老年腔隙性脑梗死病人认知功能障碍的影响因素分析
Analysis of the influencing factors of cognitive impairment in elderly patients with lacunar infarction
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摘要: 目的：分析影响老年腔隙性脑梗死（lacunar infarction，LI）病人认知功能障碍的相关因素，为改善LI病人认知功能提供参考依据。方法：收集117例老年LI病人作为LI组，根据发病部位分为双侧组、左侧组和右侧组，选取同期门诊健康体检者100名作为对照组，比较2组蒙特利尔认知评估量表（MoCA）评分，并通过单因素和多因素logistic回归分析法分析影响老年LI病人认知功能的相关因素。结果：117例LI病人MoCA总分为（24.92±2.96）分，发生认知功能障碍64例（54.70%）；LI组延迟回忆、注意力、语言、视空间/执行功能及MoCA总分均低于对照组（P<0.05~P<0.01）；延迟回忆、语言、视空间/执行功能及MoCA总分右侧组均高于双侧组和左侧组（P<0.05~P<0.01），左侧组亦高于双侧组（P<0.05~P<0.01）；注意力评分右侧组高于双侧组（P<0.01）；影响因素分析结果显示病灶部位、高血压、糖尿病、蛋白质病变为影响老年LI病人认知功能的独立危险因素（P<0.05~P<0.01）。结论：老年LI病人多伴有认知功能障碍，以视空间/执行功能、注意力、语言、延迟回忆障碍为主，病灶位于左侧或者双侧病人认知功能障碍更加明显，发病部位、重度蛋白质病变、高血压、糖尿病为影响老年LI病人认知功能障碍的相关危险因素。
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关键词:
- 腔隙性脑梗死 /
- 认知功能障碍 /
- 蒙特利尔认知评估量表
Abstract: Objective:To investigate the clinical factors of cognitive impairment in elderly patients with lacunar infarction(LI),and provide reference in improving the cognitive function of patients.Methods:One hundred and seventeen elderly patients with LI(LI group) were subdivided into the bilateral group,left group and right group according to the lesion location,and 100 healthy people were set as the control group.The score of Montreal cognitive assessment scale(MoCA) between two groups was compared.The influencing factors of cognitive function in elderly patients with LI were analyzed using the single factor analysis and multi factor logistic regression analysis.Results:Among 117 cases,the total score of MoCA was(24.92±2.96),the cognitive dysfunction in 64 cases(54.70%) were found.The delayed recall,attention,language,visual space/executive function and MoCA score in LI group were lower than those in control group(P<0.05 to P<0.01).The delayed recall,language,visual space/executive function and MoCA score in right group were higher than those in bilateral group and left group(P<0.05 to P<0.01),and which in left group was higher than that in bilateral group(P<0.05 to P<0.01).The attention score in right group was higher than that in bilateral group(P<0.01).The analysis result of influencing factors showed that the lesion location,hypertension,diabetes mellitus and protein disease were the independent risk factors of cognitive function in elderly patients with LI(P<0.05 to P<0.01).Conclusions:The elderly LI patients complicated with cognitive dysfunction is often,and the visuospatial/executive function,attention,language,memory disorders are the major performances,the cognitive dysfunction in bilateral or left side lesions patients is more obvious,the lesion location,severe protein lesion,hypertension and diabetes are the related risk factors affecting the cognitive dysfunction in elderly patients with LI. -
[1] PEDDER H,VESTERINEN HM,MACLEOD MR,et al.Systematic review and meta-analysis of interventions tested in animal models of lacunar stroke[J].Stroke,2014,45(2):563. [2] KLARENBEEK P,VAN OOSTENBRUGGE RJ,ROUHL RP,et al.Ambulatory blood pressure in patients with lacunar stroke:association with total MRI burden of cerebral small vessel disease[J].Stroke,2013,44(11):2995. [3] XIA ZY,SUN QJ,YANG H,et al.Effect of carotid artery stenting on cognitive function in patients with internal carotid artery stenosis and cerebral lacunar infarction:a 3-year follow-up study in China[J].PLoS One,2014,10(6):e0129917. [4] 全国第四届脑血管病学术会议.各类脑血管病诊断要点[J].中华神经科杂志,1996,29(6):379. [5] 黄静,钟远.腔隙性脑梗死认知功能损害患者头颅MRI特征[J].实用老年医学,2013,27(2):114. [6] 王炜,王鲁宁.蒙特利尔认知评估量表在轻微认知损伤患者筛查中的应用[J].中华内科杂志,2007,46(5):414. [7] LÜ P,JIN H,LIU Y,et al.comparison of risk factor between lacunar stroke and large artery atherosclerosis stroke:a cross-sectional study in china[J].PLoS One,2016,11(3):e0149605. [8] HINMAN JD,LEE MD,TUNG S,et al.Molecular disorganization of axons adjacent to human lacunar infarcts[J].Brain,2015,138(Pt3):736. [9] MAKIN SD,TURPIN S,DENNIS MS,et al.Cognitive impairment after lacunar stroke:systematic review and meta-analysis of incidence,prevalence and comparison with other stroke subtypes[J].J Neurol Neurosurg Psychiatry,2013,84(8):893. [10] 赵培秀,张楠,程焱.腔隙性脑梗死患者的认知损害:危险因素和特征[J].国际脑血管病杂志,2014,22(1):28. [11] 孙雪.老年腔隙性脑梗死患者认知功能障碍及危险因素分析[J].神经损伤与功能重建,2015,10(4):337. [12] WISEMAN S,MARLBOROUGH F,DOUBAL F,et al.Blood markers of coagulation,fibrinolysis,endothelial dysfunction and inflammation in lacunar stroke versus non-lacunar stroke and non-stroke:systematic review and meta-analysis[J].Cerebrovasc Dis,2014,37(1):64. [13] 韩阅,贾建平,周爱红,等.初发腔隙性脑梗死的病灶数量和部位对患者认知功能的影响[J].中国脑血管病杂志,2009,6(11):568. [14] 黄静,钟远.老年腔隙性脑梗死患者认知功能障碍特点及其相关因素研究[J].实用老年医学,2010,24(4):319. [15] 黄连铭.老年腔隙性脑梗死后影响认知功能障碍的危险因素分析[J].现代中西医结合杂志,2015,24(12):1334. [16] 李红琏,贾俊栋,尹雪,等.老年腔隙性脑梗死患者与认知功能障碍相关性研究[J].疑难病杂志,2015,14(7):679. [17] VAN OVERBEEK EC,STAALS J,KNOTTNERUS IL,et al.Plasma tPA-Activity and progression of cerebral white matter hyperintensities in lacunar stroke patients[J].PLoS One,2016,11(3):e0150740. [18] 孙建芳,张翠玲.老年腔隙性脑梗死部位与认知功能障碍的关系及随时间发展趋势的研究[J].临床和实验医学杂志,2015,14(18):1518. [19] LEE JH,OH E,OH MS,et al.Highly variable blood pressure as a predictor of poor cognitive outcome in patients with acute lacunar infarction[J].Cogn Behav Neurol,2014,27(4):189. [20] 殷琪,许晋川,吕静美,等.肥胖与腔隙性脑梗死后轻度认知障碍的相关性研究[J].现代医学,2014,42(9):1040. -
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