卒中后认知障碍与软脑膜侧支循环的代偿程度及静脉溶栓治疗的相关性分析

Correlation between cognitive impairment after stroke and compensatory degree of leptomeningeal collaterals and intravenous thrombolytic therapy

摘要:

目的 比较急性缺血性卒中患者卒中后认知障碍的发生与软脑膜侧支循环的代偿程度及是否接受静脉溶栓治疗的相关性。方法 前瞻性收集2019年1月至2021年3月在石河子市人民医院住院的急性前循环脑梗死患者161例，获取患者入院时人口学资料，包括是否溶栓、性别、合并症等；通过蒙特利尔认知评估量表（Montreal cognitive assessment，MoCA）评分、简易精神状态检查量表（mini mental state examination，MMSE）评分评估患者认知功能；入院时美国国立卫生院卒中量表（National Institute of Health Stroke Scale，NIHSS）评分获取患者神经功能缺损症状；通过Blessed行为量表（Blessed behavior scale，BBS）评分评估患者的日常生活能力；通过区域软脑膜评分（regional leptomeningeal collateral score，rLMC）获取患者软脑膜侧支循环；根据卒中后6个月是否合并认知障碍分为认知障碍组和非认知障碍组，采用logistic多因素回归方法进行统计比较，分析2组患者软脑膜侧支循环，是否静脉溶栓，以及合并症、血糖、血脂等因素与卒中后认知障碍相关性。结果 共161例急性前循环梗死患者，其中认知障碍组85例，非认知障碍组76例。单因素分析发现是否溶栓、rLMC、年龄及BBS评分的差异具有统计学意义；多因素二元logistic回归模型分析显示：①是否溶栓对认知障碍发生率的影响具有统计学意义，为保护因素；②年龄、rLMC、NIHSS评分、BBS评分对认知障碍发生率的影响具有统计学意义，且均为危险因素；③性别、高血压对认知障碍发生率的影响无统计学意义。结论 良好的侧支循环与静脉溶栓治疗可降低急性缺血性卒中发生卒中后认知障碍，年龄越大及入院时NIHSS评分越高，急性缺血性卒中发生卒中后认知障碍的风险越大。

Abstract:

Objective To explore the correlation between post-stroke cognitive impairment and the degree of compensation of leptomeningeal collaterals and intravenous thrombolytic therapy in patients with acute ischemic stroke.Methods A total of 161 patients with acute anterior circulation cerebral infarction hospitalized in Shihezi People's Hospital from January 2019 to March 2021 were prospectively collected， and the demographic data at admission were obtained， including thrombolysis， gender， complications， etc. The cognitive function of patients was evaluated by Montreal cognitive assessment （MoCA） and mini mental state examination（MMSE）； the neurological deficit symptoms were obtained by the National Institute of Health Stroke Scale （NIHSS） score at admission； the ability of daily living of patients was evaluated by the score of Blessed behavior scale（BBS）； the regional leptomeningeal collateral score （rLMC） was used to evaluate the leptomeningeal collateral circulation. According to whether there was cognitive impairment 6 months after stroke， they were divided into cognitive impairment group and non-cognitive impairment group. Logistic multivariate regression method was used for statistical comparison to analyze the relationship between leptomeningeal collateral circulation， intravenous thrombolysis， complications， blood glucose， blood lipid and cognitive impairment after stroke.Results There were 161 patients with acute anterior circulation infarction， including 85 cases in cognitive impairment group and 76 cases in non-cognitive impairment group. Univariate analysis showed that there were significant differences in thrombolysis， rLMC， age and the score of BBS； multivariate binary logistic regression model showed that：①whether thrombolytic therapy had a statistically significant effect on the incidence of cognitive impairment， which was a protective factor；②age，rLMC， NIHSS score and BBS score had statistically significant effects on the incidence of cognitive impairment， and they were all risk factors；③there was no significant effect of gender and hypertension on the incidence of cognitive impairment.Conclusion Good collateral circulation and intravenous thrombolytic therapy can reduce the occurrence of post-stroke cognitive impairment in acute ischemic stroke. The older the age and the higher NIHSS score at admission， the greater the risk of post-stroke cognitive impairment in acute ischemic stroke.