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目的探索缺血性卒中后早期(3个月内)认知功能恶化的发生率以及相关危险因素。方法前瞻性连续入组住院治疗的195例急性缺血性卒中患者。根据卒中急性期(发病14d以内)和卒中后3个月患者简明精神状态量表(MMSE)总分是否降低2分以上,分为认知功能恶化组和非恶化组,并进行组间对比。采用logistic回归分析缺血性卒中后早期认知功能恶化的危险因素。结果缺血性卒中急性期有117例(60.0%)患者被诊断为卒中后认知障碍(PSCI)。卒中后3个月有37例(19.0%)患者发生了认知功能的恶化。单因素logistic回归分析显示缺血性卒中后早期认知功能恶化和年龄、性别、受教育年限、急性期MMSE评分、急性期临床痴呆量表(CDR)评分、入院时糖化血红蛋白水平有关(P<0.05)。多因素logistic回归分析显示,年龄>70岁(RR=2.509,P=0.045)、文盲(RR=3.038,P=0.011)、入院时糖化血红蛋白水平(RR=1.364,P=0.016)是缺血性卒中后早期认知功能恶化的危险因素;急性期MMSE评分(RR=0.852,P=0.001)为其保护因素。结论年龄>70岁、文盲、糖化血红蛋白水平高、卒中急性期存在严重的认知功能障碍是缺血性卒中患者早期认知功能恶化的危险因素。
Objective To explore the incidence of cognitive impairment and related risk factors in the early (within 3 months) after ischemic stroke. Methods A total of 195 hospitalized acute ischemic stroke patients prospectively and consecutively enrolled. Patients were divided into two groups according to whether the MMSE score was reduced by more than 2 points in the acute phase of stroke (within 14 days after onset) and in the 3 months after stroke, and divided into cognitive deterioration group and non-deterioration group. Logistic regression was used to analyze the risk factors of early cognitive decline after ischemic stroke. Results 117 (60.0%) patients were diagnosed as post-stroke cognitive impairment (PSCI) in the acute stage of ischemic stroke. In the three months after stroke, 37 patients (19.0%) had a worsening of cognitive function. Univariate logistic regression analysis showed that the deterioration of early cognitive function after ischemic stroke was related to age, sex, years of education, MMSE score of acute phase, clinical dementia scale of acute phase (CDR) and admission hemoglobin level (P < 0.05). Multivariate logistic regression analysis showed that the level of glycosylated hemoglobin (RR = 1.364, P = 0.016) at admission was significantly higher in those with age> 70 years (RR = 2.509, P = 0.045) The risk factors for the deterioration of cognitive function were early post-stroke. The MMSE score of acute phase (RR = 0.852, P = 0.001) was the protective factor. Conclusions Age> 70 years old, illiterate, high level of glycosylated hemoglobin, and severe cognitive impairment in acute stage of stroke are the risk factors of early cognitive impairment in ischemic stroke patients.