摘要： 目的 探讨代谢综合征与缺血性卒中后认知损害之间的关系。方法 连续收集94 例首发缺血性卒中患者的临床资料，分为非代谢综合征（非MetS）组和代谢综合征（MetS）组，对发病后2 周和3 个月时患者记忆力、执行功能、注意力、视空间等功能进行评价，参照Ballard 等方法观察两组间认知功能演变的差异性。结果 发病后2 周和3 个月时，94 例患者认知损害发生率分别为24.47%（23/94）和22.34%（21/94），其中非痴呆性认知损害发生率分别为21.28%（20/94）和19.15%（18/94），痴呆性认知损害发生率均为3.19%（3/94、3/94）。MetS 组患者发病2 周和3 个月时认知损害发生率分别为37.50%（15/40）和35.00%（14/40），与非MetS 组之间差异有统计学意义（Z = 2.500，P = 0.012；Z = 2.513，P = 0.012）；MMSE 总评分，以及延迟回忆和画钟测验评分均低于非MetS 组（P < 0.05）。MetS 组患者发病后3 个月时认知功能进一步恶化的病例数高于非MetS 组患者，差异有统计学意义（Z = 2.134，P = 0.033）。结论 代谢综合征可增加缺血性卒中后认知损害发生率，以非痴呆性认知损害为主，主要累及执行功能、记忆力，其认知状态演变亦呈恶化趋势。

关键词: 代谢疾病, 脑缺血, 痴呆, 血管性, 认知障碍

Abstract: Objective To explore the relation between metabolic syndrome (MetS) and cognitive impairment after ischemic stroke. Methods Ninety-four cases of first ischemic stroke patients were divided into stroke without MetS group (n = 54) and stroke with MetS group (n = 40) according to the diagnostic criteria for MetS defined by Metabolic Syndrome Researching Group of Chinese Diabetes Society. All patients underwent Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), animal Verbal Fluency Test (aVFT), Trial Making Test-A (TMT-A) at 2 weeks and 3 months after stroke to evaluate mental state such as verbal learning memory, and executive, attentional and visuospatial abilities. The incidence and development of cognitive impairment were also assessed. Results At 2 weeks and 3 months after stroke, the incidence of cognitive impairment were 24.47% (23/94) and 22.34% (21/94), respectively, and in the cognitive impairment patients the incidence of non-dementia were 21.28% (20/94) and 19.15% (18/94), while the incidence of dementia were 3.19% (3/94) and 3.19% (3/94), respectively. The incidence of cognitive impairment was higher in the stroke patients with MetS than the stroke patients without MetS, 37.50% (15/40) vs 14.81% (8/54) (Z = 2.500, P = 0.012) at 2 weeks after stroke and 35.00% (14/40) vs 12.96% (7/54) (Z = 2.513, P = 0.012) at 3 months after stroke. In the scores of MMSE, delay recall and CDT of the stroke patients with MetS were all lower than those without MetS at 2 weeks after stroke and at 3 months after stroke (P < 0.05, for all). The stroke patients with MetS had more cognition deterioration than the stroke patients without MetS at 3 months after stroke, the difference was significant (Z = 2.134, P = 0.033). Conclusion MetS can increase the incidence of cognitive impairment, especially non-dementia cognitive impairment in post ischemic stroke. Executive dysfunction and hypomnesis are often seen. The development of cognitive impairment in stroke patients with MetS tends to deterioration.

Key words: Metabolic diseases, Cerebral ischemia, Dementia, vascular, Cognitive disorders