脑梗死后认知障碍自然改变临床及基础探究.docVIP

脑梗死后认知障碍自然改变临床及基础探究 　　　徐晓云，李 刚，黄 蕾，顾晓波，朱雯霞　　　　　　　　　　　　　　　【摘要】 目的 探讨急性脑梗死后认知障碍自然改变的特点及机制。方法 101例脑梗死患者在急性期（3周）和康复期（6个月）应用改良的HDS-R量表做认知测评。发病3周和6个月时做神经功能缺损评分，并收集脑血管病危险因素相关资料。观察项目结果和认知动态变化结果作单因素、Logistic 回归分析和相关分析。老龄与青年Wistar大鼠各15只，比较训练1个月前后水迷宫实验与跳台实验相关参数的差异。结果 认知功能在6个月时有10%患者恢复正常，好转35.6%，退步22.8%。Logistic多元回归分析康复期认知障碍发生的危险因素是年龄。老龄鼠与青年鼠在水迷宫实验中，表现出学习记忆能力的显著差异；在跳台实验中，老龄鼠与青年鼠在初次测试其伤害回避能力时无显著差异，而1个月后，老年鼠伤害回避能力明显下降。结论 脑梗死后认知障碍的自然改变呈双向性特点，年龄是康复期认知障碍退变的独立危险因素，与年龄相关的脑功能储备机制值得进一步研究。 【关键词】 脑梗死；认知障碍；自然改变 【Abstract】 Objective To study the characters and mechanism of cognitive deficit after acute cerebral infarction.Methods Cognitive function was tested in 101 cerebral infarction cases with HDS-R at the phase of 3 weeks and 6 moths of post-stroke. Meanwhile，the data of risk factors of cerebral vascular disease were collected. Logistic regression analysis was adopted for data statistics.15 age rats and 15 young rats were studied in Y-maze discrimination learning experiment and one-trial passive avoidance response experiment. The difference was found before and after 1 month training.Results In the 6th month after acute cerebral infarction，the cognitive deficit disappeared in 10% subjects，had been improved in 35.6% subjects and worsened in 22.8% subjects. Age was correlated significantly with cognitive disorder (Plt;0.01). In Y-maze discrimination learning experiment and one-trial passive avoidance response experiment after 1 month training，there was significant difference between the two groups.Conclusion The changes of cognitive deficit after cerebral infarction have two directions： improved and worsened. Aging is the main risk factor of cognitive deficit and might have a harmful effect on brain function restoration. The mechanism is reserved to be studied further. 【Key words】 cerebral infarction；cognitive deficit；natural changes 脑梗死后认知障碍是影响患者康复质量和导致血管性痴呆的重要原因，相关危险因素和防治研究已屡见报道，尚未见循证医学证实的有效干预措施。与对脑梗死后肢体运动功能改变规律的深入认识相比，对于认知障碍的自然改变研究甚少，因而目前该领域的许多临床和基础研究缺乏自然改变的依据和参照。本文前瞻性观察脑梗死患者