目的 探讨卒中后发生认知障碍的危险因素.方法 回顾性纳入2018年6月-2019年6月邯郸市第一医院神经内科连续收治的急性缺血性卒中患者,采用MMSE、MoCA量表评估认知功能,将其分为卒中后认知障碍(post-stroke cognitive impairment,PSCI)和无认知障碍(no cognitive impairment,NCI)两组,并采用多因素logistic回归模型分析卒中后发生认知障碍的危险因素.结果 共纳入162例急性缺血性卒中患者,平均年龄59.79±6.71岁,男性97例(59.9％);PSCI组78例(48.1％),NCI组84例(51.9％).多因素分析结果显示,初中及以上教育水平(OR?0.153,95％CI 0.052～0.454)、既往卒中史(OR?2.915,95％CI?1.262～6.730)、大面积梗死(OR?7.710,95％CI 1.591～37.364)、脑萎缩(OR?4.494,95％CI?1.210～16.698)是PSCI的独立影响因素.结论 PSCI的发生比例较高;高教育水平是PSCI发生的独立保护因素,既往卒中史、梗死面积大、脑萎缩是PSCI发生的独立危险因素.

炎症反应是缺血性卒中后病理生理的核心内容,其过程涉及免疫和炎症细胞,不同途径和来源的被激活的炎症因子共同参与.早期小胶质细胞、中性粒细胞被激活,随之淋巴细胞的聚集和浸润也增加了对脑细胞的损伤;但也有研究发现,在特定刺激下,中性粒细胞可以从促炎表型向抗炎表型转变,进而保护脑细胞;淋巴细胞中部分T细胞亚型可以抑制促炎因子的表达、调节淋巴细胞的活性,从而起到脑保护作用.另外,在缺血性卒中后,除脑内局部的炎症反应外,外周循环的炎性反应和免疫抑制也参与其病理机制.免疫调节有望成为未来缺血性卒中治疗的靶点.

Objective To explore the relationship of post-stroke depression and anxiety with cognitive impairment. Methods 98 patients with first ischemic stroke who were admitted to the First Hospital of Handan from January 2017 to March 2018 were selected. 50 inpatients with non-stroke in the same period were chosen as control group.The patients of the two groups were assessed using the following scales within 2 days after hospitalization, including Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), activity of daily living scale (ADL), Montreal cognitive assessment (MOCA) and NIHSS. The cognitive impairment, anxiety and depression in both groups were analyzed. The correlation analysis of ADL, MoCA, NIHSS and HAMA, HAMD scores were performed. Results 62 (63.3%) patients in stroke group were diagnosed with cognitive dysfunction, 53 (54.1%) patients with anxiety, and 42 (42.9%) patients with depression; while in control group, 14 (28%) cases with cognitive dysfunction, 17 (34.0%) ones with anxiety, and 9 (18.0%) ones with depression. The MoCA and ADL scores in stroke group were both lower than that in control group, and the differences were statistically significant. The correlation analysis of HAMA and ADL, MoCA, NIHSS score showed that the correlation coefficients r=-0.526 (P<0.001), r=-0.592 (P<0.001) and r=0.412 (P<0.001), respectively; the correlation coefficients of HAMD score and ADL, MoCA, NIHSS were r=-0.490 (P<0.001), r=-0.571 (P<0.001) and r=0.606 (P<0.001), respectively. The correlation coefficients of ADL, MoCA and NIHSS were r=0.933 (P<0.001) and r=-0.842 (P<0.001). The correlation coefficient of MoCA and NIHSS wasr=-0.911 (P<0.001). Conclusions The incidence of anxiety and depression after ischemic stroke were higher, and they were both correlated with cognitive impairment. The more severe post-stroke anxiety and depression, the more serious the neurological deficit and the worse the activity of daily living.

Objective To explore the influencing factors of mild vascular cognitive impairment (mVCI). Methods Patients with acute ischemic stroke within 14 days from onset who were admitted to Handan First Hospital From August 2015 to October 2018 were selected. All the patients were assessed by mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). According to the scores, these patients were divided into mVCI group and normal cognition (NCI) group. The clinical data were compared between the two groups, using univariate analysis and multivariate logistic regression analysis were used to analyze the influencing factors of mVCI. Results Finally, a total of 205 patients were included in this study, with 97 cases in mVCI group and 108 cases in NCI group. The proportion of patients with low education (P=0.006), hypertension (P=0.032), diabetes (P=0.041) and smoking (P=0.026) in mVCI group were significantly higher than that in NCI group. The levels of plasma homocysteine (P=0.016), triglyceride (P=0.040), cholesterol (P=0.026) and Pittsburgh sleep quality index (P<0.001) were significantly higher in mVCI group than that in NCI group. Elevated plasma homocysteine level ( OR 1.139, 95% CI 1.012-1.283, P=0.031) and multivariate logistic regression analysis showed that poor sleep quality (OR 1.301, 95% CI 1.107-1.530, P=0.001) were independent risk factors for mVCI, and high education degree ( OR 0.652, 95% CI 0.434-0.978, P=0.039) was a protective factor. Conclusions Hyperhomocysteinemia and poor sleep quality are independent risk factors for mVCI, while high education degree is a protective factor for mVCI.

Mild cognitive impairment (MCI) is a transition state between normal cognition and dementia. MCI has a close relationship with Post-stroke depression (PSD). MCI with depression is common. PSD is also considered to be an important risk factor for MCI progressing to dementia. The research progress of the relations between PSD and MCI is reviewed in the paper, which is emphatically recommends the new progress in MCI and PSD, including epidemiology, related mechanisms, and treatment.