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

摘要： 背景　认知障碍和失眠障碍均是卒中后常见的并发症，两者常以共病形式出现且相互影响，进而影响卒中患者功能康复，延长住院时间。卒中发生后，患者的激素水平及脑血流会发生改变，这可能与卒中并发症存在相关性。目的　分析卒中后认知障碍（PSCI）伴失眠患者的临床资料，并分析其相关因素。方法　选取2018年8月—2020年2月在浙江省立同德医院就诊的门诊及住院卒中患者55例，将PSCI伴失眠患者作为观察组（n=40），卒中后不伴有认知障碍和睡眠障碍者作为对照组（n=15）。记录两组一般资料，相关临床量表评分，血清下丘脑-垂体-肾上腺（HPA）轴激素〔促肾上腺激素（ACTH）、皮质醇（CORT）〕、下丘脑-垂体-甲状腺（HPT）轴激素〔促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）〕、同型半胱氨酸（Hcy）和神经特异性烯醇化酶（NSE）水平。采用磁共振动脉自旋标记序列（ASL）测定患者脑血流量（CBF），对两组感兴趣区（ROI）进行比较分析。结果　两组文化程度比较，差异有统计学意义（P<0.05）。观察组蒙特利尔认知评估量表（MoCA）评分、Barthel指数低于对照组，美国国立卫生研究院卒中量表（NIHSS）、匹兹堡睡眠质量指数（PSQI）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）评分均高于对照组（P<0.05）。两组血清TSH、FT3、FT4水平比较，差异无统计学意义（P>0.05）；观察组患者ACTH、CORT水平高于对照组（P<0.05）。两组血清Hcy水平比较，差异无统计学意义（P>0.05）；观察组血清NSE水平高于对照组（P<0.05）。观察组左侧额叶CBF值低于对照组（P<0.05）。Spearman秩相关分析结果显示，观察组患者MoCA评分与年龄、NIHSS评分、血清NSE水平呈负相关（rs=-0.321，P=0.043；rs=-0.478，P=0.002；rs=-0.433，P=0.005），与Barthel指数、右顶叶、左顶叶、右侧额叶、左侧额叶、右侧颞叶、右侧枕叶、左侧枕叶、右侧丘脑CBF值呈正相关（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=688，P=0.001；rs=0.705，P=0.009；rs=0.582，P=0.009；rs=0.576，P=0.010）；观察组患者PSQI评分与HAMD评分、HAMA评分、血清CORT水平、右侧枕叶CBF值呈正相关（rs=0.603，P<0.001；rs=0.591，P<0.001；rs=0.635，P<0.001；rs=0.593，P=0.007）。结论　PSCI伴失眠患者的抑郁、焦虑程度较高，HPA轴相对亢进，血清NSE水平偏高，相关性分析提示PSCI伴失眠患者的睡眠障碍程度与血清CORT水平、HAMD及HAMA评分、右侧枕叶CBF值呈正相关；认知功能与年龄、NIHSS评分、血清NSE水平呈负相关，与Barthel指数和大部分脑区CBF值呈正相关。

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