颈动脉支架置入术对脑梗死患者认知功能的影响及危险因素分析  

The influence of the cognitive function and related dangerous factors in patients with lacunar infarction after carotid artery stenting

作　　者：杨华 夏章勇[2] 单广振[2] 郭存举[2] 曲怀谦[2] 王翠兰[3] 

机构地区：[1]聊城山东聊城市第三人民医院,252000 [2]聊城市人民医院神经内科 [3]山东大学齐鲁医院脑血管病科

出　　处：《中华行为医学与脑科学杂志》2013年第7期603-606,共4页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：国家“十一五”科技支撑计划课题项目（2006BA101A11）

摘　　要：目的探讨颈动脉支架置入术（CAS）对腔隙性脑梗死患者认知功能的影响及相关危险因素。方法采用蒙特利尔认知评价量表（MoCA）、简易精神状态检查（MMSE）分别对43例腔隙性脑梗死患者颈动脉支架置人术前及术后1月、6月、1年、2年进行神经心理学测验，并与41例正常人比较。结果与对照组比较，治疗组患者MMSE评分在术前及术后1月、6月，MoCA评分在术前（19．39±2．17）分、术后1月（19．51±1．99）分，复制立方体在术前，交替连线测验、注意、延迟回忆在术前、术后1月，画钟在术前及术后1月、6月均明显降低，差异有统计学意义（P〈0．05或P〈0．01）。与术前比较，治疗组患者MMSE、Mo—CA评分在术后6月、1年、2年，交替连线测验在术后2年，复制立方体、画钟在术后1年、2年，注意、延迟回忆在术后6月、1年、2年均明显升高，差异有统计学意义（P〈0．05或P〈0．01）。在随访2年时Logistic回归分析表明，MoCA评分与患者年龄（OR=50．751，95％C11．407—19．464；P=0．006）、高血压（OR=8．012，95％CI1．212～27．550；P=0．042）、低教育水平（OR=11．586，95％CI 1．164—16．903；P=0．029）有相关性，与糖尿病、CAS无相关性。结论腔隙性脑梗死患者认知功能损害在CAS2年后明显改善，且以视空间功能、注意力、延迟回忆为著，但CAS不是认知功能的独立保护因素，高龄、高血压、低教育水平是其独立危险因素。Objective To explore the influence of the cognitive function and related dangerous factors in patients lacunar infarction（LI） after carotid artery stenting （CAS）. Methods Neuropsychological tests （ MoCA and MMSE）were conducted in 43 patients with LI before CAS, 1 month,6 months, 1 year and 2 years after CAS and the scores were compared with those of 41 healthy cases. Results Compared with control group, in therapy group,MMSE scores before CAS, 1 month and 6 months after CAS ,MoCA scores before CAS（19.39 ＋2.17） and 1 month after CAS（ 19.51 _＋ 1.99） and the scores of Cube Copying before CAS,Alternating Trail Making Test,at- tention and delayed recall before CAS, 1 month after CAS and Clock Drawing before CAS, 1 month and 6 months after CAS all lowered obviously. There were statistical differences（ P〈 0.05 or P 〈 0.01 ）. Compared with before CAS, in therapy group, MMSE scores and MoCA scores 6 months, 1 year and 2 years after CAS, the scores of Alter- nating Trail Making Test 2 years after CAS, Cube Copying and Clock Drawing 1 year and 2 years after CAS and at- tention and delayed recall 6 months, 1 year and 2 years after CAS all increased obviously. There were statistical differences （ P 〈 0.05 or P〈 0.01 ）. In the follow-up of 2 years ,the result of Logistic Regression Analysis showed that MoCA scores has correlation with age（ OR = 50. 751,95% CI 1. 407 ~ 19. 464 ; P = 0.006）, high blood pres- sure（ 0R=8.012,95% CI1.212 -27.550; P=0.042）and low levels of education（ OR= 11.586,95% CI1. 164 ~ 16. 903; P = 0.029）and no correlation with diabetes and CAS. Conclusion Cognitive impairment in patients with LI is improved 2 years after CAS, and visuospatial function, attention and delayed recall are significantly im- proved. But CAS is not independent protective factors for cognitive functions, and old age,low education levels and high blood pressure are independent risk factors for cognitive impairment in patients with LI.

关 键 词：颈动脉支架置入术 腔隙性脑梗死 认知障碍 神经心理学测验 LOGISTIC回归分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]