青年卒中后认知障碍的危险因素分析

doi:10.3969/j.issn.1673-5765.2018.11.003

摘要/Abstract

摘要：

目的探讨青年卒中后认知障碍（post-stroke cognitive impairment，PSCI）的危险因素。

方法连续收集2016年12月-2017年12月在天津市环湖医院神经内科住院的18～45岁的缺血性卒中患者165例，记录患者人口学资料、血管危险因素、实验室检查资料，所有患者于发病14 d内行蒙特利尔认知评估量表（Montreal cognitive assessment scale，MoCA）测评，根据MoCA评分<26分认为认知功能障碍，分为PSCI组和认知功能正常组，采用多因素Logistic回归分析青年PSCI的独立危险因素。

结果研究共纳入165例青年卒中患者，其中男性128例（77.6%），平均年龄（40.02±5.20）岁。青年卒中发病14 d内出现PSCI的比例为64.8%（107例）。多因素Logistics回归分析显示较低受教育程度[比值比（odds ratio，OR）6.752，95%可信区间（confidence interval，CI）1.385～32.906，P =0.018]、入院时NIHSS评分较高（OR 1.660，95%CI 1.372～2.009，P＜0.001）、既往缺血性卒中（OR 3.728，95%CI 1.376～10.104，P =0.010）是青年PSCI的独立危险因素。

结论青年PSCI的患病率仍较高，较低受教育程度、入院时NIHSS评分较高、既往缺血性卒中的患者 PSCI风险更高。

文章导读： 本文对青年缺血性卒中患者卒中后14d发生认知障碍的相关因素进行多因素分析，结果显示教育程度、发病严重程度及既往缺血性卒中病史与认知障碍的发生有关。

关键词: 青年卒中; 卒中后认知障碍; 危险因素

Abstract:

Objective To investigate the risk factors of post-stroke cognitive impairment (PSCI) in young ischemic stroke patients.

Methods Young patients (age 18-45 years) with ischemic stroke in neurology department of Tianjin Huanhu hospital from December 2016 to December 2017 were enrolled consecutively. Demographic information, vascular risk factors, laboratory test results were collected. All of the patients were assessed by Montreal cognitive assessment (MoCA) scale within 14 days from onset. According to the MoCA score, all patients were divided into PSCI (MoCA score <26) group and normal cognitive function group. Multivariate Logistic regression analysis was used to analyze the independent risk factors of young PSCI.

Results A total of 165 young patients (mean age 40.02 ± 5.20; 77.6% male) were identified, and 64.8% (n =107) had PSCI within 14 days from onset. Multivariate Logistic regression analysis showed that the lower level of education [odds ratio (OR) 6.752, 95% confidence interval (CI) 1.385-32.906, P =0.018], higher NIHSS score on admission (OR 1.660, 95%CI 1.372-2.009, P <0.001), previous ischemic stroke (OR 3.728, 95%CI 1.376-10.104, P =0.010) were independent risk factors of PSCI in young adult stroke patients.

Conclusions The prevalence of PSCI in young people is still high, especially those with lower level of education, higher NIHSS score on admission and previous ischemic stroke, should be paid more attention to screen PSCI.

Key words: Young stroke; Post-stroke cognitive impairment; Risk factor

吴昊, 纪勇. 青年卒中后认知障碍的危险因素分析[J]. 中国卒中杂志, 2018, 13(11): 1134-1138.

WU Hao, JI Yong. Analysis of Risk Factors of Post-stroke Cognitive Impairment in Young Stroke Patients[J]. Chinese Journal of Stroke, 2018, 13(11): 1134-1138.

参考文献

[1] PUTAALA J，METSO A J，METSO T M，et al.

Analysis of 1008 consecutive patients aged 15 to 49

with first-ever ischemic stroke：the Helsinki young

stroke registry[J]. Stroke，2009，40（4）：1195-1203.

[2] GEORGE M G，TONG X，KUKLINA E V. Trends

in stroke hospitalizations and associated risk factors

among children and young adults，1995-2008[J].

Ann Neurol，2011，70（5）：713-721.

[3] ADAMS H P，KAPPELLE L J，BILLER J，et al.

Ischemic stroke in young adults. Experience in 329

patients enrolled in the Iowa Registry of stroke in

young adults[J]. Arch Neurol，1995，52（5）：491-

495.

[4] LI F，YANG L，YANG R，et al. Ischemic Stroke in

Young Adults of Northern China：Characteristics and

Risk Factors for Recurrence[J]. Eur Neurol，2017，77

（3-4）：115-122.

[5] OH H，PARK J，SEO W. A 2-year prospective

follow-up study of temporal changes associated with

post-stroke cognitive impairment[J/OL]. Int J Nurs

Pract，2018，24（2）：e12618. https：//doi.org/10.1111/

ijn.12618.

[6] CHAN E，KHAN S，OLIVER R，et al.

Underestimation of cognitive impairments by the

Montreal Cognitive Assessment（MoCA）in an acute stroke unit population[J]. J Neurol Sci，2014，343（1-

2）：176-179.

[7] PARK Y H，JANG J W，PARK S Y，et al. Executive

function as a strong predictor of recovery from

disability in patients with acute stroke：a preliminary

study[J]. J Stroke Cerebrovasc Dis，2015，24（3）：

554-561.

[8] RENJEN P N，GAUBA C，CHAUDHARI

D. Cognitive Impairment After Stroke[J/OL].

Cureus，2015，7（9）：e335. https：//doi.org/10.7759/

cureus.335.

[9] SCHAAPSMEERDERS P，MAAIJWEE N A，VAN

DIJK E J，et al. Long-term cognitive impairment

after first-ever ischemic stroke in young adults[J].

Stroke，2013，44（6）：1621-1628.

[10] 中国高血压防治指南修订委员会. 中国高血压防治

指南[J]. 中华高血压杂志，2011，19（8）：701-742.

[11] 中华医学会神经病学分会脑血管病学组. 中国急性

缺血性脑卒中诊治指南[J]. 中华神经科杂志，2015，

48（4）：246-257.

[12] 陈灏珠. 心脏病学[M]. 人民卫生出版社，北京，2003：

1203.

[13] 中国成人血脂异常防治指南修订联合委员会. 中国

成人血脂异常防治指南解读（2016年修订版）[J]. 中

国循环杂志，2016，31（10）：937-939.

[14] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南

[J]. 中国糖尿病杂志，2015，88（3）：26-89.

[15] 中华医学会风湿病学分会. 2016中国痛风诊疗指南

[J]. 中华内科杂志，2016，55（11）：892-899.

[16] 中国卒中学会，卒中后认知障碍管理专家委员会. 卒

中后认知障碍管理专家共识[J]. 中国卒中杂志，2017，

12（6）：519-531.

[17] NIJSSE B，VISSER-MEILY J M，VAN MIERLO

M L，et al. Temporal Evolution of Poststroke

Cognitive Impairment Using the Montreal Cognitive

Assessment[J]. Stroke，2017，48（1）：98-104.

[18] MAHON S，PARMAR P，BARKER-COLLO S，

et al. Determinants，Prevalence，and Trajectory

of Long-Term Post-Stroke Cognitive Impairment：

Results from a 4-Year Follow-Up of the ARCOS-IV

Study[J]. Neuroepidemiology，2017，49（3-4）：129-

134.

[19] OJALA-OKSALA J，JOKINEN H，KOPSI V，et al.

Educational history is an independent predictor of

cognitive deficits and long-term survival in postacute

patients with mild to moderate ischemic stroke[J].

Stroke，2012，43（11）：2931-2935.

[20] 陈永明，吕薇，张建明，等. 急性缺血性卒中后认知

功能障碍危险因素分析[J]. 中国卒中杂志，2017，12

（9）：822-826.

[21] STERN Y. Cognitive reserve in ageing and

Alzheimer's disease. The Lancet. Neurology，2012，11

（11）：1006-1012.

[22] HUANG Y，YANG S，JIA J. Factors related to longterm

post-stroke cognitive impairment in young

adult ischemic stroke[J/OL]. Med Sci Monit，2015，

21：654-660. https：//doi.org/10.12659/MSM.892554.

[23] QU Y，ZHUO L，LI N，et al. Prevalence of poststroke

cognitive impairment in china：a communitybased，

cross-sectional study[J/OL]. PLoS One，2015，

10（4）：e0122864. https：//doi.org/10.1371/journal.

pone.0122864.