无症状颈动脉狭窄患者认知功能障碍评估及其危险因素研究  

Evaluation of Cognitive Impairment in Patients with Asymptomatic Carotid Stenosis and Its Risk Factors

作　　者：张华[1] 张淑平[1] 王小新[2] 

机构地区：[1]首都医科大学附属北京安贞医院神经内科,北京市100029 [2]北京市密云县医院神经内科,101500

出　　处：《中国全科医学》2017年第17期2051-2056,2063,共7页Chinese General Practice

摘　　要：目的采用事件相关电位P300(ERP-P300)、简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估无症状颈动脉狭窄(ACS)患者的认知功能,并分析其认知功能障碍的危险因素。方法选取2015年于首都医科大学附属北京安贞医院神经内科住院和门诊就诊的ACS患者179例为研究对象,根据颈动脉狭窄程度分级,<30%为无狭窄组(90例),30%~69%为轻中度狭窄组(49例),70%~99%为重度狭窄组(40例)。收集患者临床资料,检测血清同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)、低密度脂蛋白胆固醇(LDL-C)、血尿酸(UA)、空腹血糖水平;采用MMSE、MoCA评价患者认知功能,采用Keypoint肌电图诱发电位仪进行ERP-P300检测,记录潜伏期和波幅;采用Fazekas评分评价脑白质病变程度。结果各组吸烟、高血压检出率比较,差异均有统计学意义(P<0.05)。各组MMSE评分、ERP-P300波幅比较,差异无统计学意义(P>0.05)。各组MoCA评分、ERP-P300潜伏期、Fazekas评分比较,差异均有统计学意义(P<0.05);其中,轻中度狭窄组MoCA评分低于无狭窄组,重度狭窄组MoCA评分低于无狭窄组、轻中度狭窄组;轻中度狭窄组ERP-P300潜伏期长于无狭窄组,重度狭窄组ERP-P300潜伏期长于无狭窄组、轻中度狭窄组(P<0.05)。MMSE对ACS患者认知功能障碍的检出率为16.8%(15/89),低于MoCA的检出率43.8%(39/89)(χ~2=18.892,P<0.001)。多因素Logistic回归分析显示,高血压[OR=2.671,95%CI(1.877,3.609)]、ERP-P300潜伏期延长[OR=5.014,95%CI(2.983,8.429)]、颈动脉重度狭窄[OR=3.232,95%CI(1.134,9.208)]是ACS患者认知功能障碍的危险因素。结论 ACS患者可早期出现认知功能障碍,且与高血压、颈动脉狭窄程度有关;MoCA和ERP-P300在预测ACS患者认知功能障碍中较为敏感,可作为评价ACS患者认知功能障的辅助检查手段。Objective To evaluate the cognitive function in the patients with asymptomatic carotid stenosis（ACS） by event related potentials P300（ERP-P300）,mini-mental state examination（MMSE） and Montreal Cognitive Assessment（MoCA）,and to explore the risk factors of cognitive impairment.Methods A total of 179 patients with ACS,who were hospitalized and outpatient in Department of Neurology,Beijing Anzhen Hospital,Capital Medical University in 2015,were selected as the research objects.According to the degree of coronary artery stenosis,subjects were divided into no stenosis group（〈30%,n=90）,mild to moderate stenosis group（30%-69%,n=49） and severe stenosis group（70%-99%,n=40）.The clinical data were collected,and levels of serum homocysteine（Hcy）,hypersensitive C-reactive protein（hs-CRP）,low density lipoprotein cholesterol（LDL-C）,serum uric acid（UA）,and FPG were measured.MMSE,MoCA were used to evaluate the cognitive function of patients,and ERP-P300 detection was conducted by the keypoint EMG evoked potentiometer to record the latent period and amplitude,and Fazekas score were used to evaluate degree of white matter lesions.Results There was significant difference in the detection rate of smoking and hypertension among all the groups（P〈0.05）.There were no significant differences in scores of ERP-P300 amplitude and MMSE among all the groups（P〉0.05）.The latent period of ERP-P300,and scores of MoCA and Fazekas were significantly different among all the groups（P〈0.05）.Among them,the MoCA score in mild to moderate stenosis group was lower than that in no stenosis group,and the MoCA score in severe stenosis group was lower than that in no stenosis group and mild to moderate stenosis group（P〈0.05）.The latent period of ERP-P300 in mild to moderate stenosis group was longer than that in no stenosis group,and the latent period of ERP-P300 in severe stenosis group was longer than that in no stenosis group and mild to moderate stenosis group（P〈0.05）.The rate of MM

关 键 词：颈动脉狭窄 认知障碍 事件相关电位 P300 危险因素 

分 类 号：R543.4[医药卫生—心血管疾病]