摘要
目的 分析缺血性脑卒中合并脑微出血对患者认知功能的影响.方法 采用磁敏感加权成像（SWI）,检测2014年1月至2015年6月宁波市第一医院神经内科收治的268例确诊为急性缺血性脑卒中患者, 将其分为脑微出血阴性组（199例）和脑微出血阳性组（69例）.对于脑微出血阳性组患者,根据脑微出血的数量将其分为：1级（1~5个）和2级（≥6个）.采用蒙特利尔认知评估量表（MoCA）评价患者认知功能.比较各组认知功能的差异.结果 脑微出血阳性组患者MoCA总分和视空间与执行能力、注意2个分项认知领域评分分别为（20.95±4.53）、（2.53±1.09）、（3.83±0.97）分,均显著低于脑微出血阴性组患者[分别为（26.82±1.25）、（3.16±1.24）、（4.91±0.84）分;t=16.59、3.75、8.83,均P〈0.01].脑微出血1级患者MoCA总分和注意这个分项认知领域的评分分别为（21.53±4.61）、（4.11±0.91）分,均显著低于脑微出血阴性组患者（t=14.09、14.23,均P〈0.01）.而脑微出血1级患者MoCA总分和视空间与执行能力、注意、定向3个分项认知领域的评分分别为（21.53±4.61）、（2.88±1.06）、（4.11±0.91）、（4.96±0.40）分,均显著高于脑微出血2级患者[分别为（18.58±3.08）、（2.23±0.95）、（3.63±1.01）、（3.85±0.39）分;t=2.85、P〈0.01,t=2.54、P〈0.05,t=5.63、P〈0.01,t=2.58、P〈0.01].多因素回归分析提示缺血性脑卒中患者MoCA评分的独立影响因素包括脑微出血阳性（OR=3.15,95% CI 1.28~5.12,P=0.005）及脑微出血数量（OR=1.73,95% CI 1.08~2.32,P=0.031）.结论 脑微出血及其数量与缺血性脑卒中患者的认知功能损害独立相关,随着脑微出血数量的增多,缺血性脑卒中患者在某些方面的认知功能损害更为突出.
Objective To investigate the impact of cerebral microbleeds （CMBs） on cognitive function in ischemic stroke patients.Methods A total of 268 acute ischemic stroke patients recruited in the Ningbo First Hospital from January 2014 to June 2015 were divided into CMBs group （199 patients） and non-CMBs group （69 patients） according to whether complicated with CMBs by susceptibility-weighted imaging （SWI）.According to the microbleed number, CMBs group patients were divided into 2 grades： grade 1 （1-5 CMBs） and grade 2 （≥6 CMBs）. Montreal Cognitive Assessment （MoCA） was used to evaluate and compare the global cognitive function and cognitive domains of the patients. Results The total MoCA score and the scores of visuospatial/executive, attention domains in CMBs group were 20.95±4.53, 2.53±1.09, 3.83±0.97, while those in non-CMBs group were 26.82±1.25, 3.16±1.24 and 4.91±0.84. The total MoCA score and the scores of visuospatial/executive, attention domains were significantly lower in CMBs group than those in non-CMBs group （t=16.59, P〈0.01;t=3.75, P〈0.01;t=8.83, P〈0.01）. The total MoCA score and the score of attention domain in grade 1 CMBs group were 21.53±4.61 and 4.11±0.91 , which were significantly lower than those in non-CMBs group （t=14.09, P〈0.01;t=14.23, P〈0.01）. Whereas the total MoCA score and the scores of visuospatial/executive, attention, orientation domains in grade 1 CMBs group were 21.53±4.61, 2.88±1.06, 4.11±0.91, 4.96±0.40, which were significantly higher than those in grade 2 CMBs group （18.58±3.08, 2.23±0.95, 3.63±1.01, 3.85±0.39, respectively;t=2.85, P〈0.01;t=2.54, P〈0.05;t=5.63, P〈0.01;t=2.58, P〈0.01）. Multivariate regression analysis showed that independent risk factors of MoCA scores in ischemic stroke patients included CMBs （OR=3.15, 95% CI 1.28-5.12, P=0.005） and the number of CMBs （OR=1.73,95% CI 1.08-2.32,P=0.031）. Conclusions CMBs and the number of CMBs were independently associated with cognitive impairment
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2017年第5期332-337,共6页
Chinese Journal of Neurology
关键词
卒中
脑出血
认知障碍
Stroke
Cerebral hemorrhage
Cognition disorders
