熊学辉瞿丹霞

轻中型颅脑损伤继发轻度认知功能障碍危险因素分析

熊学辉*瞿丹霞*

目的探讨轻中型颅脑损伤患者继发轻度认知功能障碍（mild cognitive impairment，MCI）的危险因素。方法 收集2014年7月1日至2015年7月1日我院收治的106例轻中型颅脑损伤患者影像资料，采用简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）、Addenbrooke改良认知评估量表（ACE-R）评估患者颅脑损伤后3个月的认知功能，以患者是否继发MCI为因变量、脑组织病变部位和类型为自变量，采用单因素和多因素logistic回归分析研究不同病变部位对于患者继发轻度认知功能障碍的影响性。结果 共30例患者继发MCI、69例患者认知功能正常，7例患者失访。单因素logistic回归分析显示：患者的年龄及GCS评分均未见显著差异（P＞0.05）；多发病灶、损伤半球、累及脑叶、脑白质病变、累及内囊之间存在统计学意义（P＜0.05）。多因素logistic回归分析显示：累及左半球（P=0.029，OR=1.637，95%CI：1.348～2.169）、累及颞叶（P＜0.001，OR= 1.521，95%CI：1.240～2.203）、累及内囊（P=0.024，OR=1.526，95%CI：1.107～2.329）、多发病灶（P＜0.001，OR=1.936，95%CI：1.287～3.228）是危险因素。结论 位于左半球、双侧额叶及颞叶区、内囊前肢的损伤病变及多发损伤病灶是轻、中型颅脑损伤患者继发MCI的危险因素。

颅脑损伤 轻度认知功能障碍 危险因素

【Abstract】Objective To investigate the risk factors of the mild cognitive impairment（Mild Cognitive Impairment，MCI）secondary to the mild to moderate traumatic brain injury patients.Method The clinical and neuroimaging data from 106 patients with mild to moderate traumatic brain injury during July 1，2014 to July 1，2015 were collected.Cognitive function in patients with head injury after three months was assessed using the Mini-Mental State Examination （MMSE），Montreal Cognitive Assessment（MoCA），Addenbrooke improved cognitive assessment（ACE-R）.The impact of the different lesions on cognitive function was analyzed using univariate and multivariate logistic regression with patients with secondary MCI as the dependent variable and brain tissue lesions as independent variables.Results Sixty-nine patients had normal cognitive function whereas 30 patients had MCI.seven patients were lost to follow.Univariate logistic regression analysis did not revealed any significance in age and GCS scores（P＞0.05），but revealed significances in multiple lesions，lesioned hemisphere，the lobar white matter lesions and the internal capsule involvement（P＜0.05）.Multivariate logistic regression analysis showed that the left hemisphere（P=0.029，OR=1.637，95%CI=1.348～2.169），temporal lobe area（P＜0.001，OR=1.521，95%CI=1.240～2.203），anterior limb（P=0.024，OR=1.526，95%CI=1.107～2.329），multi-ple lesions（P＜0.001，OR=1.936，95%CI=1.287～3.228）were the risk factors of MCI.Conclusion Lesions in the left hemisphere，bilateral frontal and temporal lobe area，internal capsule injury and multiple lesions damage are the risk factors of the mild cognitive impairment secondary to the mild to moderate traumatic brain injury.

【Key words】Brain injury Mild cognitive impairment Risk factors

认知功能障碍（cognitive dysfunction，CD）泛指各类病因所致认知功能的损害，为轻中型颅脑损伤最常见的并发症之一，包括轻度认知功能损害（mild cognitive impairment，MCI）及痴呆（dementia）。研究表明MCI患者发展为痴呆比正常人群痴呆的发病率高10倍［1］，流行病学资料显示，轻、中、重度脑损伤分别会有10%、17%、甚至100%的比例遗留不同程度的认知功能障碍。深入了解颅脑损伤患者继发MCI的危险因素，具有重要的临床意义［2］。……