脑梗死部位对患者认知功能的影响及意义

赵建华; 张静; 蔡萌萌; 晁琳琳; 师晶晶; 鲍婕妤

doi:10.16766/j.cnki.issn.1674-4152.003056

脑梗死部位对患者认知功能的影响及意义

doi: 10.16766/j.cnki.issn.1674-4152.003056

郑州大学人民医院(河南省人民医院)神经内科，河南郑州 450003

基金项目:

河南省医学科技攻关计划项目 SBGJ202102034

详细信息

通讯作者:
鲍婕妤，E-mail：jianhuaz@zzu.edu.cn

中图分类号: R743.3
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出版历程
- 收稿日期: 2022-11-25
- 网络出版日期: 2023-08-28

The effect and significance of cerebral infarction location on cognitive function

Department of Neurology, People's Hospital of Zhengzhou University (Henan Provincial People's Hospital), Zhengzhou, Henan 450003, China

摘要

摘要: 目的分析脑梗死患者临床资料和认知障碍的变化，评估梗死部位对认知功能的影响及意义。方法本研究为前瞻性观察性研究，纳入2020年1月—2021年1月郑州大学人民医院收治的急性脑梗死患者316例，在发病后2周、发病后6个月、发病后12个月时评估患者认知功能，根据评估结果分为卒中后认知功能下降组(PSCI组, 44例)和未下降组(NPSCI组，272例)，评估患者认知功能变化情况。结果 PSCI组梗死部位累及额叶(15.91%，7/44)、基底节区(13.64%，6/44)、丘脑(18.18%，8/44)的比例高于NPSCI组[额叶(4.78%，13/272)、基底节区(5.51%，15/272)、丘脑(6.62%，18/272)]，2组差异有统计学意义(均P < 0.05)。对2组认知功能评分进行重复测量方差分析发现，2组患者的认知功能差异有统计学意义(P < 0.001)，发病后2周与发病后6个月、12个月之间的认知功能差异均有统计学意义(均P < 0.001)。广义估计方程显示，认知功能的影响因素为梗死灶累及额叶、基底节区、丘脑(P < 0.05)；同时发现发病后12个月与发病后2周、发病后6个月的认知功能差异有统计学意义(P < 0.05)，即时间也是认知功能的影响因素。结论当梗死部位为额叶、基底节区、丘脑时，可能更易出现远期认知障碍。
- 脑梗死部位 /
- 认知功能障碍 /
- 丘脑梗死
Abstract: Objective To analyze the changes of clinical data and cognitive impairment in patients with cerebral infarction, and to evaluate the effect and significance of infarction location on cognitive function. Methods A total of 316 patients with acute cerebral infarction admitted to People's Hospital of Zhengzhou University from January 2020 to January 2021 were enrolled in this prospective observational study. Cognitive function was evaluated at 2 weeks, 6 months, and 12 months after the onset of stroke. According to the evaluation, the patients were divided into a post-stroke cognitive decline group (PSCI group, 44 cases) and a non-decline group (NPSCI group, 272 cases), and the changes of cognitive function were evaluated. Results The proportion of infarction sites involving frontal lobe (15.91%, 7/44), basal ganglia (13.64%, 6/44) and thalamus (18.18%, 8/44) in PSCI group were higher than those in NPSCI group [frontal lobe (4.78%, 13/272), basal ganglia (5.51%, 15/272) and thalamus (6.62%, 18/272)], the differences between the two groups were statistically significant (all P < 0.05). Repeated measures analysis of variance showed that the cognitive function scores of the two groups were significantly different (P < 0.001). Pairwise comparison showed that there were statistically significant differences between 2 weeks after onset and 6 and 12 months after onset (P < 0.001). Further generalized estimating equation showed that there were significant differences in the frontal lobe, basal ganglia and thalamus when the infarction was involved (P < 0.05). At the same time, it was found that the difference of cognitive function between 12 months and 2 weeks, 6 months after onset was statistically significant (P < 0.05), that was, time was also an influencing factor of cognitive function. Conclusion Long-term cognitive impairment is more likely to occur in patients with infarcts located in frontal lobe, basal ganglia and thalamus.
- Location of infarction /
- Cognitive impairment /
- Thalamus infarction

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图 1 脑梗死患者不同梗死部位影像学表现

注：A为DWI序列可见左侧额叶高信号；B为DWI序列可见左侧基底节区高信号；C为DWI序列可见左侧丘脑高信号。

Figure 1. Imaging findings of different infarction sites in patients with cerebral infarction

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表 1 认知功能下降与未下降组脑梗死患者一般资料比较

Table 1. Comparison of general data between cerebral infarction patients with and without cognitive decline

组别	例数	年龄 (x±s，岁)	男性 [例(%)]	受教育水平 (x±s，年)	高血压 [例(%)]	糖尿病 [例(%)]	高脂血症 [例(%)]	房颤 [例(%)]
NPSCI	272	57.32±4.92	193(70.96)	9.18±4.02	149(54.78)	46(16.91)	21(7.72)	28(10.29)
PSCI	44	58.64±6.38	32(72.73)	8.07±4.40	26(59.09)	9(20.45)	2(4.55)	5(11.36)
统计量		1.576^a	0.058^b	1.674^a	0.285^b	0.331^b	0.566^b	0.046^b
P值		0.116	0.810	0.095	0.594	0.565	0.452	0.830

组别	例数	吸烟 [例(%)]	饮酒 [例(%)]		病因分型[例(%)]
组别	例数	吸烟 [例(%)]	饮酒 [例(%)]		大动脉粥样硬化型	心源性栓塞型	小动脉闭塞型	其他原因型
NPSCI	272	111(40.81)	45(16.54)		137(50.37)	30(11.03)	79(29.04)	26(9.56)
PSCI	44	17(38.64)	8(18.18)		21(47.73)	6(13.64)	11(25.00)	6(13.64)
统计量		0.074^b	0.073^b		1.118^b
P值		0.785	0.787		0.773
注：^a为t值，^b为χ²值。

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表 2 认知功能下降组和未下降组脑梗死患者梗死部位比较[例(%)]

Table 2. Comparison of infarct location between cerebral infarction patients with and without cognitive decline [cases (%)]

组别	例数	额叶	顶叶	颞叶	枕叶	岛叶	基底节区	丘脑	脑干	小脑	其他
NPSCI	272	13(4.78)	7(2.57)	5(1.84)	29(10.66)	0	15(5.51)	18(6.62)	25(9.19)	27(9.93)	133(48.90)
PSCI	44	7(15.91)	1(2.27)	1(2.27)	3(6.82)	0	6(13.64)	8(18.18)	1(2.27)	1(2.27)	16(36.36)
χ²值		7.913	0.014	0.038	0.615		4.027	6.708	2.401	2.747	2.388
P值		0.005	0.906	0.845	0.433		0.045	0.010	0.121	0.097	0.096

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表 3 认知功能下降组和未下降组脑梗死患者不同时间点认知功能比较(x±s，分)

Table 3. Comparison of cognitive function at different time points between cognitive decline group and non-cognitive decline group of cerebral infarction patients (x±s, points)

组别	例数	发病后2周	发病后6个月	发病后12个月
NPSCI组	272	21.70±2.95	23.87±2.08	24.15±2.00
PSCI组	44	22.32±2.12	23.36±2.73	20.41±2.30
F值		1.793	18.086	127.327
P值		0.182	＜0.001	＜0.001

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表 4 脑梗死后认知功能障碍的影响因素分析

Table 4. Analysis of influencing factors of cognitive dysfunction after cerebral infarction

参数	B	SE	Wald χ²	P值	OR值	95% CI
梗死部位(参照组：其他部位)
额叶	0.519	0.172	9.255	0.002	1.681	1.203~2.348
顶叶	-0.181	0.268	0.458	0.498	0.834	0.185~0.854
颞叶	-0.570	0.342	2.787	0.095	0.565	0.290~1.104
枕叶	-0.035	0.234	0.023	0.880	0.965	0.611~1.526
基底节区	0.581	0.238	5.967	0.015	1.788	1.122~2.851
丘脑	-2.091	0.355	34.708	< 0.001	0.124	0.062~0.248
脑干	-0.271	0.219	1.533	0.216	0.763	0.497~1.171
小脑	-0.228	0.206	1.235	0.266	0.796	0.532~1.191
时间(参照组：发病后12个月)
发病后2周	-1.864	0.168	117.917	< 0.001	0.161	0.116~0.224
发病后6个月	-0.345	0.156	5.174	0.023	0.702	0.517~0.952

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