关键词: 卒中, 认知障碍, 失眠, 相关因素, 动脉自旋标记, 脑血流量

Abstract: Background　Cognitive impairment and insomnia are common post-stroke complications.They often coexist and influence each other，affecting the recovery and increasing the length of hospital stay in stroke patients.Post-stroke changes in hormone level and cerebral blood flow may be related to post-stroke complications.Objective　To explore the related factors of post-stroke cognitive impairment with insomnia by analyzing the clinical data of such patients.Methods　55 outpatients and inpatients with stroke from Tongde Hospital of Zhejiang Province were enrolled from August 2018 to February 2020，of them those with and without post-stroke cognitive impairment and insomnia were assigned to a observation group （n=40）and a control group（n=15），respectively.General demographic data，clinical scale scores，serum hypothalamic-pituitary-adrenal （HPA） axis hormones 〔adrenocorticotropic hormone （ACTH），cortisol〕，and hypothalamus-pituitary-thyroid （HPT） axis hormones 〔thyroid-stimulating hormone （TSH），free triiodothyronine （FT3），free tetraiodothyronine （FT4）〕，homocysteine and neuron-specific enolase （NSE） levels were recorded.Cerebral blood flow was measured by arterial spin labeling，and the specific region of interest was analyzed.Results　The observation group and control group had significant difference in the distribution of education level （P<0.05）.The observation group had lower mean scores of Montreal Cognitive Assessment （MoCA） and Barthel Index and higher mean scores of National Institutes of Health Stroke Scale （NIHSS），Pittsburgh Sleep Quality Index （PSQI），Hamilton Depression Rating Scale （HAMD） and Hamilton Anxiety Rating Scale （HAMA） than the control group（P<0.05）.Mean serum levels of TSH，FT3 and FT4 showed no significant intergroup difference（P>0.05）.Mean serum levels of ACTH and cortisol in the observation group were much higher （P<0.05）.There was no significant difference in serum homocysteine level between the two groups （P>0.05）.Serum NSE level in the observation group was much higher （P<0.05）.The cerebral blood flow of left frontal lobe in the observation group was significantly lower （P<0.05）.Spearman rank correlation analysis showed that MOCA score was negatively correlated with age，NIHSS score and serum NSE level （rs=-0.321，P=0.043；rs=-0.478，P=0.002；rs=-0.433，P=0.005），and positively correlated with Barthel Index，cerebral blood flow of right parietal lobe，left parietal lobe，right frontal lobe，right temporal lobe，right occipital lobe，left occipital lobe and right thalamus （rs=0.486，P=0.001；rs=0.639，P=0.003；rs=0.285，P=0.003；rs=0.723，P<0.001；rs=0.530，P=0.020；rs=0.688，P=0.001；rs=0.705，P=0.009；rs=0.582，P=0.009；rs=0.576，P=0.010）；PSQI score was positively correlated with HAMD score，HAMA score，serum cortisol level and cerebral blood flow of right occipital lobe in observation group （rs=0.603，P<0.001；rs=0.591，P<0.001；rs=0.635，P<0.001；rs=0.593，P=0.007）.Conclusion　The patients with post-stroke cognitive impairment and insomnia had increased severity of depression and anxiety，increased activity of the HPA axis，and elevated serum NSE level.Correlation analysis showed that the degree of insomnia was positively correlated with serum cortisol level，HAMD and HAMA scores，and the cerebral blood flow in right occipital lobe；cognitive function was negatively correlated with age，NIHSS score and serum NSE level，and positively correlated with Barthel Index and cerebral blood flow in most lobes.

Key words: Stroke, Cognitive impairment, Insomnia, Risk factors, ASL, Cerebral blood flow