摘要
目的探讨急性缺血性脑卒中相关阻塞性睡眠呼吸暂停(OSA)患者的认知功能损害与事件相关电位P300的相关性。方法选择2022年1月至2023年8月河北省沧州中西医结合医院神经内科收治的114例急性缺血性脑卒中相关OSA患者为研究对象,将有认知功能损害的患者设为观察组(n=38),无认知功能损害的患者设为对照组(n=76)。采用简易智力状态检查量表(MMSE)对2组患者认知功能进行测试,比较2组患者MMSE评分。采用颅脑磁共振弥散加权成像和核磁共振成像检查2组患者梗死病灶的脑区;采用SC-500型非直接接触式无干扰性睡眠监测传感器床垫对2组患者进行卒中相关OSA的筛查和评估;采用美国Nerosscan64导10/20脑电生理系统检测2组患者事件相关电位P300检测。采用单因素和多因素logistic回归分析急性缺血性脑卒中相关OSA患者认知功能损害与事件相关电位P300的相关性。结果观察组患者MMSE总分和各维度评分包括定向力、即刻记忆力、注意力+计算力、回忆能力、语言能力评分分值显著低于对照组(P<0.05)。观察组患者的年龄、糖尿病史和高同型半胱氨酸血症病史比例、呼吸暂停低通气指数(AHI)均显著高于对照组,受教育年限显著短于对照组(P<0.05)。观察组梗死病灶位于额叶、颞叶、顶叶、枕叶、丘脑、基底节、脑干、半卵圆中心患者的比例显著高于对照组(P<0.05)。观察组患者前额叶区、中央区、顶部区导联P300潜伏期均显著长于对照组(P<0.05);观察组患者中央区、顶部区导联P300波幅均显著低于对照组(P<0.05)。多因素logistic回归分析结果显示,受教育年限是急性缺血性脑卒中相关OSA患者认知功能损害的保护因素(P<0.05);有丘脑梗死灶、高AHI和P300-顶部区潜伏期长是急性缺血性脑卒中相关OSA患者认知功能损害的独立危险因素(P<0.05)。结论急性缺血性脑卒中相关OSA患者易发生多领域的认知功能受损,P300-顶部区潜伏期与急性缺血性脑卒中相关OSA患者认知功能损害密切相关,是急性缺血性脑卒中相关OSA患者认知损害的独立危险因素。
Objective To explore the correlation between cognitive impairment and event-related potential P300 in patients with acute ischemic stroke-related obstructive sleep apnea(OSA).Methods A total of 114 patients with acute ischemic stroke-related OSA admitted to the Department of Neurology of Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei from January 2022 to August 2023 were selected as the research subjects.Patients with cognitive impairment were included in the observation group(n=38),and patients without cognitive impairment were included in the control group(n=76).A standardized mini-mental state examination(MMSE)was used to test the cognitive function of patients in the two groups,and the MMSE scores of patients in the two groups were compared.The brain regions affected by infarct lesions of patients in the two groups were examined by using cranial magnetic resonance diffusion-weighted imaging and magnetic resonance imaging.The SC-500 non-contact,non-intrusive sleep monitoring sensor mattress was used to screen and assess stroke-related OSA in the two groups.The American Nerosscan 64-channel 10/20 electroencephalographic system was employed to detect event-related potential P300 of patients in the two groups.Univariate and multivariate logistic regression analysis were conducted to examine the correlation between cognitive impairment and event-related potential P300 in patients with acute ischemic stroke-related OSA.Results The total MMSE score and the scores in each dimension,including orientation,immediate memory,attention and calculation,recall ability,and language ability of patients in the observation group were significantly lower than those in the control group(P<0.05).Age,proportions with a history of diabetes,hyperhomocysteinemia,and apnea-hypopnea index(AHI)of patients in the observation group were significantly higher than those in the control group,while the years of education was significantly lower than that in the control group(P<0.05).The proportions of patients with infarct lesions located in the frontal lobe,temporal lobe,parietal lobe,occipital lobe,thalamus,basal ganglia,brainstem,and centrum semiovale in the observation group were significantly higher than those in the control group(P<0.05).The P300 latency in the prefrontal,central,and parietal regions of patients in the observation group was significantly longer than that in the control group(P<0.05).The P300 amplitude in the central and parietal regions of patients in the observation group was significantly lower than that in the control group(P<0.05).The results of multivariate logistic regression analysis indicated that the years of education was a protective factor against cognitive impairment in patients with acute ischemic stroke-related OSA(P<0.05).Thalamic infarction,high AHI,and prolonged P300 latency in the parietal region were independent risk factors for cognitive impairment in patients with acute ischemic stroke-related OSA(P<0.05).Conclusion Patients with acute ischemic stroke-related OSA are prone to cognitive impairment in multiple domains.The P300 latency in the parietal region is closely associated with cognitive impairment in patients with acute ischemic stroke-related OSA and serves as an independent risk factor for cognitive impairment in these patients.
作者
王雯
毕振云
WANG Wen;BI Zhenyun(Department of Neurology,Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei,Cangzhou 061000,Hebei Province,China)
出处
《新乡医学院学报》
CAS
2024年第7期651-656,共6页
Journal of Xinxiang Medical University
基金
河北省中医药管理局科研计划项目(编号:2019296)
河北省卫生厅2011年医学科学研究重点课题计划项目(编号:20110640)。
