急性缺血性脑卒中后认知障碍的危险因素分析及银杏二萜内酯的疗效分析
Analysis of Risk Factors of Cognitive Impairment after Acute Ischemic Stroke and Therapeutic Effect of Ginkgo Diterpene Lactone
DOI: 10.12677/ACM.2022.127946, PDF,   
作者: 李淑雅：南阳科技职业学院，河南 南阳；董胜璞, 薛延莉：陕西省人民医院，陕西 西安
关键词: 缺血性脑卒中；认知障碍；危险因素；银杏二萜内酯；治疗结果；Ischemic Stroke； Cognitive Impairment； Risk Factors； Ginkgo Diterpene Lactone； Treatment Out-come
摘要: 目的：分析急性缺血性脑卒中后认知障碍形成的危险因素，探讨应用银杏二萜内酯葡胺的疗效。方法：选取医院2019年3月至2021年4月收治的急性缺血性脑卒中患者200例，按简易智力状态检查(MMSE)、蒙特利尔认知评估(MoCA)结果分为认知障碍组(45例)和非认知障碍组(155例)，对比分析两组患者的基础资料及临床资料，并采用单因素分析和多因素Logistic回归分析探讨急性脑梗死认知障碍发生的危险因素。两组患者均予基础治疗，认知障碍组患者加用银杏二萜内酯葡胺注射液静脉滴注。结果：急性脑梗死并认知障碍发生率为22.5%；单因素分析结果显示，两组患者的低蛋白血症、吸烟史无显著差异(P > 0.05)，饮酒史、糖尿病史、高血压史、高同型半胱氨酸、颈动脉粥样硬化斑块、低维生素D水平有显著差异(P < 0.05)；Logistic多元回归分析结果显示糖尿病史、高血压史、高同型半胱氨酸、颈动脉粥样硬化斑块、低维生素D水平是认知障碍形成的独立危险因素。认知障碍组患者经银杏二萜内酯葡胺治疗后的同型半胱氨酸(Hcy)水平、肿瘤坏死因子α (TNF-α)、白介素6 (IL-6)、白介素8 (IL-8)、超敏C反应蛋白(hs-CRP)、D-D水平显著低于治疗前(P < 0.05)；两组患者治疗期间均未见发生不良反应。结论：急性缺血性脑卒后认知障碍其发生主要受患者的糖尿病史、高血压史、高Hcy、颈动脉粥样硬化斑块、低维生素D水平的影响。对于已发生认知障碍的患者，给予银杏二萜内酯葡胺治疗可有效减轻炎性反应、活性氧的产生及神经功能损伤程度，改善血液流变学，且安全性较高。
Abstract: Objective: To analyze the risk factors of cognitive impairment after acute ischemic stroke and to explore the efficacy of ginkgo diterpene lactone meglumine. Method: Two hundred patients with acute ischemic stroke treated in our hospital from March 2019 to April 2021 were divided into cog-nitive impairment group (n = 45) and non-cognitive impairment group (n = 155 cases) according to the results of mini mental state examination (MMSE) and Montreal cognitive assessment (MoCA). The basic and clinical data of the two groups were compared and analyzed. Univariate analysis and multivariate Logistic regression analysis were used to explore the risk factors of cognitive impair-ment in patients with acute cerebral infarction. Patients in both groups were given basic treatment, and patients in cognitive impairment group were treated with Ginkgo biloba diterpene lactone me-glumine injection intravenously. Result: The incidence of acute cerebral infarction with cognitive impairment was 22.5%. Univariate analysis showed that there was no significant difference in hy-poproteinemia and smoking history between the two groups (P > 0.05). There were significant dif-ferences in drinking history, diabetes, hypertension, high homocysteine, carotid atherosclerotic plaque and low vitamin D levels (P < 0.05). Logistic multiple regression analysis showed that history of diabetes, hypertension, high homocysteine, carotid atherosclerotic plaque and low vitamin D lev-el were independent risk factors for cognitive impairment. The levels of homocysteine (Hcy), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), hypersensitive C-reactive pro-tein (hs-CRP) and dexamethasone D in patients with cognitive impairment were significantly lower than those before treatment in patients with cognitive impairment, and no adverse reactions were found in both groups during treatment. Conclusion: The occurrence of cognitive impairment after acute ischemic stroke is mainly affected by the history of diabetes, hypertension, high Hcy, carotid atherosclerotic plaque and low vitamin D level. For patients with cognitive impairment, ginkgo diterpene lactone meglumine treatment can effectively reduce inflammatory reaction, the produc-tion of reactive oxygen species and the degree of neurological damage, improve hemorheology, and has high safety.
文章引用：李淑雅, 董胜璞, 薛延莉. 急性缺血性脑卒中后认知障碍的危险因素分析及银杏二萜内酯的疗效分析[J]. 临床医学进展, 2022, 12(7): 6556-6562. https://doi.org/10.12677/ACM.2022.127946

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