标题：首发脑梗死患者危险因素对认知功能障碍程度的影响

      作者：李鸣，胡琴，曾伟，张细六，华梅    (武汉市第五医院神经内科，湖北 武汉 430050)

      卷次： 2016年27卷24期

      【摘要】 目的 探讨首发脑梗死患者危险因素对认知功能障碍程度的影响。方法 纳入我院于2013年12月至 2015年 12月期间收治的 102例首发脑梗死患者为观察组，同期随机抽取年龄相匹配的 55例体检人群为对照组。两组受检者均采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、Addenbrooke改良认知评估量表(ACE-R)评估认知功能，并测定血压、血糖、颈动脉粥样硬化性斑块等脑梗死相关危险因素。比较两组受检者的血压、血糖、颈动脉粥样硬化性斑块情况，并分析各项危险因素对认知功能障碍程度的影响。结果 与对照组比较，观察组患者合并有高血压、糖尿病、颈动脉粥样硬化斑块人数的比例明显增加(21.81% vs 86.27%；14.54% vs25.49%；36.36% vs 90.20%)，差异均有统计学意义(P<0.05)，观察组患者的MMSE、MoCA和ACE-R量表评分降低[(27.55±2.10)分 vs (23.96±3.54)分；(27.29±2.31)分 vs (24.33±3.4)分；(86.41±4.69)分 vs (60.23±14.18)分]，差异均有统计学意义(P<0.05)。观察组患者的血压水平越高，认知功能水平越差，差异有统计学意义(P<0.05)，三种量表均较敏感；观察组患者血糖控制情况越差，认知功能水平越差，差异有统计学意义(P<0.05)，以MMSE及MoCA量表敏感；观察组患者的颈动脉狭窄程度越重，认知功能水平越差，差异有统计学意义(P<0.05)，以MMSE、MoCA量表敏感；脑梗死患者合并危险因素越多，认知功能水平越差，三种量表均较敏感。结论 首发脑梗死患者，其认知功能较正常人群存在不同程度的下降，血压、血糖水平和颈动脉粥样硬化狭窄程度以及合并上述危险因素数量均可加重其认知功能障碍程度。
      【关键词】 脑梗死；认知功能障碍；高血压；糖尿病；颈动脉粥样硬化性狭窄
      【中图分类号】 R743.33 【文献标识码】 A 【文章编号】 1003—6350（2016）24—3984—04

Effects of cerebral infarction risk factors on the degree of cognitive impairment in patients with first cerebralinfarction.
LI Ming, HU Qin, ZENG Wei, ZHANG Xi-liu, HUA Mei. Department of Neurology, the Fifth Hospital of Wuhan,Wuhan 430050, Hubei, CHINA
【Abstract】 Objective To investigate the effects of cerebral infarction risk factors on the degree of cogni-tive impairment in patients with first cerebral infarction. Methods A total of 102 patients with first cerebral infarc-tion, who admitted to our hospital from December 2013 to December 2015, were selected as the experimental group.At the same time, 55 age-matched subjects for health examination were randomly selected as the control group. Thecognitive function was assessed by Mini-mental State Examination (MMSE), Montreal Cognitive Assessment (Mo-CA), Addenbrooke Cognitive Examination-revised (ACE-R), and blood pressure, blood glucose and carotid arteryatherosclerotic plaque in both groups was measured. The blood pressure, blood glucose and carotid artery atheroscle-rotic plaque of the two groups were compared, and the influence of various risk factors on the degree of cognitivedysfunction was analyzed. Results Compared with the control group, the incidence of hypertension, diabetes melli-tus and carotid artery atherosclerotic plaque in the experimental group significantly increased (21.81% vs 86.27% ,14.54% vs 25.49%, 36.36% vs 90.20%, respectively, all P<0.05), and MMSE, MoCA, ACE-R scale scores in the experi-mental group significantly decreased, (27.55±2.10) vs (23.96±3.54), (27.29±2.31) vs (24.33±3.4), (86.41±4.69) vs (60.23±14.18), respectively, all P<0.05. In the experimental group, the higher the blood pressure level, the worse the cognitivefunction (P<0.05), and the three scales were all sensitive. In the observation group, the worse the blood glucose control,the worse the cognitive function, with statistically significant difference (P<0.05), and MMSE and MoCA scale were sen-sitive. In the observation group, the more severe the carotid stenosis, the worse the cognitive function, with statisticallysignificant difference (P<0.05), and MMSE and MoCA scale were sensitive. The more the merger risk factors of cerebralinfarction, the lower level of cognitive function (P<0.05), in which three scale were sensitive. Conclusion The cogni-tive function of the patients with first cerebral infarction is lower than that of the normal people. The levels of blood pres-sure and blood glucose, carotid atherosclerotic stenosis and the number of the merged risk factors can exacerbate the de-gree of cognitive dysfunction.
      【Key words】 Cerebral infarction; Cognitive dysfunction; Hypertension; Diabetes mellitus; Carotid astherosclerot-ic stenosis·论 著·doi:10.3969/j.issn.1003-6350.2016.24.009