【摘要】 目的:探讨无症状腔隙性脑梗死患者发生认知障碍的危险因素并分析其认知障碍特点。方法:选取经头颅CT或MRI确诊的无症状腔隙性脑梗死住院患者215例,依据有无认知障碍将其分为腔梗伴认知障碍组(105例)及腔梗不伴认知障碍组(110例)。收集患者基本临床资料并行MMSE及MoCA量表测定。结果:(1)腔梗伴认知障碍组患者认知及情感量表评分(MMSE、MoCA、HAMA、HAMD)、同型半胱氨酸水平、脑白质病变程度、吸烟比例以及高血压、糖尿病、高脂血症患病率均高于腔梗不伴认知障碍组,差异均有统计学意义(P<0.05);(2)两组MoCA量表比较提示腔梗伴认知障碍患者认知功能损害主要表现在视空间与执行功能、注意、语言、延迟回忆等领域,差异均有统计学意义(P<0.01);(3)二元Logistic回归分析显示高血压、糖尿病、高脂血症、吸烟、脑白质病变、HAMD、高同型半胱氨酸是认知障碍发生的危险因素,OR值分别为3.689(95%CI:1.395-9.751)、2.742(95%CI:1.063-7.077)、2.763(95%CI:1.077-7.085)、2.975(95%CI:1.120-7.902)、3.216(95%CI:1.942-5.324)、1.474(95%CI:1.227-1.770)及1.261(95%CI:1.131-1.405)。结论:无症状腔隙性脑梗死伴高血压、糖尿病、高脂血症、吸烟、抑郁、脑白质病变及高同型半胱氨酸者更易发生认知障碍,且主要损害在视空间与执行功能、注意、语言、延迟回忆等方面。因此有效控制高血压、糖尿病、高脂血症、吸烟、高同型半胱氨酸、抑郁等认知功能障碍早期危险因素,有助于延缓认知功能障碍的发生发展。更多还原

【Abstract】 Objective: To investigate the mechanism and risk factors of cognitive impairment in patients with asymptomatic lacunar infarction and analyze its correlation with the risk factors. Methods: 215 patients with asymptomatic lacunar cerebral infarction diagnosed by head CT or MRI were divided into 105 cases of cavities with cognitive impairment and 110 cases of cavities without cognitive impairment.The basic clinical data of patients were collected and measured by MMSE and MoCA scale. Results:(1) The cognitive and emotional scale score(MMSE,MoCA,HAMA,HAMD) and the level of homocysteine,the prevalence of hypertension,diabetes and hyperlipidemia,the degree of white matter and the proportion of smoking were higher in the cognitive impairment group,and the difference was statistically significant.(2) The MoCA scales indicated that in the patients with cognitive disorders, the cognitive impairment mainly in visual space and executive function,attention,language,delayed recall and so on,and the difference was statistically significant(P<0.01).(3) Bivariate regression analysis showed Hypertension,diabetes,hyperlipidemia,smoking,white matter disease,HAMD,Hyperhomocysteinemia were independent risk factors for cognitive impairment.The values of OR were 3.689(95%CI:1.395-9.751);2.742(95%CI: 1.063-7.077);2.763(95%CI:1.077-7.085);2.975(95%CI:1.120-7.902);3.216(95%CI:1.942-5.324);1.474(95%CI:1.227-1.770)and 1.261(95%CI:1.131-1.405)respectively. Conclusion:Patients with asymptomatic lacunar infarction with hypertension,diabetes,hyperlipidemia,smoking,Hyperhomocysteinemia,depression,and white matter lesions are more likely to have cognitive impairment,and are mainly impaired in visual space and executive function,attention,language,delayed recall and so on.Therefore,effective control of early risk factors for cognitive impairment such as hypertension,diabetes,hyperlipidemia,smoking,Hyperhomocysteinemia and depression can help delay the development of cognitive impairment.更多还原