支架植入术对认知功能障碍伴大脑中动脉狭窄患者认知功能的影响  

Impact of stent implantation on cognitive function in patients with cognitive dysfunction and middle cerebral artery stenosis

作　　者：张继杰 牛小莉[2] 王贺波[2] 张帆[3] 楚宝 马良 ZHANG Jijie;NIU Xiaoli;WANG Hebo;ZHANG Fan;CHU Bao;MA Liang(Graduate School of Hebei Medical University,Shijiazhuang 050051,China;Department of Neurology,Department of Radiology,Hebei General Hospital,Shijiazhuang 050051,China;Catheterization Division,Department of Radiology,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学研究生学院,河北石家庄050051 [2]河北省人民医院神经内科,河北石家庄050051 [3]河北省人民医院影像科导管室,河北石家庄050051

出　　处：《中国介入影像与治疗学》2019年第2期71-76,共6页Chinese Journal of Interventional Imaging and Therapy

基　　金：河北省卫生和计划生育委员会科研基金项目(20170350)

摘　　要：目的探讨支架植入术对轻中度认知功能障碍伴单侧大脑中动脉(MCA)M1段重度狭窄患者认知功能的影响。方法将28例轻中度认知功能障碍伴单侧MCA M1段重度狭窄患者分为治疗组(n=13,接受支架植入术)及对照组(n=15)。对治疗组术前1周、术后6、12个月及对照组同期进行简易智力状态检查(MMSE)评分、蒙特利尔认知评估(MoCA)评分及事件相关电位P300检测。对治疗组中5例于术前1周及术后1个月行CT灌注成像(CTP),计算患侧与健侧脑血流量(CBF)和脑血容量(CBV)比值(rCBF和rCBV)、平均通过时间(MTT)和达峰时间(TTP)差值(dMTT和dTTP),并进行统计学分析。结果术前1周2组间MMSE、MoCA评分、事件相关电位P300的潜伏期及波幅差异均无统计学意义(P均>0.05)。治疗组术后6、12个月相关评分及指标与对照组同期比较差异均有统计学意义(P均<0.05)。治疗组中,术前1周、术后6、12个月MMSE、MoCA评分差异均有统计学意义(P均<0.05),两两比较显示术后12个月MMSE、MoCA评分均高于术前1周(P均<0.05),术后6个月MoCA评分高于术前1周(P=0.010)。2组间术前1周事件相关电位P300潜伏期及波幅差异均无统计学意义(P均>0.05),治疗组术后6、12个月潜伏期均短于对照组同期指标(P均<0.01),波幅均大于对照组同期指标(P均<0.05)。治疗组术前1周、术后6、12个月潜伏期、波幅差异均有统计学意义(P均<0.05);与术前1周比较,术后6、12个月潜伏期缩短(P均<0.01),波幅增大(P均<0.05);与术后6个月比较,术后12个月潜伏期缩短(P=0.010)。治疗组中,有无脑血管病危险因素患者间术前1周、术后6、12个月MMSE、MoCA评分差异均无统计学意义(P均>0.05);5例接受CTP检查者术后1个月rCBF高于术前1周(P<0.01),rCBV、dMTT及dTTP均低于术前1周(P均<0.05)。结论支架植入术可改善轻中度认知功能障碍伴单侧MCA M1段重度狭窄患者脑组织血流灌注,从而改善其认知功能。事件相关�Objective To investigate the impact of stent implantation on cognitive function in patients with mild-tomoderate cognitive dysfunction associated with severe stenosis of unilateral middle cerebral artery(MCA)M1 segment.Methods According to whether stent implantation,28 patients with mild-to-moderate cognitive dysfunction associated with unilateral MCA M1 severe stenosis were divided into treatment group(n=13)and control group(n=15).The examinations of mini-mental state examination(MMSE)score,Montreal cognitive assessment(MoCA)score and the event-related potential P300 were performed on all patients in treatment group 1 week before stent implantation and 6,12 months after implantation,as well as in control group during the same period.Totally 5 patients in treatment group underwent CT perfusion imaging(CTP)1 week before stent implantation and 1 month after implantation.Cerebral blood flow(CBF)and cerebral blood volume(CBV)were measured and the ratios of CBF and CBV between the affected side and contralateral side(rCBF and rCBV)were calculated.Meanwhile,mean transit time(MTT),peak time(TTP)and the differences of between the two sides(dMTT and dTTP)were obtained,and then statistical analysis was performed.Results There was no significant difference of MMSE and MoCA scores,nor the latency and amplitude of P300 between the two groups 1 week before stent implantation(all P >0.05).However,6 and 12 months after implantation and the corresponding period,the differences were statistically significant between the two groups(all P<0.05).In treatment group,the differences of the scores of MMSE and MoCA were statistically significant 1 week before stent implantation,6 and 12 months after implantation(all P<0.05).The pairwise comparison showed that the scores of MMSE and MoCA 12 months after stent implantation were higher than those 1 week before implantation(both P<0.05),and the score of MoCA 6 months after implantation was higher than that 1 week before implantation(P=0.010).There was no significant difference of the latency

关 键 词：大脑中动脉 支架 认知 体层摄影术 X线计算机 灌注成像 

分 类 号：R654.3[医药卫生—外科学] R815[医药卫生—临床医学]