Abstract: Objective To explore the cognitive impairment of type 2 diabetes mellitus (DM) patients with acute cerebral infarction and the influencing factors. Methods A total of 145 patients with acute cerebral infarction were divided into 2 groups: simple cerebral infarction group (SCI group, n = 60) and diabetes combined with cerebral infarction (DCI group, n = 85). According to Oxfordshire Community Stroke Project (OCSP) classification, cerebral infarctions were classified as following subtypes: total or partial anterior circulation infarct (TACI/PACI), posterior circulation infarct (POCI) and lacunar infarct (LACI). Plasma homocysteine (Hcy) concentration was determined by enzyme amplified chemiluminometry. Mini-Mental State Examination (MMSE) was used to assess cognitive status. Results Plasma Hcy level in DCI group [(17.06 ± 4.41) μmol/L] was significantly higher than that in SCI group [(15.49 ± 4.11) μmol/L; t = 2.185, P = 0.031]. MMSE score in DCI group (25.36 ± 3.11) was lower than that in SCI group (26.48 ± 2.26; t = 2.502, P = 0.013). Plasma Hcy level was the highest, and MMSE score was the lowest in TACI/PACI patients, and were followed by POCI and LACI patients in successive order. In DCI group MMSE score was significantly negatively correlated with age (r = -0.696, P = 0.000), systolic blood pressure (r = -0.406, P = 0.000), diastolic blood pressure (r = - 0.371, P = 0.000), total cholesterol (r = -0.477, P = 0.000), triglyceride (r = -0.384, P = 0.000), low density lipoprotein-cholesterol (r = -0.487, P = 0.000), plasma Hcy (r = - 0.923, P = 0.000), DM duration (r = -0.653, P = 0.000), and glycosylated hemoglobin (HbA1c; r =-0.663, P = 0.000); but was positively correlated with smoking (rs = 0.238, P = 0.028), cardiovascular disease (rs = 0.626, P = 0.000), years of education (r = 0.426, P = 0.000), and high density lipoprotein-cholesterol (r = 0.360, P = 0.001). MMSE score was also related to the stroke subtypes (rs = -0.557, P = 0.000). Conclusion Cognitive impairment of DCI patients may be closely related to homocysteinemia-induced neurotoxicity, stroke subtype, related risk factors for cerebrovascular disease, diabetic duration and glycemic control status.

Key words: Brain infarction, Diabetes mellitus, Cognition disorders, Cysteine, Case-control studies

摘要： 目的 探讨2 型糖尿病伴发脑梗死患者急性期认知损害及其影响因素。方法 选择发病时间≤ 7 d 且诊断明确的急性期单纯脑梗死和糖尿病伴发脑梗死患者，酶放大化学发光法检测血浆同型半胱氨酸水平，简易智能状态检查量表（MMSE）评价认知损害程度。结果 糖尿病伴发脑梗死组患者血浆同型半胱氨酸水平［（17.06 ± 4.41）μmol/L］高于、MMSE 评分（25.36 ± 3.11）低于单纯脑梗死组［（15.49 ± 4.11）μmol/L 和（26.48 ± 2.26）］，且组间差异有统计学意义（t = 2.185，P = 0.031；t = -2.502，P =0.013）；以完全/部分前循环梗死患者血浆同型半胱氨酸水平最高、MMSE 评分最低，其次为后循环梗死和腔隙性梗死。糖尿病伴发脑梗死组患者MMSE 评分分别与年龄、糖尿病病程、血压、总胆固醇、三酰甘油、低密度脂蛋白-胆固醇、糖化血红蛋白、同型半胱氨酸和脑卒中亚型呈负相关（均P = 0.000）；与吸烟、心血管病病史、受教育程度和高密度脂蛋白?胆固醇呈正相关（P < 0.05 或P < 0.01）。结论 糖尿病伴发脑梗死患者认知损害可能与高同型半胱氨酸血症导致的神经毒性、脑卒中类型、脑血管病相关危险因素，以及糖尿病病程和血糖控制状态具有密切关系。

关键词: 脑梗死, 糖尿病, 认知障碍, 半胱氨酸, 病例对照研究