摘要目的 分析缺血性脑卒中合并脑微出血对患者认知功能的影响.方法 采用磁敏感加权成像(SWI),检测2014年1月至2015年6月宁波市第一医院神经内科收治的268例确诊为急性缺血性脑卒中患者, 将其分为脑微出血阴性组(199例)和脑微出血阳性组(69例).对于脑微出血阳性组患者,根据脑微出血的数量将其分为:1级(1~5个)和2级(≥6个).采用蒙特利尔认知评估量表(MoCA)评价患者认知功能.比较各组认知功能的差异.结果 脑微出血阳性组患者MoCA总分和视空间与执行能力、注意2个分项认知领域评分分别为(20.95±4.53)、(2.53±1.09)、(3.83±0.97)分,均显著低于脑微出血阴性组患者[分别为(26.82±1.25)、(3.16±1.24)、(4.91±0.84)分;t=16.59、3.75、8.83,均P<0.01].脑微出血1级患者MoCA总分和注意这个分项认知领域的评分分别为(21.53±4.61)、(4.11±0.91)分,均显著低于脑微出血阴性组患者(t=14.09、14.23,均P<0.01).而脑微出血1级患者MoCA总分和视空间与执行能力、注意、定向3个分项认知领域的评分分别为(21.53±4.61)、(2.88±1.06)、(4.11±0.91)、(4.96±0.40)分,均显著高于脑微出血2级患者[分别为(18.58±3.08)、(2.23±0.95)、(3.63±1.01)、(3.85±0.39)分;t=2.85、P<0.01,t=2.54、P<0.05,t=5.63、P<0.01,t=2.58、P<0.01].多因素回归分析提示缺血性脑卒中患者MoCA评分的独立影响因素包括脑微出血阳性(OR=3.15,95% CI 1.28~5.12,P=0.005)及脑微出血数量(OR=1.73,95% CI 1.08~2.32,P=0.031).结论 脑微出血及其数量与缺血性脑卒中患者的认知功能损害独立相关,随着脑微出血数量的增多,缺血性脑卒中患者在某些方面的认知功能损害更为突出.

abstractsObjective To investigate the impact of cerebral microbleeds (CMBs) on cognitive function in ischemic stroke patients.Methods A total of 268 acute ischemic stroke patients recruited in the Ningbo First Hospital from January 2014 to June 2015 were divided into CMBs group (199 patients) and non-CMBs group (69 patients) according to whether complicated with CMBs by susceptibility-weighted imaging (SWI).According to the microbleed number, CMBs group patients were divided into 2 grades: grade 1 (1-5 CMBs) and grade 2 (≥6 CMBs). Montreal Cognitive Assessment (MoCA) was used to evaluate and compare the global cognitive function and cognitive domains of the patients. Results The total MoCA score and the scores of visuospatial/executive, attention domains in CMBs group were 20.95±4.53, 2.53±1.09, 3.83±0.97, while those in non-CMBs group were 26.82±1.25, 3.16±1.24 and 4.91±0.84. The total MoCA score and the scores of visuospatial/executive, attention domains were significantly lower in CMBs group than those in non-CMBs group (t=16.59, P<0.01;t=3.75, P<0.01;t=8.83, P<0.01). The total MoCA score and the score of attention domain in grade 1 CMBs group were 21.53±4.61 and 4.11±0.91 , which were significantly lower than those in non-CMBs group (t=14.09, P<0.01;t=14.23, P<0.01). Whereas the total MoCA score and the scores of visuospatial/executive, attention, orientation domains in grade 1 CMBs group were 21.53±4.61, 2.88±1.06, 4.11±0.91, 4.96±0.40, which were significantly higher than those in grade 2 CMBs group (18.58±3.08, 2.23±0.95, 3.63±1.01, 3.85±0.39, respectively;t=2.85, P<0.01;t=2.54, P<0.05;t=5.63, P<0.01;t=2.58, P<0.01). Multivariate regression analysis showed that independent risk factors of MoCA scores in ischemic stroke patients included CMBs (OR=3.15, 95% CI 1.28-5.12, P=0.005) and the number of CMBs (OR=1.73,95% CI 1.08-2.32,P=0.031). Conclusions CMBs and the number of CMBs were independently associated with cognitive impairment in ischemic stroke patients. And with the increasing of the microbleed number, the impairments of certain cognitive domains were more obviously.