急性脑梗死早期认知功能与脑血流灌注相关关系的临床分析  

Relation between cognitive impairment and cerebral blood perfusion in acute ischemic stroke patients

作　　者：李慧英[1] 蒋初明[1] 高永红[2] 邹煦[3] 任菁[2] 甄伟兰 刘洁[1] 朱传明[4] 

机构地区：[1]北京航天总医院神经内科,100076 [2]北京航天总医院干部医疗科,100076 [3]北京航天总医院血液内科,100076 [4]北京航天总医院影像中心,100076

出　　处：《中华老年心脑血管病杂志》2015年第4期385-388,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市丰台区科技项目(ksf11006)

摘　　要：目的探讨急性脑梗死患者发病后2周内认知功能与脑血流灌注的关系。方法选择急性脑梗死患者19例作为病例组,同期住院的无缺血性脑卒中患者或门诊健康志愿者11例作为对照组。对受试者进行神经心理学测试,包括画钟测验(CDT)、蒙特利尔认知评估量表(MoCA);用单光子发射计算机断层摄影(SPECT)2日法测量静息及腺苷负荷后各脑区的局部脑血流量,同时计算放射性摄取比值(UR);分析各认知领域与各脑区UR的关系。结果 2组CDT、MoCA总分比较,差异有统计学意义(P<0.01)。病例组左侧枕叶、左侧颞叶及右侧顶叶UR与MoCA总分相关(r=0.574、0.538、0.533,P=0.010、0.017、0.019);右侧小脑、左侧颞叶UR与延迟回忆评分相关(r=0.525、0.475,P=0.021、0.040);右侧额叶、左侧额叶及右侧颞叶UR与CDT评分相关(r=-0.526、-0.499、-0.516,P=0.021、0.029、0.024)。结论急性脑梗死早期已存在不同程度的认知功能障碍,其血流动力学改变与认知功能障碍可能相关。联合静息及腺苷负荷SPECT对发现急性脑梗死早期血流动力学的改变更敏感。Objective To study the relation between cognitive impairment and cerebral blood perfusion in acute ischemic stroke（AIS）patients.Methods Nineteen AIS patients served as an AIS group and 11 healthy volunteers served as a control group in this study.The subjects underwent neuropsychology test,including CDT and MoCA.Their regional cerebral blood flow（rCBF）was tested by SPECT-2protocol after rest and adenosine stress.Their radioactive uptake ratio（UR）was calculated.Relation between cognitive impairment and radioactive UR was analyzed.ResultsThe scores of CDT,MoCA,visuospatial ability and executive function were significantly different in AIS group and control group（P〈0.01）.The radioactive UR differed greatly in left basal ganglia,left frontal lobe and left temporal lobe between the 2groups（P〈0.05）,and was related with the total MoCA score（r=0.574,r=0.538,r=0.533,P=0.010,P=0.017,P=0.019）.The radioactive UR in right cerebellar lobe and left temporal lobe was related with the delayed recall score（r=0.525,r=0.475,P=0.021,P=0.040）.The radioactive UR in right frontal lobe,left frontal lobe and right temporal lobe was related with the CDT score（r=-0.526,r=-0.499,r=-0.516,P=0.021,P=0.029,P=0.024）.Conclusion AIS patients have different degrees of cognitive impairment.Their hemodynamic change is related with cognitive impairment.SPECT protocol can show their early hemodynamic change after rest and adenosine stress.

关 键 词：脑梗死 认知障碍 神经心理学测验 体层摄影术 发射型计算机 单光子 血流动力学 局部血流 

分 类 号：R743.33[医药卫生—神经病学与精神病学]