陈　婡　王晓梅　吴春岚　孙　凤.同济大学医学院，上海200092；2.上海市第十人民医院，上海200072；.上海市中西医结合医院，上海200082

慢性脑缺血患者发生认知功能障碍的影响因素分析

陈婡1王晓梅2▲吴春岚3孙凤3
1.同济大学医学院，上海200092；2.上海市第十人民医院，上海200072；3.上海市中西医结合医院，上海200082

目的探讨慢性脑缺血患者发生认知功能障碍的影响因素。方法选取2013年2月～2016年1月上海市中西医结合医院神经内科收治的慢性脑缺血患者97例，依据蒙特利尔认知评价量表（MoCA）评分分为认知障碍组（MoCA评分≤26分）和无认知障碍组（MoCA评分＞26分），比较两组患者的MoCA评分，并对患者临床资料进行单因素分析和多因素Logistic回归分析。结果认知障碍组MoCA评分为（22.47±2.39）分，无认知障碍组Mo-CA评分为（28.05±2.56）分，差异有统计学意义（P＜0.05）。两组患者的年龄、文化程度、吸烟、合并冠心病、高血压、糖尿病、焦虑、抑郁、病变部位、心房颤动、脑白质疏松、LDL-C偏高、hs-CRP偏高、Hcy偏高差异有统计学意义（P＜0.05）。多因素Logistic回归分析显示，年龄＞65岁、合并冠心病、高血压、焦虑、抑郁、左侧大脑半球病变、hs-CRP偏高是影响慢性脑缺血患者发生认知功能障碍的独立危险因素（P＜0.05）。结论慢性脑缺血患者发生认知功能障碍的风险较高，其中病变发生于左侧大脑半球、高龄患者及合并基础心脑血管疾病的患者更易出现认知功能障碍，临床上应对高危患者进行针对性心理干预和健康教育，以期降低认知功能障碍发生率。

慢性脑缺血；认知功能障碍；影响因素；年龄

［Abstract］Objective To discuss the influencing factors of cognitive dysfunction in patients with chronic cerebral ischemia.Methods 97 cases with chronic cerebral ischemia were selected from February 2013 to January 2016 in Department of Neurology，Shanghai Hospitals of Traditional Chinese and Western Medicine.On the basis of the Montreal cognitive evaluation scale，pateints were divdied in to the cognitive impairment group（MoCA score≤26 points）and non-cognitive impairment group（MOCA score＞26 points）.MOCA scores were compared between the two groups，and single factor analysis and multivariate Logistic regression analysis were used to analyze the clinical data of the patients. Results The MoCA score of the cognitive impairment group was（22.47±2.39）points，which of the non-cognitive impairment group was（28.05±2.56）points，the difference was statistically significant（P＜0.05）.There were statistically significant differences between the two gorups in age，education，smoking and combined with coronary heart disease，hypertension，diabetes，anxiety，depression，location of lesion，atrial fibrillation，leukoaraiosis，higher LDL-C level，higher hs-CRP level and higher Hcy level（P＜0.05）.Multi-factor Logistic regression analysis showed that age＞65 years old，combined with coronary heart disease，hypertension，anxiety，depression，left hemisphere lesions and higher hs-CRP level were the independent risk factors of cognitive dysfunction in patients with chronic cerebral ischemia（P＜0.05）.Conclusion There is a higher risk of cognitive dysfunction in patients with chronic cerebral ischemia.The lesions locate in the left hemisphere of the brain，elderly patients and combined with cardiovascular and cerebrovascular diseases may be more prone to have cognitive dysfunction.High-risk patients should be given specific psychological intervention and health education in clinic，in order to reduce the incidence of cognitive dysfunction.

［Key words］Chronic cerebral ischemia；Cognitive dysfunction；Influencing factors；Age

慢性脑缺血是指长期脑血流灌注不足，最早由日本学者于20世纪90年代提出。……