摘要： 研究背景 急性缺血性卒中可导致认知功能障碍，甚至引起血管性痴呆，早期识别血管性认知损害、积极寻找相关因素、及时进行有效治疗可以减少甚至防止认知功能进一步减退，本研究旨在探讨急性缺血性卒中后认知功能障碍及其相关因素。方法 选择符合入组条件的急性缺血性卒中患者共314 例，分别应用蒙特利尔认知评价量表（MoCA）评价认知功能、美国国立卫生研究院卒中量表（NIHSS）评价脑卒中后神经功能缺损程度、Barthel指数评价日常生活活动能力、汉密尔顿抑郁量表（HAMD）评价情绪状态。结果 与脑卒中后无认知功能障碍组相比，脑卒中后认知功能障碍组患者受教育程度低、日常生活活动能力差（P = 0.000，0.008），而HAMD评分和NIH SS评分增加（均P = 0.000），血清超敏C-反应蛋白和糖化血红蛋白水平升高（P = 0.002，0.005）；其中血清超敏C-反应蛋白和糖化血红蛋白水平、NIHSS 评分、HAMD评分与MoCA 评分呈负相关（均P < 0.05 ），Barthel指数与MoCA 评分呈正相关（P < 0.05 ）；影像学分型以皮质型缺血性脑血管病和左侧大脑半球缺血性脑血管病为主（P < 0.05 ）。Logistic回归分析提示，受教育程度低、糖尿病病史、HAMD评分、血清超敏C-反应蛋白和糖化血红蛋白水平是脑卒中后认知功能障碍的危险因素。结论 脑卒中后认知损害与社会人口学因素、脑卒中部位、抑郁程度、神经功能缺损程度，以及血清超敏C ? 反应蛋白水平、血糖控制情况密切相关。

关键词: 脑缺血, 卒中, 认知障碍, 神经心理学测验, 横断面研究, 糖尿病, C 反应蛋白质

Abstract: Background  Acute ischemic stroke may decline cognitive function and induce vascular dementia (VaD). In early identification of vascular cognitive impairment (VCI), active searching for relevant factors, effective and timely treatment can reduce or even prevent further decline of cognitive function. The purpose of this study is to investigate the cognitive impairment after acute ischemic stroke and its associated factors. Methods  A total of 314 cases of acute ischemic stroke patients were recruited in this study. The Montreal Cognitive Assessment (MoCA) was used to evaluate the degree of cognitive impairment. The American National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the extent of neurological deficit. The Barthel Index (BI) was used to evaluate activities of daily living. Hamilton Depression Rating Scale (HAMD) was used to evaluate the patients' mental or emotional state. Results  Based on the examination results, post-stroke cognitive impairment (PSCI) group were less educated ( P = 0.000) with lower BI score ( P = 0.008), higher HAMD score and higher NIHSS score ( P = 0.000, for all), and elevated serum high-sensitivity C-reactive protein (hs-CRP, P = 0.002) and glycosylated hemoglobin A1c (HbA1c) levels (P = 0.005) than those in post-stroke no cognitive impairment (PSNCI) group. In PSCI group, the concentration of serum hs-CRP and HbA1c, NIHSS and HAMD scores were negatively correlated with the MoCA rating (P < 0.05, for all); whereas, BI score was positively correlated with the MoCA rating (P < 0.05). The subjects in PSCI group had more cortical ischemic vascular disease (CIVD) and left hemisphere ischemic vascular disease (LHIVD) than subjects in PSNCI group ( P < 0.05). Logistic regression analysis indicated that lower education, history of diabetes, higher HAMD score, higher serum hs-CRP and HbA1c levels were independent risk factors for PSCI. Conclusion  Cognitive impairment after acute ischemic stroke may be closely related to demographic factors, serum hs-CRP level, stroke subtype, HAMD score, the extent of neurological deficit, as well as glycemic control status.

Key words: Brain ischemia, Stroke, Cognition disorders, Neuropsychological tests, Cross-sectional studies, Diabetes mellitus, C-reactive protein