Risk factors of cognitive function impairment and depression status in patients with first-episode acute ischemic stroke
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摘要:目的 探讨首发急性缺血性脑卒中患者认知功能障碍和抑郁状态的相关影响因素。方法 选取急性缺血性脑卒中患者206例，采用蒙特利尔认知评估量表将其分为卒中后认知功能障碍组146例、非卒中后认知功能障碍组60例，采用汉密尔顿抑郁量表将其分为卒中后抑郁组52例、非卒中后抑郁组154例。收集患者的人口学特征及临床指标进行统计学分析。结果 卒中后认知功能障碍组年龄、合并高血压比例、同型半胱氨酸(Hcy)、C反应蛋白(CRP)水平显著高于非卒中后认知功能障碍组，男性比例、文化程度、Barthel指数以及血红蛋白(Hb)、空腹血糖(GLU)、肌酐(Cre)水平显著低于非卒中后认知功能障碍组(P < 0.05或P < 0.01)。卒中后抑郁组男性比例、CRP水平显著低于非卒中后抑郁组(P < 0.05); 卒中后抑郁组合并高血压、合并冠心病、前部病灶比例以及GLU、丙氨酸转氨酶(ALT)、Cre、Hcy水平均显著高于非卒中后抑郁组(P < 0.05或P < 0.01)。多因素Logistic逐步回归分析显示，年龄、文化程度、Hb、Hcy是首发急性缺血性脑卒中患者认知功能障碍的独立影响因素; 性别、Hcy是首发急性缺血性脑卒中患者抑郁的独立影响因素。结论 Hcy水平是首发急性缺血性脑卒中患者认知功能障碍和抑郁的共同影响因素，年龄、文化程度、Hb是认知功能障碍的独立影响因素，性别是抑郁的独立影响因素，应在患者发病早期进行筛查和干预。Abstract:Objective To explore the related risk factors of cognitive impairment and depression in patients with first-episode acute ischemic stroke.Methods A total of 206 patients with acute ischemic stroke were divided into post-stroke cognitive impairment group (146 cases) and non-post-stroke cognitive impairment group (60 cases) by Montreal Cognitive Assessment Scale (MCAS). The Hamilton Depression Scale was used to assign these patients into post-stroke depression group(52 cases) and non-post-stroke depression group(154 cases). The demographic characteristics and clinical indicators of the patients were collected for statistical analysis.Results The age, ratio of patients complicating with hypertension, homocysteine(Hcy) and C reactive protein(CRP) levels in post-stroke cognitive impairment group were significantly higher, male ratio, education level, Barthel index, hemoglobin(Hb), fasting blood glucose (GLU) and creatinine(Cre) levels were significantly lower than those in the non post-stroke cognitive impairment group (P < 0.05 or P < 0.01). The male proportion and CRP level in the post-stroke depression group were significantly lower than those in the non-post-stroke depression group (P < 0.05). The post-stroke depression group had significantly higher complicating with hypertension, coronary heart disease, anterior lesion ratio, GLU, alanine aminotransferase (ALT), Cre, Hcy levels than the non-post-stroke depression group (P < 0.05or P < 0.01). Multivariate Logistic regression analysis showed that age, education level, Hb and Hcy were independent influencing factors of cognitive dysfunction patients with first-episode acute ischemic stroke, while gender and Hcy were independent influencing factors of depression patients with first-episode acute ischemic stroke.Conclusion Hcy level is the common influencing factor of first-episode acute ischemic stroke patients with cognitive dysfunction and depression. Age, education level and Hb are independent influencing factors of cognitive dysfunction, and gender is an independent influencing factor of depression. Therefore, screening and intervention should be carried out at the early stage of onset.
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Keywords:
- first-episode stroke /
- cognitive impairment /
- depression /
- influencing factors
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表 1 卒中后认知功能障碍组与非认知功能障碍组人口学特征及临床指标比较(x±s)[n(%)]
指标 卒中后认知功能障碍组(n=146) 非卒中后认知功能障碍组(n=60) 年龄/岁 71.52±10.37 61.49±11.46** 男性 104(71.23) 54(90.00)** 文化程度初中及以上 114(78.08) 54(90.00)** BMI/(kg/m2) 24.12±2.30 24.86±2.13 高血压 114(78.08) 42(70.00)* 糖尿病 68(46.58) 28(46.67) 冠心病 34(23.29) 16(26.67) 前部病灶 96(65.75) 42(70.00) 左侧病灶 66(45.21) 32(53.33) 收缩压/mmHg 136.86±16.62 136.18±16.25 舒张压/mmHg 80.43±9.37 80.82±9.56 Hb/(g/L) 132.71±15.06 144.38±11.15** GHb/% 6.94±1.51 7.09±1.67 GLU/(mmol/L) 6.79±1.95 7.27±2.18* ALT/(U/L) 17.03±6.76 18.56±8.40 Cre/(μmol/L) 93.95±62.58 104.15±84.51** TG/(mmol/L) 1.50±1.13 1.49±0.91 TC/(mmol/L) 4.05±0.91 4.20±0.73 HDL-C/(mmol/L) 1.27±0.42 1.24±0.45 LDL-C/(mmol/L) 2.41±0.73 2.58±0.85 叶酸/(μg/L) 318.64±115.50 315.86±106.11 Hcy/(μmol/L) 21.58±12.61 15.25±8.03* CRP/(mg/L) 11.05±5.31 4.46±3.61** NIHSS评分/分 2.60±1.45 2.56±1.50 Barthel指数/分 72.25±13.09 84.13±9.75** BMI: 体质量指数; Hb: 血红蛋白; GHb: 糖化血红蛋白; GLU: 空腹血糖; ALT: 丙氨酸转氨酶; Cre: 肌酐; TG: 三酰甘油; TC: 总胆固醇; HDL-C: 高密度脂蛋白胆固醇; LDL-C: 低密度脂蛋白胆固醇; Hcy: 同型半胱氨酸; CRP: C反应蛋白; NIHSS: 美国国立卫生研究院卒中量表; Barthel指数: 日常生活能力量表。与卒中后认知功能障碍组比较, *P < 0.05, **P < 0.01 
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表 2 卒中后抑郁组与非抑郁组人口学特征及临床指标比较(x±s)[n(%)]
指标 卒中后抑郁组(n=52) 非卒中后抑郁组(n=154) 年龄/岁 66.21±11.47 66.93±11.69 男性 36(69.23) 122(79.22)* 已婚 48(92.31) 132(85.71) BMI/(kg/m2) 24.73±2.55 24.56±2.31 高血压 46(88.46) 110(71.43)* 糖尿病 24(46.15) 72(46.75) 冠心病 20(38.46) 30(19.48)** 前部病灶 44(84.62) 94(61.04)** 左侧病灶 26(50.00) 72(46.75) 收缩压/mmHg 136.30±16.9 135.96±17.24 舒张压/mmHg 81.95±11.31 80.57±10.91 Hb/(g/L) 137.51±13.64 134.83±14.25 GHb/% 6.92±1.57 6.97±1.35 GLU/(mmol/L) 7.36±2.58 6.76±2.41* ALT/(U/L) 20.41±6.15 16.73±7.58* Cre/(μmol/L) 108.63±95.20 90.71±49.28** TG/(mmol/L) 1.59±0.61 1.50±0.47 TC/(mmol/L) 4.10±0.86 4.08±0.79 HDL-C/(mmol/L) 1.12±0.30 1.15±0.41 LDL-C/(mmol/L) 2.50±0.76 2.47±0.71 叶酸/(μg/L) 7.42±3.29 7.30±3.05 Hcy/(μmol/L) 20.39±11.85 14.80±7.52* CRP/(mg/L) 6.24±4.06 9.97±6.13* NIHSS评分/分 2.87±1.63 2.75±1.59 Barthel指数/分 75.92±25.74 76.49±0.81 BMI: 体质量指数; Hb: 血红蛋白; GHb: 糖化血红蛋白; GLU: 空腹血糖; ALT: 丙氨酸转氨酶; Cre: 肌酐; TG: 三酰甘油; TC: 总胆固醇; HDL-C: 高密度脂蛋白胆固醇; LDL-C: 低密度脂蛋白胆固醇; Hcy: 同型半胱氨酸; CRP: C反应蛋白; NIHSS: 美国国立卫生研究院卒中量表; Barthel指数: 日常生活能力量表。与卒中后抑郁组比较, *P < 0.05, **P < 0.01。
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表 3 首发急性缺血性卒中后认知功能障碍影响因素的Logistic回归分析
影响因素 B SE Wald χ2 P OR(95%CI) 年龄 2.751 0.963 8.472 0.015 1.859(0.971~4.209) 文化程度 -1.392 0.731 6.658 0.033 1.305(0.776~1.927) Hb -1.869 0.834 7.751 0.026 1.773(1.036~3.964) Hcy 2.063 1.155 10.859 0.005 2.638(1.341~7.592)
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表 4 首发急性缺血性卒中后认知功能障碍影响因素的Logistic回归分析
影响因素 B SE Wald χ2 P OR(95%CI) 性别 -1.526 0.563 5.267 0.042 1.213(0.506~2.058) Hcy 1.851 1.037 9.215 0.011 2.149(1.163~5.395)
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