非糖尿病急性缺血性脑卒中患者认知功能障碍特点及其危险因素研究

目的　探讨非糖尿病急性缺血性脑卒中患者认知功能障碍特点及其发生认知功能障碍的危险因素。方法　收集2016年12月—2017年7月新疆医科大学第一附属医院神经内科经颅脑MRI确诊的急性缺血性脑卒中住院患者96例为研究对象，根据北京版蒙特利尔认知评估量表（MoCA）评分分为无认知功能障碍组（MoCA≥26分，n=51）和认知功能障碍组（MoCA<26分，n=45）。收集患者一般资料及实验室检查指标。结果　患者MoCA视空间与执行力、命名能力、注意力、计算力、语言能力、延迟回忆能力、定向力、抽象思维能力维度评分均低于标准分（P<0.05），其中，视空间与执行力、延迟回忆能力、抽象思维能力维度评分与标准分差距较大。多因素Logistic回归分析显示，高龄〔OR=1.190，95%CI（1.062，1.333）〕、脑血管狭窄〔OR=10.449，95%CI（1.696，64.389）〕、空腹血糖（FPG）>4.7 mmol/L〔OR=41.378，95%CI（2.801，611.350）〕、低密度脂蛋白胆固醇（LDL-C）升高〔OR=3.481，95%CI（1.120，10.822）〕、尿微量清蛋白升高〔OR=1.067，95%CI（1.009，1.128）〕是认知功能障碍的危险因素，较长的受教育年限〔OR=0.505，95%CI（0.326，0.782）〕、高密度脂蛋白胆固醇（HDL-C）升高〔OR=0.020，95%CI（0.001，0.359）〕是其保护因素（P<0.05）。结论　非糖尿病急性缺血性脑卒中患者认知功能障碍与前、后循环梗死均相关，脑血管狭窄及较高的血糖水平是认知功能障碍的重要常见危险因素，适当干预脑卒中后脑血管狭窄及高血糖水平将对改善认知功能障碍获益。

Characteristics and Risk Factors of Cognitive Impairment in Patients with Non-diabetic Acute Ischemic Stroke

Objective　To investigate the characteristics and risk factors of cognitive impairment in patients with non-diabetic acute ischemic stroke.Methods　We enrolled 96 inpatients with acute ischemic stroke diagnosed by brain MRI from Department of Neurology，the First Affiliated Hospital of Xinjiang Medical University from December 2016 to July 2017.We collected their clinical data and results of laboratory tests.And based on the assessment results of Beijing version of the Montreal Cognitive Assessment（MoCA），we assigned those with MoCA<26 and MoCA ≥26 to cognitive impairment group（n=45），non-cognitive impairment group（n=51），respectively.Results　The mean scores of visuospatial abilities and executive functions，naming ability，attention ability，capacity of calculation，language ability，delayed recollection，level of orientation，abstract thinking ability for the participants were all lower than full credit（P<0.05）.In particular，the mean scores of the visuospatial abilities and executive functions，delayed recollection，abstract thinking ability had a large gap comparied with full credit.Multivariate Logistic regression analysis showed that older age〔OR=1.190，95%CI（1.062，1.333）〕，cerebrovascular stenosis 〔OR=10.449，95%CI（1.696，64.389）〕，FPG >4.7 mmol/L〔OR=41.378，95%CI（2.801，611.350）〕，elevated LDL-C level 〔OR=3.481，95%CI（1.120，10.822）〕，elevated microalbumin level in the urine〔OR=1.067，95%CI（1.009，1.128）〕 were risk factors for cognitive impairment，while increased years of education〔OR=0.505，95%CI（0.326，0.782）〕 and elevated HDL-C level 〔OR=0.020，95%CI（0.001，0.359）〕 were protective factors for cognitive impairment（P<0.05）.Conclusion　Cognitive function is associated with both anterior and posterior circulation infarction in patients with non-diabetic acute ischemic stroke.Intracranial and extracranial vascular stenosis and increased FPG levels are important risk factors for cognitive impairment，so appropriately targeted interventions will benefit the improvement of cognitive function.