首次前循环TIA后脑血流量降低与认知功能减退的关系  

Relationship between cognitive impairment and reduced cerebral blood flow after first-time anterior circulation transient ischemic attack

作　　者：王俊[1,2] 王建[2] 王庆松[2] 王志强[1,2] 段丹[2] 李余霞[2] 

机构地区：[1]第三军医大学研究生管理大队,重庆400038 [2]成都军区总医院神经内科,成都610083

出　　处：《第三军医大学学报》2015年第12期1262-1266,共5页Journal of Third Military Medical University

基　　金：成都军区医学科学技术研究"十二五"计划研究项目(C12045);成都军区总医院重点研究项目(2013YG-A006)~~

摘　　要：目的运用脑CT灌注成像技术评估首次TIA后认知功能减退是否与脑血流量变化有关。方法选择性回顾2009年8月至2014年8月在成都军区总医院神经内科住院的发病24 h内首次临床诊断为前循环TIA及认知量表评定正常的50例患者,发病1周内进行全脑CTPI检查,分别监测感兴趣区域脑血容量(cerebral blood volume,CBV)、脑血流量(cerebral blood flow,CBF)、平均通过时间(mean transit time,MTT)、达峰时间(time to peak,TTP);发病第4周进行认知量表评价,根据认知量表结果分为VCI组与对照组,比较2组患者早期CTPI灌注参数的差异,并将VCI组认知量表评分与灌注参数进行相关性分析。结果 VCI组与对照组在年龄、性别、血压、血脂、血糖、同型半胱氨酸、前循环TIA发作至入院平均时间及前循环TIA发作至完成CTPI的平均时间等方面结果相仿,基线水平无统计学差异;VCI组与对照组相比,VCI组CBF降低,MTT、TTP明显延长,差异有统计学意义(P<0.05);2组患者CBV相仿,差异无统计学意义(P>0.05);Spearman相关性分析显示Mo CA与VCI组MTT值负相关(r=-0.51,P=0.009)。结论 TIA发生后脑血流灌注降低与认知功能下降的发生有一定相关性,提示CTPI对前循环TIA后VCI早期预警有一定诊断价值。Objective To adopt brain CT perfusion imaging（ CTPI） technology to assess whether cognitive impairment is associated with cerebral blood flow changes after the first-time transient ischemic attack（ TIA）. Methods Fifty patients were diagnosed with the first-time anterior circulation TIA and normal cognition in August 2009 to August 2014 at the department of Neurology,and underwent CTPI examination in1 week after onset to monitor the cerebral blood volume（ CBV）,cerebral blood flow（ CBF）,mean transit time（ MTT）,and time to peak（ TTP）. After 4 weeks,the patients received cognitive assessment,and according to the assessment results,the patients were divided into vascular cognitive impairment（ VCI） group and control group. Early CTPI perfusion parameters of the 2 groups were compared,and the relationship between cognitive assessment scores and the perfusion parameters was analyzed. Results The VCI group and the control group had similar results in age, sex, hypertension, hyperlipidemia, diabetes,hyperhomocysteinemia,average time of TIA seizures and average time of complete CTPI,and the baselines had no statistical significant differences. Compared with the control group,the VCI group showed lower CBF,and longer MTT and TTP,and the differences were statistically significant（ P 〈 0. 05）. There was no statistically significant difference in CBV between the 2 groups. Spearman correlation analysis indicated that MTT was negatively correlated with the scores of Montreal cognitive assessment（ r =- 0. 51,P = 0. 009）.Conclusion The reduced cerebral blood flow after TIA is correlated with cognitive impairment,and CTPI is helpful for early diagnosis of VCI.

关 键 词：短暂性脑缺血发作 CT灌注成像 痴呆 血管性认知障碍 

分 类 号：R364.12[医药卫生—病理学] R749.13[医药卫生—基础医学]