作者：李鑫，徐斌，元小冬，王笛，马英，张萍淑

单位：

1.063000 河北省唐山市，华北理工大学附属开滦总医院神经内科 2.063000 河北省唐山市，河北省神经生物机能重点实验室 通信作者：张萍淑，E-mail：1977nana@sina.com

Units：

1.Department of Neurology, Kailuan General Hospital, North China University of Science and Technology, Tangshan 063000, China 2.Key Laboratory of Neurobiological Function of Hebei Province, Tangshan 063000, China Corresponding author: ZHANG Pingshu, E-mail: 1977nana@sina.com

关键词：

腔隙性脑梗死; 认知障碍; 影响因素分析;

Keywords：

Lacunar cerebral infarction; Cognitive impairment; Root cause analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.001

Funds：

2020 年河北省重点研发计划项目（203777116D）；2019 年唐山市科学技术研究与发展计划项目（19150256E）；2020 年河北省医学适用技术跟踪项目（GZ2020002）

摘要：

背景多发腔隙性脑梗死(MLI)患者常以认知功能损伤就诊,若不及时干预则可能导致痴呆,进而影响患者的生活质量。因此,寻找MLI患者发生认知障碍的影响因素具有重要的临床意义。目的探讨MLI患者发生认知障碍的影响因素。方法连续选取2021年1—6月华北理工大学附属开滦总医院神经内科收治的MLI患者198例,根据简易智力状态检查量表(MMSE)评分将其分为认知障碍组(MMSE评分<27分,n=94)和无认知障碍组(MMSE评分为27～30分,n=104)。比较两组患者临床资料、梗死灶分布情况、呼吸暂停低通气指数(AHI)、昼夜节律类型量表(CTI)-灵活性/刚性分量表(FR)评分、CTI-困倦/活力分量表(LV)评分、抑郁程度、焦虑程度;MLI患者发生认知障碍的影响因素分析采用多因素Logistic回归分析。结果认知障碍组患者中有饮酒史、高同型半胱氨酸血症(HHcy)病史者所占比例高于无认知障碍组(P <0.05)。认知障碍组患者中额叶梗死、脑桥梗死及基底核梗死者所占比例高于无认知障碍组(P <0.05)。多因素Logistic回归分析结果显示,HHcy病史[OR=2.053,95%CI(1.080,3.900)]、额叶梗死[OR=2.262,95%CI(1.035,4.943)]、AHI[OR=1.030,95%CI(1.005,1.056)]及CTI-FR评分[OR=0.846,95%CI(0.757,0.945)]是MLI患者发生认知障碍的独立影响因素(P <0.05)。结论伴有HHcy、额叶梗死、AHI增加及睡眠生物节律灵活性减弱的MLI患者更易发生认知障碍,应引起临床重视。

Abstract：

【Abstract】 Background Patients with multiple lacunar infarction (MLI) are often treated with cognitive impairment.If not intervened in time, it may lead to dementia and affect the quality of life of patients. Therefore, it is of great significanceto find the influencing factors of cognitive impairment in patients with MLI.Objective To explore the influencing factors ofcognitive impairment in patients with MLI.Methods A total of 198 patients with MLI treated in the Department of Neurology,Kailuan General Hospital, North China University of Science and Technology from January to June 2021 were selected. Accordingto the Mini-Mental State Examination (MMSE) score, they were divided into cognitive impairment group (MMSE score< 27,n=94) and non-cognitive impairment group (MMSE score was 27-30, n=104) . The clinical data, infarct distribution, apneahypopnea index (AHI), Circadian Type Inventory (CTI) -Flexibility or Rigidity (FR) score, CTI-Lanfuid or Vigorous (LV) score,depression and anxiety were compared between the two groups; multivariate Logistic regression analysis was used to analyze theinfluencing factors of cognitive impairment in patients with MLI. Results The proportion of patients with drinking history andhyperhomocysteinemia (HHcy) history in the cognitive impairment group was higher than that in the non-cognitive impairmentgroup (P < 0.05) . The proportion of patients with frontal lobe infarction, pontine infarction and basal ganglia infarction inthe cognitive impairment group was higher than that in the non-cognitive impairment group (P < 0.05) . Multivariate Logisticregression analysis showed that HHcy history [OR=2.053, 95%CI (1.080, 3.900) ] , frontal lobe infarction [OR=2.262, 95%CI(1.035, 4.943) ] , AHI [OR=1.030, 95%CI (1.005, 1.056) ] and CTI-FR score [OR=0.846, 95%CI (0.757, 0.945) ] were theindependent influencing factors for cognitive impairment in patients with MLI (P < 0.05) . Conclusion MLI patients withHHcy, frontal lobe infarction, increased AHI and decreased flexibility of sleep biological rhythm are more likely to have cognitiveimpairment, which should be paid more attention in clinical practice.

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