摘要
目的探讨血清25-羟维生素D_(3)[25(OH)D_(3)]对老年首发脑梗死患者卒中后认知功能的影响。方法选取270例老年首发脑梗死患者作为研究对象,入院时评估美国国立卫生研究院卒中量表(NIHSS)评分、蒙特利尔认知量表(MoCA)评分,随访6个月,于3个月时复测MoCA评分,6个月时评估改良Rankin量表(mRS)评分。根据3个月时MoCA评分将患者分为早期卒中后认知障碍(PSCI)组和早期卒中后认知正常(Non-PSCI)组,比较2组患者的临床资料;采用Logistic回归分析确定老年首发脑梗死患者早期PSCI的独立影响因素;绘制受试者工作特征(ROC)曲线评价血清25(OH)D_(3)水平对老年首发脑梗死患者早期PSCI的预测价值;根据血清25(OH)D_(3)截断值将患者分为低VD组与正常VD组,比较2组间早期PSCI发病率、MoCA评分差异。结果270例患者中,早期PSCI发病率高达60.37%(163/270)。血清25(OH)D_(3)水平(OR=0.834,95%CI为0.766~0.907,P<0.001)是老年首发急性脑梗死患者早期PSCI的独立影响因素,女性患者血清25(OH)D_(3)水平与脑梗死后早期认知功能的关联强度大于男性患者。血清25(OH)D_(3)预测老年首发脑梗死患者早期PSCI的ROC曲线下面积为0.751(P<0.05),最佳截断值为23.17 ng/mL。低VD组早期PSCI发病率高于正常VD组,MoCA评分低于正常VD组,差异有统计学意义(P<0.05)。结论正常水平血清25(OH)D_(3)是老年首发脑梗死患者早期PSCI的独立保护性因素。血清25(OH)D_(3)水平会影响老年首发脑梗死患者卒中后认知功能,且对老年女性卒中后认知功能的影响要大于老年男性。
Objective To investigate the effect of serum 25-hydroxyvitamin D_(3)[25(OH)D_(3)]on cognitive function after stroke in elderly patients with with first-episode ischemic stroke.Methods A total of 270 elderly patients with first-episode cerebral infarction were selected as study subjects.The National Institutes of Health Stroke Scale(NIHSS)scores and Montreal Cognition Scale(MoCA)scores were assessed at admission.The follow-up period lasted 6 months,and the MoCA score was re-measured at 3 months,and the modified Rankin Scale(mRS)score was assessed at 6 months.According to the MoCA score at 3 months,the patients were divided into early post-stroke cognitive impairment(PSCI)group and early post-stroke cognitive normal(non-PSCI)group,and the clinical data of the two groups was compared.Logistic regression analysis was used to determine the independent influencing factors of early PSCI in elderly patients with first-episode cerebral infarction.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum 25(OH)D_(3) level on early PSCI in elderly patients with first-episode cerebral infarction.Patients were further divided into low VD group and normal VD group according to the serum 25(OH)D_(3) cut-off value,and the early PSCI incidence and MoCA scores between the two groups were compared.Results Among 270 patients,the incidence rate of early PSCI was as high as 60.37%(163/270).Serum 25(OH)D_(3) level was an independent influencing factor for early PSCI in elderly patients with first-episode acute cerebral infarction(OR=0.834,95%CI,0.766 to 0.907,P<0.001).The correlation between serum 25(OH)D_(3) level and early cognitive function after cerebral infarction was stronger in female patients than in males.The area under ROC curve of serum 25(OH)D_(3) in predicting early PSCI of elderly patients with first-episode cerebral infarction was 0.751(P<0.05),and the best cutoff value was 23.17 ng/mL.The incidence of early PSCI in low VD group was higher than that in normal VD group,and the MoCA sc
作者
陆珍辉
郭啸鸣
李新玲
曹志勇
朱连海
朱向阳
LU Zhenhui;GUO Xiaoming;LI Xinling;CAO Zhiyong;ZHU Lianhai;ZHU Xiangyang(Department of Neurology,First People′s Hospital of Nantong City of Jiangsu Province,Nantong,Jiangsu,226001)
出处
《实用临床医药杂志》
CAS
2021年第17期61-66,共6页
Journal of Clinical Medicine in Practice
基金
江苏省卫生健康委科研项目(H2019057)
江苏省南通市卫生和计划生育委员会科研课题(QA2019015)。
