-C level helps keep normal cognitive function; age,gender,HDL-C level are the most important factors of cognitive function.
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