代谢综合征对急性幕上皮质下腔隙性脑梗死患者短期预后的影响

Effect of metabolic syndrome on short-term prognosis of acute supertentorium subcortical lacunnar infarction

摘要:

目的 探讨代谢综合征（MS）对急性幕上皮质下腔隙性脑梗死患者短期认知功能和神经功能的影响。方法 回顾性分析2016年5月—2018年6月潍坊市人民医院神经内科收治的106例急性幕上皮质下腔隙性脑梗死患者的临床资料，根据是否患MS分为MS组46例和非MS组60例，以发病90 d的改良Rankin量表（mRS）评分≥3分为预后不良。所有患者行颅脑MRI检查，比较两组腔隙性梗死灶数量和Fazekas量表评分；比较两组入院及发病90 d的美国国立卫生研究院卒中量表（NIHSS）评分、蒙特利尔认知评估（MoCA）评分和mRS评分；比较两组的血生化指标。采用多因素一般Logistic回归分析短期预后不良的影响因素。结果 MS组患者的腰围、收缩压、舒张压、空腹血糖（FBG）、餐后2 h血糖（2 hPG）、腔隙性梗死灶数量、Fazekas量表评分高于非MS组（P <0.05），高密度脂蛋白胆固醇（HDL-C）低于非MS组（P <0.05）。MS组患者的入院NIHSS评分、入院mRS评分、发病90 d的NIHSS评分均高于非MS组（P <0.05），入院MoCA评分和发病90 d的MoCA评分均低于非MS组（P <0.05），两组发病90 d的mRS评分比较，差异无统计学意义（P >0.05）。多因素一般Logistic回归分析显示MS是急性幕上皮质下腔隙性脑梗死短期预后不良的独立影响因素［O^R=3.695（95% CI：1.288，10.600）］。结论 MS是急性幕上皮质下腔隙性脑梗死短期预后不良的独立影响因素，与脑卒中后神经功能损伤有关，可能与认知功能下降有关。

Abstract:

Objective To explore the effect of metabolic syndrome (MS) on short-term cognitive impairment and neurological dysfunction in patients with acute supertentorium subcortical lacunnar infarction.Methods A total of 106 acute supertentorium subcortical lacunnar infarction patients were selected from May 2016 to June 2018 in this retrospective study. The patients were divided into the MS group and No-MS group according to the diagnostic criteria of MS. The modified Rankin Scale ≥ 3 at 90 d of onset was considered a poor prognosis. All subjects underwent brain MRI and neuropsychological assessments and had blood tests. The results were compared between the two groups. Logistic regression analysis was used to explore the independent influencing factors of short-term prognosis.Results The waistline, the levels of blood pressure, fasting plasma glucose, total cholesterol were higher, and the level of high-density lipoprotein cholesterol was lower in the MS group than in the No-MS group (P < 0.05). The number of lacunnar infarction, the score of Fazekas, the baseline scores of NIHSS and modified Rankin Scale, the score of NIHSS at 90 d were higher in the MS group than in the No-MS group (P < 0.05). The baseline score and the score at 90 d of MoCA were lower in the MS group than in the No-MS group (P < 0.05). There were no statistically significant difference in the score of modified Rankin Scale at 90 d between the MS group and the No-MS group (P > 0.05). The binary logistic regression analysis found that MS was independent risk factor of short-term prognosis [O^R = 3.695 (95% CI: 1.288, 10.600) ].Conclusions In acute supertentorium subcortical lacunnar infarction patients, MS is the independent risk factor of the short-term prognosis. MS is associated with the decline of post-stroke neuromotor dysfunction and possibly related with post-stroke cognitive decline.