后循环缺血性卒中与认知障碍相关性研究

摘要/Abstract

摘要：

目的探究后循环缺血性卒中与认知障碍发生的关系。方法连续选取2013年11月至2014年11月浙江大学医学院附属第一医院及嘉兴市第二医院收治的急性后循环缺血性卒中患者67例，收集患者人口学、影像学及认知功能评价资料，并通过磁共振成像统计梗死部位；通过简明精神状态量表、阿尔兹海默病评定量表认知分量表、临床痴呆量表评估认知功能；根据认知诊断标准同时结合认知功能评价结果，将患者分为认知功能正常组、血管性轻度认知障碍组、血管性痴呆组。结果 67例患者中，认知功能正常32例（47.8%）、血管性轻度认知障碍20例（29.9%），血管性痴呆15例（2 2.4%）。通过校正年龄、性别、汉密尔顿抑郁评分等因素后，多因素回归分析显示：颞枕叶缺血性卒中［比值比（odd ratio，OR）75.89，95%可信区间（confidence interval， C I ）3.92～1 470.06）］增加认知障碍发生风险，脑桥缺血性卒中患者发生认知障碍的风险比非脑桥缺血性卒中降低90%（OR 0.10，95%CI 0.02～0.60）；进一步分析显示，颞枕叶缺血性卒中（OR 542.24，95%CI 7.85～37 481.44）增加轻度认知障碍发生风险；小脑缺血性卒中（OR 12.49， 95%CI 1.03～151.58）增加血管性痴呆发生风险。结论 50%以上后循环缺血性卒中患者发生认知障碍；其中颞枕叶及小脑缺血性卒中增加认知障碍发生风险，脑桥缺血性卒中与认知障碍发生无显著相关性。

文章导读： 小脑及颞枕叶缺血性卒中增加认知障碍发生风险，小脑参与认知系统的工作。

关键词: 后循环; 缺血性卒中; 认知障碍

Abstract:

Objective To investigate the relationship between posterior cerebral artery ischemic stroke and cognitive impairment. Methods Sixty-seven patients with acute posterior circulation ischemic stroke were continuously included from the first affiliated hospital of Zhejiang university and Jiaxing second hospital from November 2013 to November 2014. We collected demographic data, imaging data and evaluated cognitive function. Magnetic resonance imaging was used to calculate patients’ infarction sections. Mini-Mental State Examination(MMSE), Alzheimer's Disease Assessment Scale-cognitive subscales(ADAS-cog), Clinical Dementia Rating scale(CDR) were used to evaluate cognition in post-stroke patients. According to cognitive impairment diagnosis standards, patients were divided into three groups: the normal cognitive function, the vascular mild cognitive impairment and the vascular dementia group.lobe ischemic stroke increased(OR =75.89, 95%CI 3.92-1470.06),which in patients with pontine ischemic stroke reduced by 90%(OR=0.10, 95%CI 0.02-0.60); the further analysis shows that, the odds ratio of mild cognitive impairment in patients with occipitotemporal lobe ischemic stroke increased further(OR =542.24, 95%CI 7.85-37481.44); and the odds ratio of vascular dementia in patients with cerebellar ischemic stroke also increased(OR=12.49, 95%CI 1.03-151.58﹚. Conclusion More than Fifty percents patients occurred cognitive impairment after posterior cerebral artery ischemic stroke. The occipitotemporal and cerebellar ischemic stroke increased the risk of suffering cognitive impairment, while the pontine ischemic stroke uncorrelated with cognitive impairment. Results Among 67 enrolled patients, 32 patients had normal cognition(47.8%), 20 patients had mild cognitive impairment (29.9%), 15 patients had vascular dementia (22.4%). Accoding to adjusting the age,sex,scores of Hamilton Depression Rating Scale ,multivariate logistic regression analysis showed that, the odds ratio (OR) of cognitive impairment in patients with occipitotemporal

Key words: Posterior cerebral artery; Ischemic stroke; Cognitive impairment

阮婕，计仁杰，魏果，周琼，沈和平，孟繁霞，袁怀武，罗本燕. 后循环缺血性卒中与认知障碍相关性研究[J]. 中国卒中杂志, 2015, 10(12): 1012-1018.

RUAN Jie, JI Ren-Jie, WEI Guo, et al.. Correlation of Posterior Cerebral Artery Ischemic Stroke and Cognitive Impairment[J]. Chinese Journal of Stroke, 2015, 10(12): 1012-1018.

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