不同程度颈动脉狭窄患者治疗后认知功能改变情况研究  

Cognitive Function Changes in Patients with Different Degrees of Carotid Stenosis after Treatment

作　　者：李艳艳[1] 高连波[1] 田沈[1] 周环[1] 王正则[1] 

机构地区：[1]中国医科大学附属第四医院神经内科,辽宁省沈阳市110032

出　　处：《中国全科医学》2014年第15期1710-1714,共5页Chinese General Practice

基　　金：辽宁省教育厅科学技术研究项目(L2010699)

摘　　要：目的探讨颈动脉支架植入治疗、药物治疗对不同程度颈动脉狭窄患者认知功能的影响。方法选取2011年12月—2012年12月在中国医科大学附属第四医院神经内科住院治疗的颈动脉狭窄患者51例（病例组）及无颈动脉狭窄患者17例（对照组）。根据单侧颈动脉狭窄率,将病例组患者分为轻度狭窄组（狭窄率为0-50%,20例）、中度狭窄组（狭窄率为51%-70%,15例）、重度狭窄组（狭窄率〉70%,16例）,其中轻度狭窄组患者接受规范的药物治疗,中度和重度组患者接受支架植入术。采用简易智能精神状态检查量表（MMSE）、顺背测试、连线测试B、韦氏智能量表中的词汇测试及数字符号测试比较患者的认知功能,然后比较轻度狭窄组患者药物治疗前后及中度、重度狭窄组患者支架植入治疗前后认知功能的改变。结果 （1）与对照组比较,轻度狭窄组患者的顺背测试、词汇测试、数字符号测试得分降低;中度狭窄组患者的顺背测试、数字符号测试得分降低,连线测试B得分升高;重度狭窄组患者的MMSE、顺背测试、词汇测试、数字符号测试得分降低,连线测试B得分升高（P〈0.05）。（2）与治疗前比较,轻度狭窄组患者药物治疗3个月、6个月MMSE、顺背测试、词汇测试、数字符号测试得分升高,连线测试B得分降低（P〈0.05）;中度狭窄组患者支架植入治疗后1个月顺背测试、词汇测试得分升高,连线测试B得分降低,而治疗后3个月、6个月患者认知功能的5个指标均改善（P〈0.05）;重度狭窄组患者支架植入治疗后1个月、3个月、6个月MMSE、顺背测试得分升高,连线测试B得分降低（P〈0.05）。结论 （1）颈动脉狭窄患者存在认知功能障碍,且颈动脉狭窄程度不同,患者累及的认知功能领域亦不同。（2）早期规范的药物治疗可以改善轻度颈动脉狭窄患者的认知功能;颈内动脉支架植入术可以改善Objective To explore the influence of carotid stenting and drug therapy on cognitive function in patients with different degrees of carotid stenosis.Methods 51 patients with carotid stenosis（case group） and 17 patients without carotid stenosis（control group） were enrolled in the study when they were admitted to the department of neurology,the Fourth Affiliated Hospital of China Medical University from December 2011 to December 2012.Case group patients were divided into 3 groups according to rate of unilateral carotid stenosis：mild stenosis group（stenosis rate：0- 50%,twenty cases）,moderate stenosis group（stenosis rate：51%- 70%,fifteen cases）,severe stenosis group（stenosis rate： 70%,sixteen cases）.Patients in mild stenosis group received standard medical treatment,moderate and severe stenosis group received carotid stenting.Cognitive function of patients was assessed by Mini- Mental State Examination（MMSE）,forward digital span,trail- making B,words test and digital symbol test of Wechsler Adult Intelligence Scale of Chinese Version（WAIS- RC）,cognitive function was compared among four groups.And cognitive function of mild stenosis group was compared before and after drug therapy,cognitive function of moderate stenosis group and severe stenosis group was compared before and after carotid stenting.Results Compared with control group,patients in mild stenosis group got lower score in forward digital span,words test and digit symbol test;Patients in moderate stenosis group got lower score in forward digital span and digit symbol test,but got higher score in trail- making B test;Patients in severe stenosis group got lower score in MMSE,forward digital span,words test and digital symbol test,but got higher score in trail- making B test（P〈0.05）.Compared with score before treatment,patients in mild stenosis group got higher score in MMSE,forward digital span,words test and digit symbol test,and got lower score in trail- making B test 3months and 6 months after drug therapy（P〈0.0

关 键 词：颈动脉狭窄 颈动脉支架 认知障碍 

分 类 号：R743[医药卫生—神经病学与精神病学]