急性缺血性脑卒中伴轻度认知障碍中医证素与MoCA量表评分的相关性分析*

作者：申少珍，张家成，杨 芃，刘言祥，常静玲

单位：北京中医药大学东直门医院，北京 101100

引用：引用：申少珍，张家成，杨芃，刘言祥，常静玲.急性缺血性脑卒中伴轻度认知障碍中医证素与MoCA量表评分的相关性分析[J].中医药导报,2026,32(3):94-97,105.

DOI：10.13862/j.cn43-1446/r.2026.03.016

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摘要：

目的：探讨急性缺血性脑卒中（AIS）合并轻度认知障碍（MCI）患者的中医证候要素与蒙特利尔认知评估量表（MoCA）评分的相关性。方法：选取2024年1月至2025年3月在北京中医药大学东直门医院住院接受诊治的117例AIS合并MCI的患者为研究对象。对所有入组患者开展中医证候要素的调查，详细记录其一般临床资料，并运用MoCA量表对患者的认知功能状况进行评估，进而分析中医证候要素与各认知维度之间的关联性。结果：纳入117例患者，年龄（65.24±8.23）岁，中医证候要素以血瘀（50.43%）、痰湿（43.60%）、气虚（38.46%）最为常见，且3种及以上证素组合占比（41.88%）高于2种组合（27.35%）。认知功能分析显示：阴虚证患者在画钟试验、记忆力及MoCA总分上均低于非阴虚证（P＜0.05）；气虚证在注意力及语言命名测试评分上低于非气虚证（P＜0.05）；痰湿证在视空间与执行能力及复制立方体评分上低于非痰湿证（P＜0.05）；风证在语言命名及定向力评分上高于非风证（P＜0.05）。相关分析表明，痰湿证视空间下降、阴虚证记忆下降、气虚证注意力下降与受教育年限偏低相关（P＜0.05）；阴虚证记忆及MoCA总分下降与年龄偏高及HAMD评分呈负相关（P＜0.05）。结论：AIS伴MCI患者的中医证素以血瘀、痰湿、气虚为主，且多为复合证型。不同证素对应的认知损害具有偏向性，临床可据此实施个性化认知干预，但仍需扩大样本进一步探究。

关键词：急性缺血性脑卒中；轻度认知障碍；中医证素；蒙特利尔认知评估量表；相关性

Abstract：

Objective: To explore the correlation between TCM syndrome elements and the Montreal Cognitive Assessment (MoCA) scale scores in patients with acute ischemic stroke (AIS) complicated by mild cognitive impairment (MCI). Methods: A total of 117 AIS patients with MCI admitted to Dongzhimen Hospital, Beijing University of Chinese Medicine, from January 2024 to March 2025 were enrolled. TCM syndrome elements were differentiated, general clinical data were recorded, and cognitive function was assessed using the MoCA scale. The correlation between TCM syndrome elements and various cognitive domains was then analyzed. Results: Among the 117 patients, the average age was (65.24±8.23) years. The most common TCM syndrome elements were blood stasis (50.43%), phlegm-dampness (43.60%), and qi deficiency (38.46%). Combinations of three or more syndrome elements (41.88%) were more frequent than combinations of two elements (27.35%). Cognitive function analysis showed: Patients with yin deficiency syndrome had lower scores in the clock drawing test, memory, and total MoCA score compared to those without yin deficiency (P<0.05); patients with qi deficiency syndrome had lower scores in attention and language naming tests compared to those without qi deficiency (P<0.05); patients with phlegm-dampness syndrome had significantly lower scores in visuospatial/executive function and cube copying compared to those without phlegm-dampness (P<0.05); patients with wind syndrome had higher scores in language naming and orientation compared to those without wind syndrome (P<0.05). Correlation analysis indicated that decreased visuospatial function in phlegm-dampness syndrome, decreased memory in yin deficiency syndrome, and decreased attention in qi deficiency syndrome were correlated with lower years of education (P<0.05). Decreased memory and total MoCA score in yin deficiency syndrome were negatively correlated with higher age and HAMD score (P<0.05). Conclusion: The TCM syndrome elements in AIS patients with MCI are predominantly blood stasis, phlegm-dampness, and qi deficiency, often presenting as complex syndromes. Different syndrome elements correspond to specific cognitive impairments, suggesting that personalized cognitive interventions based on syndrome differentiation could be implemented clinically, although further studies with larger samples are needed.

Key words：acute ischemic stroke; mild cognitive impairment; TCM syndrome element; MoCA; correlation

发布时间：2026-03-28

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