2025 年第 6 期 第 20 卷

无症状脑梗死患者简易精神状态检查量表和蒙特利尔认知评估量表评分变化及其与双重抗血小板聚集治疗效果的关系

Changes of mini-mental state examination and Montreal cognitive assessment scores in patients with silent brain infarction and their relationship with the effect of dual antiplatelet aggregation therapy

作者：吴小坤1齐文帅2祖喆3付子娟4马原源1张晋霞1

英文作者：Wu Xiaokun1， Qi Wenshuai2， Zu Zhe3， Fu Zijuan4， Ma Yuanyuan1， Zhang Jinxia1

单位：1华北理工大学附属医院神经内科，唐山063000；2河北省唐山市丰南区中医医院内三科，唐山063300；3河北省唐山市中医医院肛肠科，唐山063000；4河北省唐山市工人医院神经内科，唐山063000

英文单位：1Department of Neurology North China University of Science and Technology Affiliated Hospital Tangshan 063000 China; 2the Third Department of Internal Medicine Fengnan District Hospital of Traditional Chinese Medicine Hebei Province Tangshan 063300 China; 3Department of Anorectal Medicine Tangshan Traditional Chinese Medicine Hospital Hebei Province Tangshan 063000 China; 4Department of Neurology Tangshan Gongren Hospital Hebei Province Tangshan 063000 China

关键词：无症状脑梗死；认知功能；双重抗血小板聚集治疗；临床疗效

英文关键词：Silentbraininfarction;Cognitivefunction;Dualantiplateletaggregationtherapy;Clinicalefficacy

• 摘要：

• 目的 探究无症状脑梗死（SBI）患者简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）评分变化及其与双重抗血小板聚集治疗效果的相关性。方法 回顾性分析2022年8月至2023年10月于华北理工大学附属医院就诊的SBI患者110例，根据治疗方案将患者分为常规组（50例）和双抗组（60例），其中常规组患者给予阿司匹林肠溶片进行治疗，双抗组给予硫酸氢氯吡格雷和阿司匹林肠溶片双重抗血小板聚集治疗方案进行治疗。收集患者一般资料，于治疗前，治疗1、3个月后检测患者神经系统标志物、认知功能、凝血功能水平，评估患者治疗3个月后临床效果。采用Logistic回归方程分析影响SBI患者临床疗效的危险因素；采用受试者工作特征曲线分析评估患者治疗前认知功能水平对临床效果的预测价值。结果 治疗1、3个月后，2组神经生长因子、脑源性神经营养因子（BDNF）水平及MMSE、MoCA评分较治疗前均呈上升趋势，且各时点双抗组均高于常规组（均P<0.05）；治疗1、3个月后，2组神经元特异性烯醇化酶（NSE）、胶质纤维酸性蛋白因子、纤维蛋白原（FIB）、血小板最大聚集率、D-二聚体水平较治疗前均呈降低趋势，且各时点双抗组均低于常规组（均P<0.05）。治疗3个月后，双抗组有效率高于常规组［86.7%（52/60）比70.0%（35/50）］（χ2=4.581，P=0.032）。Logistic回归分析结果显示，既往史、吸烟史、饮酒史、治疗前BDNF、NSE、FIB、D-二聚体水平及MMSE、MoCA评分均为SBI患者临床疗效的影响因素（均P＜0.05）。受试者工作特征曲线分析结果显示，MMSE、MoCA联合预测SBI患者临床疗效结局的曲线下面积=0.848。结论 双重抗血小板聚集治疗方案可有效改善SBI患者神经系统标志物水平、认知水平及凝血功能。同时SBI患者发病后认知功能水平对患者临床长期预后具有明显影响，在临床治疗过程中，除对患者临床症状进行监测外，还需对患者认知功能进行及时评估，以获得最佳治疗效果。

• Objective To investigate the changes of mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scores in patients with silent brain infarction (SBI) and their relationship with the effect of dual antiplatelet aggregation therapy. Methods A total of 110 SBI patients admitted to North China University of Science and Technology Affiliated Hospital from August 2022 to October 2023 were retrospectively analyzed. According to the treatment regimen, the patients were divided into conventional group (50 cases) and dual antibody group (60 cases). The conventional group was treated with bay aspirin, and the dual antibody group was treated with dual antiplatelet aggregation therapy (aspirin and clopidogrel bisulfate). The general data of the patients were collected, and the levels of nervous system markers, cognitive function, and coagulation function were detected before treatment, 1 and 3 months after treatment, and the clinical effect of the patients after 3 months of treatment was evaluated. Logistic regression equation was used to analyze the risk factors affecting the clinical efficacy of SBI patients. Receiver operating characteristic curve analysis was used to evaluate the predictive value of cognitive function before treatment for clinical efficacy. Results After 1 and 3 months of treatment, the levels of nerve growth factor and brain-derived neurotrophic factor (BDNF), MMSE and MoCA scores in both groups showed an upward trend, and the scores in the dual antibody group were higher than those in the conventional group at each time point (all P<0.05). After 1 and 3 months of treatment, the levels of neuron-specific enolase (NSE), glial fibrillary acidic protein factor, fibrinogen (FIB), maximum platelet aggregation rate, and D-dimer in the two groups showed a decreasing trend compared with those before treatment, and those in the dual antibody group were lower than those in the conventional group at each time point (all P<0.05）. After 3 months of treatment, the effective rate of the dual antibody group was higher than that of the conventional group ［86.7% (52/60) vs 70.0% (35/50)］(χ2=4.581, P=0.032). Logistic regression analysis showed that past history, smoking history, drinking history, BDNF, NSE, FIB, D-dimer levels before treatment, MMSE and MoCA scores were the influencing factors of clinical efficacy in patients with SBI (all P<0.05). The receiver operating characteristic curve analysis showed that the area under the curve of MMSE and MoCA combined to predict the clinical efficacy of SBI patients was 0.848. Conclusions Dual antiplatelet aggregation therapy can effectively improve the level of neurological markers, cognitive level and coagulation function in patients with SBI. At the same time, the level of cognitive function after the onset of SBI has a significant impact on the long-term clinical prognosis of patients. In the process of clinical treatment, in addition to monitoring the clinical symptoms of patients, The cognitive function of patients should be evaluated in time to obtain the best treatment effect.