单侧颈内动脉重度狭窄或闭塞后侧支循环开放对认知功能的影响  

The influence of collateral circulation recruitment on various cognitive functions after severe unilateral stenosis or unilateral occlusion of the internal carotid artery

作　　者：方俐[1] 李晓裔[1] 邵西仓[1] 何颖[1] 李玉琢[1] 王盼[1] 刘姝[1] 吴云[1] 申志微 Fang Li;Li Xiaoyi;Shao Xicang;He Ying;Li Yuzhuo;Wang Pan;Liu Shu;Wu Yun;Shen Zhiwei(Electroneurophysiology Center,People＇s Hospital of Guizhou,Guiyang 550002,China)

机构地区：[1]贵州省人民医院神经电生理中心,贵阳550002

出　　处：《中华老年医学杂志》2018年第11期1223-1227,共5页Chinese Journal of Geriatrics

基　　金：贵州省科学技术厅联合基金（黔科合LH字[2015]7149号）;贵阳市科技计划项目（筑科合同[20151001]号）

摘　　要：目的应用经颅多普超声（TCD）研究单侧颈内动脉重度狭窄或闭塞后侧支循环开放情况及其对各认知领域功能的影响。方法利用TCD评估176例单侧颈内动脉重度狭窄或闭塞后侧支循环情况。根据侧支循环开放情况将研究对象分成单支组、多支组、无侧支组，为了研究各单支对认知功能的影响，又把单支组分为前交通组、后交通组和眼动脉组，同时设对照组。对各组间进行中文版蒙特利尔（MoCA）评分，比较各组的MoCA总评分及子项目评分。结果154例（87.5%）有侧支循环开放，单支开放80例（45.5%），多支开放74例（42.1%），无侧支循环开放22例（12.5%）。与对照组比较，多支组、单支组、无侧支组MoCA总评分（24.2±1.7）分、（21.9±2.3）分、（19.0±2.4）分、执行与视空间评分（3.9±0.7）分、（3.2±0.8）分、（2.4±0.6）分、抽象思维评分（1.7±0.5）分、（1.6±0.5）分、（1.3±0.5）分、延迟记忆评分（2.9±0.8）分、（1.9±0.8）分、（1.6±0.5）分均明显低于对照组（26.3±1.1）分、（4.7±0.5）分、（2.0±0.0）分、（3.6±1.0）分（F＝80.52、63.21、12、48.99，均P〈0.05），单支组和无侧支循环组计算与注意力评分（4.6±0.6）分、（4.3±0.7）分明显低于对照组（5.2±0.7）分（P〈0.05），无侧支循环组定向力评分（4.7±0.7）分明显低于对照组（5.7±0.5）分（P〈0.05）。与多支组比较，单支组和无侧支循环组MoCA总评分（21.9±2.3、19.0±2.4）、执行与视空间评分（3.2±0.8）分、（2.4±0.6）分、注意力评分（4.6±0.6）分、（4.3±0.7）分均明显低于多支组（24.2±1.7、3.9±0.7、5.1±0.5）（均P〈0.05），无侧支循环组抽象思维评分（1.3±0.5）分、延迟记忆评分（1.6±0.5）分、定向力评分（4.7±0.7）分明显低于多支组（1.7±0.5）分、（2.9±0.8）分、（5.7±0.5）分（均P〈0.05）。与单支组比较，无侧支组ObjectiveTo investigate the influence of collateral circulation recruitment on cognitive functions in patients with severe unilateral stenosis or unilateral occlusion of the internal carotid artery by using TCD.MethodsA total of 176 patients with severe unilateral stenosis or unilateral occlusion of the internal carotid artery were enrolled and were divided into a single vessel collateral group（n=80, 45.5%）, a multiple vessel collateral group（n=74, 42.1%）and a no collateral group（n=22, 12.5%）. In order to study the influence of single vessel collateral circulation on cognitive functions, the single vessel collateral group was further divided into an anterior communicating subgroup（AcoA）, a posterior communicating subgroup（PcoA）, an ocular artery subgroup（OA）, and a normal control subgroup.All patients and 34 normal controls（NC）received MoCA, and scores for the overall assessment and individual domains were analyzed.ResultsCompared with the control group（26.3±1.1, 4.7±0.5, 2.0±0.0, 3.6±1.0）, the multiple vessel collateral group, the single vessel collateral group and the no collateral group had lower overall scores（24.2±1.7, 21.9±2.3, 19.0±2.4）, lower executive/visuospatial function（3.9±0.7, 3.2±0.8, 2.4±0.6）, lower abstraction（1.7±0.5, 1.6±0.5, 1.3±0.5）, and lower delayed recall（2.9±0.8, 1.9±0.8, 1.6±0.5）（F=80.52, 63.21, 12, 48.99, all P〈0.05）; both collateral groups had lower scores in subtraction and attention（4.6±0.6 vs. 5.2±0.7, 4.3±0.7 vs. 5.2±0.7）; the no collateral group had lower scores in orientation（4.7±0.7 vs. 5.7±0.5）（P〈0.05）. Compared with the multiple vessel collateral group, both the single vessel collateral group and the no collateral group had lower overall scores（21.9±2.3 vs. 24.2±1.7, 19.0±2.4 vs. 24.2±1.7）, executive/visuospatial function（3.2±0.8 vs. 3.9±0.7, 2.4±0.6 vs. 3.9±0.7）, subtraction and attention（4.6±0.6 vs. 5.1±0.5, 4.3±0.7 vs. 5.1±0.5）（all P〈0.05）; the no collater

关 键 词：经颅多普勒超声 颈内动脉 重度狭窄或闭塞 侧支循环 认知功能 

分 类 号：R749.13[医药卫生—神经病学与精神病学]