摘要目的 寻找简便易行且敏感、有效地预测短暂性脑缺血发作(TIA)患者认知功能障碍发生的方法,以便及时干预TIA患者认知功能障碍的发生和进展.方法 选取首次发病,且可独立自主行走的TIA患者36例[蒙特利尔认知评估量表(MoCA)评分不低于26分],设为TIA患者组;另选取年龄、性别及受教育年限与TIA患者组相匹配的正常受试者36例设为作正常对照组.2组受试者均于入组后当天进行1次双重任务行走步态分析,并于入组12个月后对2组受试者进行MoCA量表评定.采用SPSS 22.0版统计学软件进行数据分析,通过诊断试验验证步态参数预测认知功能障碍的可靠性,并计算接受者操作特性曲线(ROC)下面积.结果 入组后当天,异常步长的TIA患者的步长变异率分别与正常对照组和非异常步长的TIA患者比较,差异均有统计学意义(P<0.05);异常平均步速的TIA患者的平均步速分别与正常对照组和非异常平均步速的TIA患者比较,差异均有统计学意义(P<0.05).入组后当天,正常对照组行双重任务步行时的计算正确率为(90.72±8.72)％,而TIA患者组中异常步态患者和非异常步态组患者的计算正确率均显著低于正常对照组,差异均有统计学意义(P<0.05),且异常步态患者的计算正确率显著低于非异常步态组患者,差异均有统计学意义(P<0.05).入组12个月后,异常步态患者中MoCA评分<26分的患者例数与非异常步态患者中MoCA评分<26分的患者例数比较,差异有统计学意义(P<0.01).计算参数ROC曲线下面积得出,步态参数中的步长变异率和平均步速均可预测12个月后TIA患者认知功能障碍的发生,差异有统计学意义(P<0.01).结论 双重任务行走步态分析可有效地预测TIA患者认知功能障碍的发生,较MoCA测试可更早发现异常.

abstractsObjective To find a simple, sensitive and effective method to predict the occurrence of cogni-tive impairment in patients after a transient ischemic attack ( TIA) . Methods Thirty-six persons who had survived a first TIA and could walk independently were selected into a TIA group, with another 36 healthy counterparts chosen to form a control group. Those in both groups were given a gait analysis during dual-task walking at the outset and then assessed using the MoCA scale 12 months later. Statistical analyses were conducted to assess the reliability of gait pa-rameters in predicting cognitive dysfunction, and the area under the receiver operating characteristics curve was calcu-lated. Results On the day after enrollment the variation in step length among the TIA patients with an abnormal step length was compared with variation among the normal controls and among the TIA patients with non-abnormal step-size. The differences were significant. The average walking speed of the TIA patients with an abnormal average walking speed was significantly different from that of the control group and that of the TIA patients with non-abnormal average speed. On the day after enrolling, the accuracy rate of the control group in the dual-task walking test was sig-nificantly better than that of any of the TIA patients, and the accuracy rate of the TIA patients with an abnormal gait in the dual-task walking test was significantly lower than that of the patients with a non-abnormal gait. Twelve months later the number of patients whose MoCA scores were less than 26 in the abnormal gait group was compared with that in the normal gait group, and the difference was statistically significant. The area under the receiver operating charac-teristics curve suggests that both the incidence of step length variation and the average stepping speed could signifi-cantly predict the occurrence of cognitive dysfunction 12 months later. Conclusion Quantitative analysis of gait while dual-task walking can effectively predict the occurrence of cognitive impairment in patients with TIA, and can detect abnormalities earlier than the MoCA scale test.