邹永明,舒睿,王娜,等.老年急性缺血性脑卒中患者3个月后认知障碍相关因素分析及其预测价值[J].中华物理医学与康复杂志,2023,45(1):18-23
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| 老年急性缺血性脑卒中患者3个月后认知障碍相关因素分析及其预测价值 |
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| DOI：10.3760/cma.j.issn.0254-1424.2023.01.004 |
| 中文关键词: 老年 急性缺血性脑卒中 认知功能障碍 危险因素 尿AD7c-NTP 预测价值 |
| 英文关键词: Elderly Stroke Cognitive impairment Risk factors Urinary AD7c-NTP Prediction |
| 基金项目:天津市医学重点学科（专科）建设项目资助（TJYXZDXK-052B）；天津市卫生健康科技项目（QN20016） |
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| 中文摘要: |
| 目的 探讨老年急性缺血性脑卒中患者3个月后认知障碍的相关危险因素及其预测价值。 方法 采用回顾性病例对照研究设计，纳入符合入组条件的老年急性缺血性脑卒中患者898例，排除42例后，最终纳入856例。根据蒙特利尔认知评估量表（MoCA）评分，将其分为脑卒中后非认知功能障碍（PSNCI）组（422例）和脑卒中后认知功能障碍（PSCI）组（434例）。收集患者的一般人口社会学资料、临床相关化验资料，并进行美国国立卫生研究院卒中量表（NIHSS）、Barthel指数（BI）、日常生活活动（ADL）能力、汉密尔顿抑郁量表（HAMD）评分。采用SPSS 22.0版统计学软件进行单因素分析、多因素Logistics回归分析和受试者工作曲线（ROC）分析。 结果 2组患者在性别、年龄、高血压、冠心病、痴呆家族史、受教育程度方面比较，差异有统计学意义（P<0.05）。在总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、尿阿尔茨海默病相关神经丝蛋白（AD7c-NTP)水平、NIHSS评分、BI指数、ADL评分方面比较，组间差异有统计学意义（P<0.05）。Logistics回归分析显示，冠心病、尿AD7C-NTP、HAMD评分是老年急性缺血性脑卒中患者3个月后认知障碍的独立危险因素，BI是独立保护因素。尿AD7C-NTP的ROC曲线下面积（AUC）最大（0.875），cut-off值为2.425，灵敏度为0.937，特异度为0.75，具有较好的预测价值。 结论 年龄、性别、受教育程度、吸烟、饮酒、体重指数（BMI）、冠心病、脑卒中史、痴呆家族史、AD7C-NTP、TC、TG等可能是老年急性缺血性脑卒中患者3个月后认知障碍的危险因素，其中冠心病、尿AD7c-NTP、HAMD评分是独立危险因素，BI是独立保护因素。尿AD7c-NTP对PSCI具有一定的预测价值。 |
| 英文摘要: |
| Objective To explore the risk factors for cognitive impairment 3 months after an ischemic stroke and their predictive value. Methods A retrospective case-control study considered the records of 856 elderly patients who had survived an ischemic stroke. All had been evaluated using the Montreal Cognitive Assessment scale (MoCA). They were divided according to their MoCA scores into a group without cognitive impairment (the PSNCI group) and an impaired (PSCI) group. The subjects′ demographic and clinical laboratory data were compiled. All had been assessed using the National Institutes of Health stroke scale (NIHSS), the Barthel Index (BI), and the Hamilton depression scale (HAMD). Univariate and multivariate logistic regressions were evaluated and a receiver operator characteristics (ROC) curve was computed. Results There were significant differences between the two groups in terms of gender distribution, age, hypertension and heart disease history, family history of dementia and education level. Moreover, significant differences were observed in the groups′ average total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), urinary neurofilament protein (AD7c-NTP), NIHSS scores, BIs and ADL scores. Logistic regression showed that a history of heart disease, urinary AD7C-NTP level and HAMD score were significant independent predictors of cognitive impairment 3 months after a stroke. A high BI was an independent protective factor. The area under the ROC curve for urinary AD7C-NTP was the largest (0.875) and had significant predictive value with a cut-off value of 2.43, sensitivity of 0.94 and specificity of 0.75. Conclusion Age, sex, education, smoking, drinking, body mass index, a history of heart disease or stroke, a family history of dementia and elevated AD7C-NTP, TC or TG are risk factors for cognitive impairment after a stroke. A high BI suggests a better prognosis. Urinary AD7c-NTP is a useful predictor of PSCI 3 months after a stroke. |
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