基底动脉狭窄与认知功能改变的临床分析  

Relation between basilar artery stenosis and cognitive impairment

作　　者：李慧英[1,2] 黄一宁[1] 叶长青[1] 白静[1] 

机构地区：[1]北京大学第一医院神经内科,100034 [2]北京航天总医院神经内科

出　　处：《中华老年心脑血管病杂志》2012年第8期842-846,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨基底动脉狭窄患者双侧大脑后动脉的脑血流自动调节变化与认知功能改变之间的关系。方法选择基底动脉狭窄患者15例,并根据有无脑梗死分为狭窄无梗死组9例和狭窄梗死组6例,另选健康体检者10例为对照组。应用经颅多普勒超声屏气试验和倾斜试验评价双侧大脑后动脉的脑血流自动调节功能,同时进行全面的神经心理学测试,包括蒙特利尔认知评估量表、执行能力、结构能力、记忆力(包括听觉记忆、视觉记忆和逻辑记忆)、信息处理速度及视空间能力检查。结果与对照组比较,狭窄无梗死组信息处理速度和视空间能力明显降低,狭窄梗死组信息处理速度明显降低,差异有统计学意义(P<0.05);与狭窄无梗死组比较,狭窄梗死组视空间能力明显升高,差异有统计学意义(P<0.05)。狭窄无梗死组大脑后动脉的呼吸抑制指数和前后循环血管运动反应性比值较对照组明显降低,差异有统计学意义(P<0.05)。狭窄梗死组前后循环血管运动反应性比值与视空间能力呈正相关(P<0.05)。结论基底动脉狭窄患者在发生脑梗死之前可能已经存在不同程度的认知功能障碍,其血流动力学的改变与认知功能障碍之间可能存在一定的相关性。Objective To study the relation between autoregulation of bilateral posterior cerebral artery flow and cognitive function in patients with basilar artery stenosis. Methods Fifteen patients with basilar artery stenosis were divided into stenosis group without cerebral infaction（n= 9） and stenosis group with cerebral infaction（n= 6）. Ten healthy volunteers served as a control group. Autoregulation of bilateral posterior cerebral artery flow was assessed by transcranial Doppler ultrasound breath holding test and oblique test. Executive function, structural skill, audi- tory,visual and logical memory, information processing speed and visuospatial ability were as- sayed according to the overall neurophysiolgy test and Montreal cognitive assessment（MCA）. Re- sults The information processing speed and visuospatial ability were significantly lower in steno- sis group with cerebral infarction than in control group（P〈0.05）. The visuospatial ability was significantly higher in stenosis group with cerebral infarction than in stenosis group without cerebral infarction（P〈0.05）. The breath holding index of posterior cerebral artery and the proportion of anterior and posterior circulating vascular motion reactivity were significantly lower in stenosis group with cerebral infarction and stenosis group without cerebral infarction than in control group （P〈0.05）. The proportion of anterior and posterior circulating vascular motion reactivity was positively related with the visuospatial ability （r = 0. 830, P 〈0.05）. Conclusion Patients with basilar artery stenosis may have cognitive impairment at different severity before cerebral infarction and its hemodynamic change is related with cognitive impairment.

关 键 词：椎底动脉供血不足 认知障碍 血流动力学 神经心理学测验 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]