无症状性颈内动脉中重度狭窄及支架置入对患者认知功能的影响  

Impact of asymptomatic internal carotid artery moderate to severe stenosis and stenting on cognitive function of patients

作　　者：石向群[1] 张志强[1] 张亮[1] 罗红波[1] 张晓燕[1] 张国祯[1] 曹丽[1] 汪泳[1] 

机构地区：[1]兰州军区兰州总医院神经内科,730050

出　　处：《中国脑血管病杂志》2014年第12期630-633,共4页Chinese Journal of Cerebrovascular Diseases

基　　金：甘肃省自然科学基金资助项目(2013-273)

摘　　要：目的探讨颈内动脉狭窄对患者认知功能的影响及颈内动脉支架置入对认知功能的改善作用。方法回顾性分析兰州军区兰州总医院神经内科2007年5月—2013年6月经全脑血管造影诊断的无症状性颈内动脉C1段狭窄患者92例的资料,其中中度狭窄49例和重度狭窄43例(支架置入31例),评估纳入患者的蒙特利尔认知评估量表(Mo CA)评分、美国国立卫生研究院卒中量表(NIHSS)评分以及支架置入后3个月Mo CA评分的改善情况。结果 (1)重度狭窄组Mo CA评分低于中度狭窄组[(22.6±2.9)分比(27.4±2.3)分,P<0.01],Mo CA评分<26分的患者占83.7%(36/43),明显高于中度狭窄组的22.4%(11/49),两组比较差异有统计学意义(P<0.01)。(2)在重度狭窄组中,术前Mo CA评分支架治疗组[(22.9±3.0)分]与未置入支架组[(21.9±2.4)分]比较,差异无统计学意义(P>0.05);支架置入术后3个月支架治疗组Mo CA评分[(25.4±2.7)分]明显高于未行支架治疗组[(22.2±2.8)分],差异有统计学意义(P<0.01);支架置入治疗后Mo CA评分<26分者的比例(48.4%,15/31)明显低于未置入支架者(83.3%,10/12,P=0.037)。结论颈内动脉重度狭窄可造成认知功能减退,颈内动脉支架置入术有利于颈动脉重度狭窄患者的认知功能改善。Objective To investigate the impact of internal carotid artery stenosis on cognitive function of patients and the improvement of cognitive function after internal carotid artery stenting. Methods The clinical data of 92 patients with asymptomatic internal carotid artery stenosis on segment C1 segment diagnosed by cerebral angiography at the Department of Neurology,Urumqi General Hospital of Lanzhou Military Hospital from May 2007 to June 2013 were analyzed retrospectively,including 49 with moderate stenosis and 43 with severe stenosis. Thirty-one patients had stenting. The enrolled patients were evaluated with the Montreal Cognitive Scale （MoCA）score and the National Institutes of Health Stroke Scale （NIHSS） score,and the improvement of the MoCA score at 3 month after stenting was evaluated. Results （1）The MoCA score of the severe stenosis group was lower than that of the moderate stenosis group（22. 6 ± 2. 9 vs. 27. 4 ± 2. 3,P〈0. 01）. The patients with the MoCA score 〈26 was 83. 7%（36/43）. It was significantly higher than 22. 4% in the moderate stenosis group （11/49）. There was significant difference between the 2 groups （P〈0. 01）. （2）In the severe stenosis group,there was no significant difference in the preoperative MoCA score between the stenting group （22. 9 ± 3. 0）and the non-stenting group （21. 9 ± 2. 4）（P〉0.05）;3 months after stenting,the MoCA score （25. 4 ± 2. 7）of the stenting group was significantly better＆amp;nbsp;than that of the non-stenting group （22. 2 ± 2. 8）. There was significant difference （P〈0. 01）;and after stenting,the proportion of patients with the MoCA score 〈26 （48. 4%,15/31）was significantly lower than those of the non-stenting （83. 3%,10/12,P=0. 037）. Conclusion Severe stenosis of internal carotid artery may cause cognitive dysfunction. Carotid artery stenting is conducive to improve cognitive function in patients with severe stenosis.

关 键 词：颈动脉狭窄 认知障碍 支架 血管内治疗 

分 类 号：R543.4[医药卫生—心血管疾病]