代谢综合征与老年缺血性脑卒中继发血管性认知功能障碍的相关性分析

Relationship between metabolic syndrome and vascular cognitive impairment in elderly patients after ischemic stroke

摘要:

目的探讨代谢综合征与缺血性脑卒中继发血管性认知功能障碍（VCI）的关联性。方法回顾性分析2015 年1 月-2016 年12 月该院神经内科收治的225 例首发缺血性脑卒中患者资料；其中，合并代谢综合征（MS）的67 例患者归为研究组（67 例），未合并MS 的158 例患者归为对照组，收集两组患者入院时血脂、血压、血糖及β-淀粉样蛋白（β-AP）数据，比较两组糖尿病、高血压及高脂血症发生率，出院前测定蒙特利尔认知功能评分（MoCA），判定VCI 发生率，采用Logistic回归分析研究VCI 的独立影响因素。结果两组患者治疗前β-AP、胰岛素抵抗指数、糖化血红蛋白、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇及血压等指标差异有统计学意义（P <0.05）；研究组2 型糖尿病、高血压、高脂血症及多发病灶发生率均高于对照组（P <0.05）。研究组患者出院前MoCA 总分低于对照组（ P<0.05），出院前VCI 发生率高于对照组（P <0.05）。年龄、神经功能缺损评分、多发病灶及MS 组分数目是缺血性脑卒中继发VCI 的独立影响因素（P <0.05），其中，伴MS 数目越多、年龄越高、神经功能缺损评分越高，继发VCI 的风险越高（OR>1）。结论 MS 患者缺血性脑卒中后认知功能损害程度高于未合并MS 患者，合并MS 是缺血性脑卒中继发VCI 的独立预测因子。

Abstract:

Objective To explore the relationship between metabolic syndrome (MS) and vascular cognitive impairment (VCI) after ischemic stroke. Methods A total of 225 elderly ischemic stroke patients were selected from January 2015 to December 2016 in this retrospective study. All the patients were divided into study group (67 cases with MS) and control group (158 cases without MS). Admission blood lipids, blood pressure, blood glucose and β-amyloid protein of the two groups were collected, and the incidence of diabetes,hypertension, hyperlipidemia were compared between the two groups. Montreal cognitive function score (MoCA) was used to evaluate cognitive function to calculate the incidence of VCI before discharge. Logistic regression analysis was used to explore the independent influencing factors of VCI. Results There were significant differences in β-AP, HOMA-IR, HbAlc, LDL-C, HDL-C, BP and other indicators between the two groups in admission (P < 0.05). Study group presented significantly higher incidence on T2DM, hypertension,hyperlipidemia and multiple lesions than those in the control group (P < 0.05). The total MoCA score of the patients in the study group was significantly lower than that in the control group before discharge (P < 0.05),and VCI incidence rate in the study group was significantly higher than that in the control group (P < 0.05).Age, neural function defect score, multiple lesions, number of MS components were independent risk factors of VCI secondary to ischemic stroke (P < 0.05), and the more the number of MS syndromes was and the higher of the age and neurological deficit score were, the higher the incidence of risk of VCI was ( OR > 1). Conclusions The cognitive impairment secondary to ischemic stroke is more serious in patients with MS than without MS, and MS can be an independent predictor of VCI after ischemic stroke.