作者：王国瑜1 ，汪洋 1 ，石华 2 ，郭忠伟 1 ，兰希发 1

单位：

1.066000 河北省秦皇岛市第一医院神经内科；　2.066000 河北省秦皇岛市第一医院检验科；通信作者：王国瑜，E-mail：cheerstudent@163.com

关键词：

脑梗死；脑白质疏松；认知功能损伤

Keywords：

Brain infarction；Leukoaraiosis；Cognitive impairment

CLC：

R 743.33

DOI：

DOI：10.3969/j.issn.1008-5971.2020.05.005

Funds：

摘要：

背景　近年急性脑梗死与脑白质疏松（LA）的关系是医学领域研究的热点。目的　探讨 LA 与急性脑梗死患者认知功能的关系。方法　选取 2017 年 3 月—2018 年 10 月秦皇岛市第一医院神经内科收治的急性脑梗死患者200 例，根据 LA 诊断标准分为 LA 组 110 例和无 LA 组 90 例；根据 LA 严重程度将 110 例急性脑梗死伴 LA 患者分为轻度 38 例、中度 45 例和重度27 例，根据 LA部位分为脑室周围型 44例、深部白质型34例和混合型32例。比较LA组、无 LA 组患者一般资料及蒙特利尔认知评估量表（MoCA）总评分及各认知领域（包括视空间及执行功能、命名、注意力、语言、抽象、延迟回忆、定向力）评分；比较轻度、中度和重度 LA 患者 MoCA 总评分，脑室周围型、深部白质型和混合型 LA 患者 MoCA 总评分及各认知领域评分；急性脑梗死患者 LA 严重程度与 MoCA 总评分相关性分析采用Spearman 秩相关分析。结果　LA 组患者年龄大于无 LA 组，MoCA 总评分及各认知领域评分低于无 LA 组（P<0.05）。急性脑梗死伴重度 LA 患者 MoCA 总评分低于轻度、中度者，急性脑梗死伴中度 LA 患者 MoCA 总评分低于轻度者（P<0.05）。Spearman 秩相关分析结果显示，急性脑梗死患者 LA 严重程度与 MoCA 总评分呈负相关（r s =-0.964，P<0.05）。急性脑梗死伴混合型 LA 患者视空间及执行功能评分及 MoCA 总评分低于脑室周围型、深部白质型 LA 者，急性脑梗死伴深部白质型 LA 患者视空间及执行功能评分及 MoCA 总评分低于脑室周围型 LA 者（P<0.05）。结论急性脑梗死伴 LA 患者多存在认知功能损伤，而其认知功能损伤程度与 LA 严重程度呈正相关，且混合型及深部白质型 LA 患者认知功能损伤较严重，尤其是视空间与执行功能损伤明显。

Abstract：

Background　In recent years，the relationship of leukoaraiosis （LA） with acute brain infarction hasbecome the focus of the medical community.Objective　To discuss the relationship of LA with cognitive function in patientswith acute brain infarction.Methods　200 patients with acute brain infarction in Department of Neurology，First Hospital ofQinhuangdao from March 2017 to October 2018 were selected，and they were divided into LA group （n=110） and non-LAgroup （n=90） according to diagnostic criteria of LA；110 cases of acute brain infarction complicated with LA were dividedinto mild group（ 38 cases），moderate group（ 45 cases） and severe group（ 27 cases） according to the severity of LA，and divided into periventricular group（ 44 cases），deep white matter group（ 34 cases） and mixed group（ 32 cases）according to the location of LA.Clinical data，total MoCA score and subtype（including visual space and executive function，naming，attention，language，abstraction，delayed recall，orientation） scores were compared between LA group and non-LAgroup；total MoCA score was compared in mild group，moderate group and severe group，total MoCA and subtype scores werecompared in periventricular group，deep white matter group and mixed group；correlation of the severity of LA with total MoCAscore in acute brain infarction patients was analyse by Pearson correlation analysis.Results　Age in LA group was elder than thatin non-LA group，total MoCA score and subtype scores in LA group were lower than those in non-LA group（P<0.05）.TotalMoCA score in acute brain infarction complicated with severe LA patients was lowe than that in mild，moderate LA patients，total MoCA score in acute brain infarction complicated with moderate LA patients was lowe than that in mild LA patients （P<0.05）.Pearson correlation analysis showed that，the severity of LA in patients with acute brain infarction was negative correlated withtotal MoCA score（r s =-0.964，P<0.05）.Visual space and executive function score and total MoCA score in mixed LA inpatients with acute brain infarction were lower than those in periventricular group，deep white matter group，visual space andexecutive function score and total MoCA score in deep white matter group were lower than those in periventricular group （P<0.05）.Conclusion　Acute brain infarction patients complicated with LA have cognitive impairment，while the degree of cognitiveimpairment in patients with acute brain infarction is positively correlated with the severity of LA，and patients with mixed anddeep white matter LA have more serious cognitive impairment，especially visual space and executive function impairment.

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