摘要
目的 探究液体衰减反转恢复序列血管内高信号-扩散加权成像(Fluid-attenuated inversion re-covery vascular hyperintensity-diffusion weighted imaging,FVH-DWI)不匹配与脑梗死后认知功能障碍(Cog-nitive impairment,CI)发生及预后的相关性.方法 选取2020年1月 2023年12月本院收治的163例脑梗死患者为研究对象,其中女85例,男78例;根据脑梗死后是否发生CI,分为非CI组(98例)和CI组(65例),对比2组患者年龄、性别、高血压病、糖尿病、冠心病、蒙特利尔认知评估量表总分(Montreal cognitive assess-ment,MoCA)、FVH-DWI 不匹配率等临床信息;排除上述具有共线性的混杂因素,将受教育年限＞9年、脑梗死史、脑梗死类型、FVH-DWI不匹配率、MoCA总分、白蛋白(Albumin,Alb)和同型半胱氨酸(Homocysteine,Hcy)水平纳入多因素Logistic回归分析模型,分析脑梗死后CI发生的影响因素;探讨FVH-DWI不匹配与认知功能评分的关系;根据脑梗死患者预后情况分为预后不良组(75例)与预后良好组(88例),对比2组患者的临床信息,对FVH-DWI不匹配与脑梗死预后不良的相关性进行亚组分析.结果 CI组和非CI组患者在年龄、受教育年限、脑梗死史、脑梗死数量、脑梗死类型、甘油三酯(Triglyceride,TG)、超敏C反应蛋白(hyper-sensitivity C-reactive protein,hs-CRP)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,L-DLC)、高密度脂蛋白胆固醇(High-density lipoprotein cholesterol,H-DLC)、Hcy水平、美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评分、Rankin 修订量表(Modified Rankin scale,mRS)评分、FVH评分、FVH-DWI不匹配率、视空间与执行能力、命名能力、注意力、抽象理解能力、延迟回忆、定向力、MoCA总分方面差异显著(P＜0.05);多因素Logistic回归分析显示既往脑梗死史、脑梗死类型和Hcy水平为脑梗死患者CI发生的危险因素,受教育年限＞9年、FVH-DWI不匹配为脑梗死患者CI发生的保护因素(P＜0.05),且FVH-DWI不匹配与与认知功能评分呈负相关(r＜-0.104,P＜0.05);163例脑梗死患者中预后不良患者75例(46.01％),2组患者在年龄、吸烟史、高血压病、冠心病、脑梗死史、脑梗死数量、脑梗死类型、TG,hs-CRP水平、FVH评分、FVH-DWI不匹配、认知功能障碍发生率方面均有显著差异(P＜0.05);亚组分析显示FVH-DWI不匹配与脑梗死预后不良相关性稳定存在,且亚组间不存在交互作用.结论 FVH-DWI不匹配率与脑梗死后CI发生具有相关性,且FVH-DWI不匹配为脑梗死后CI发生的保护因素,且FVH-DWI不匹配对脑梗死预后转归情况具有预测价值.
Abstract
Objective To explore the correlation between fluid-attenuated inversion recovery vascular hyperintensity-diffusion weighted imaging(FVH-DWI)mismatch and the occurrence and prognosis of cogni-tive impairment after cerebral infarction(CI).Methods 163 patients with cerebral infarction who received treatment in our hospital from January 2020 to December 2023 were selected as the research subjects,with 85 females and 78 males.According to whether CI occurs after cerebral infarction,they were divided into non CI group(98 cases)and CI group(65 cases).The age,sex,hypertension,diabetes,coronary disease,total score of Montreal cognitive assessment(MoCA),FVH-DWI mismatch rate and other clinical information of the two groups were compared.Excluding the confounding factors with collinearity mentioned above,factors such as education＞9 years,history of cerebral infarction,type of infarction,FVH-DWI mismatch rate,total score of MoCA,albumin(Alb),and homocysteine(Hcy)were included in a multivariate logistic regression a-nalysis model to analyze the influencing factors of CI occurrence after cerebral infarction.The relationship be-tween FVH-DWI mismatch and cognitive function scores was discussed.According to the prognosis of patients with cerebral infarction,they were divided into a poor prognosis group(75 cases)and a good prognosis group(88 cases).The clinical information of two groups of patients was compared and the correlation between FVH-DWI mismatch rate and poor prognosis of cerebral infarction by subgroup was analyzed.Results For the pa-tients in the CI and non CI groups,there were remarkable differences in aspects of age,years of education,history of cerebral infarction,number of infarcts,type of infarction,triglycerides(TG),hypersensitivity C-reactive protein(hs CRP),low-density lipoprotein cholesterol(L-DLC),high-density lipoprotein cholesterol(H-DLC),Hcy,NIHSS score,MRS score,FVH score,FVH-DWI mismatch rate,visual space and execu-tive ability,naming ability,attention,abstract comprehension ability,delayed recall,directional ability,and MoCA total score(P＜0.05).The multivariant logistic regression analysis result showed that the history of cerebral infarction,type of infarction,and Hcy were risk factors for the occurrence of cognitive impairment in patients with cerebral infarction.Education years＞9 years and FVH-DWI mismatch rate were protective fac-tors for the occurrence of cognitive impairment in patients with cerebral infarction(P＜0.05),and FVH-DWI mismatch was negatively correlated with cognitive function score(r＜-0.104,P＜0.05).Among 163 pa-tients with cerebral infarction,75(46.01％)had poor prognosis.There were remarkable differences between two groups in the aspects of age,smoking history,hypertension,coronary heart disease,history of cerebral infarction,number of infarcts,type of infarction,TG,hs CRP,FVH score,FVH-DWI mismatch,and inci-dence of cognitive impairment(P＜0.05).The results of subgroup analysis showed that there was a stable correlation between FVH-DWI mismatch and poor prognosis of cerebral infarction,and there was no interac-tion between subgroups.Conclusion The mismatch rate of FVH-DWI is correlated with the occurrence of CI after cerebral infarction,and FVH-DWI mismatch is a protective factor for the occurrence of CI after cerebral infarction.FVH-DWI mismatch has prognostic value for the prognosis of cerebral infarction.
NETL
NSTL
万方数据