慢性颈内动脉闭塞患者颈内动脉支架置入与认知障碍相关性研究  

Relationship between internal CAS and cognitive impairment in chronically occluded cervical internal carotid artery patients

作　　者：邱炜斌 陈旭[2] 席刚明[1] 任海燕[2] Qiu Weibin;Chen Xu;Xi Gangming;Ren Haiyan(Department of Neurology,Shanghai Xuhui Central Hospital,Shanghai 200020,China)

机构地区：[1]上海市徐汇区中心医院神经内科,200020 [2]上海市第八人民医院神经内科

出　　处：《中华老年心脑血管病杂志》2020年第6期614-617,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的通过对慢性颈内动脉闭塞患者进行侧支循环及脑灌注情况评估,探讨慢性颈内动脉闭塞与认知障碍的关系及发病机制。方法选择2015年1月~2018年1月上海市徐汇区中心医院卒中筛查门诊就诊,通过CT血管成像筛查,未发生急性脑梗死的慢性颈内动脉闭塞患者86例,根据蒙特利尔认知评估量表(MoCA)评分分为认知正常组24例(MoCA评分≥26分),认知障碍组62例(MoCA评分<26分)。认知障碍组接受颈内动脉支架置入术(CAS)32例(CAS组),未行CAS 30例(对照组)。所有研究对象接受数字减影血管造影术、CT灌注成像(CTP)检查。结果认知障碍组侧支血流0~2级比例明显高于认知正常组,3~4级比例明显低于认知正常组(P<0.05)。与基线比较,CAS组1个月和6个月MoCA总分、注意力和延迟记忆评分明显增高,差异有统计学意义(P<0.05)。与基线比较,对照组6个月MoCA总分和延迟记忆评分明显下降,差异有统计学意义(P<0.05)。与对照组比较,CAS组6个月MoCA总分、立方体/连线、画钟、注意力和延迟记忆评分明显改善(P<0.05)。CAS组6个月脑血流量、脑血容量明显高于对照组[(28.6±2.8)ml/(100 g·min)vs(17.4±2.0)ml/(100 g·min),(3.4±0.2)ml/100 g vs(1.3±0.3)ml/100 g,P<0.05],平均通过时间明显低于认知障碍组术前[(3.6±0.6)s vs(5.2±0.3)s,P<0.05]。对照组6个月CTP各项参数变化较认知障碍组术前不明显,差异无统计学意义(P>0.05)。结论慢性颈内动脉闭塞发生认知障碍与颅内侧支循环血流代偿程度相关。CAS可以恢复慢性颈内动脉闭塞患者认知功能。Objective To study the relationship between internal carotid artery stenting(CAS)and cognitive impairment and its mechanism by evaluating the collateral circulation and cerebral perfusion in chronically occluded cervical internal carotid artery(COICA)patients.Methods Eighty-six COICA patients admitted to our hospital from January 2015 to January 2016 were divided into normal cognitive function(MoCA scalescore≥26)group(n=24)and cognitive impairment(MoCA scale score<26)group(n=62)with the patients who underwent internal CAS served as a CAS group(n=32)and those who did not underwent CAS as a control group(n=30).The patients underwent DSA and brain CT perfusion imaging(CTP).Results The total MoCA scale score,attention score and delayed memory score were significantly higher than the baseline parameters in CAS group at months 1 and 6 after operation(P<0.05)while the total MoCA scale score and delayed memory score were significantly lower than the baseline parameters in control group at month 6 after operation(P<0.05).The total MoCA scale score,cube/connecting line ratio,attention score and delayed memory score were significantly improved as compared with the baseline parameters in control group at month 6 after operation(P<0.05).The CBF was significantly faster and the CBV was significantly larger while the MTT was significantly shorter in CAS group than in control group at month 6 after operation[28.6±2.8 ml/(100 g·min)vs 17.4±2.0 ml/(100 g·min),3.4±0.2 ml/100 g vs 1.3±0.3 ml/100 g,P<0.05;3.6±0.6 s vs 5.2±0.3 s,P<0.05].No significant difference was detected in CIP imaging parameters between control group at month 6 after operation and cognitive impairment group before operation(P>0.05).Conclusion Cognitive impairment is related with intracranial collateral circulation and internal CAS can restore the cognitive function in COICA patients.

关 键 词：颈动脉狭窄 认知障碍 血管造影术 数字减影 血流动力学 侧支循环 支架 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R749.1[医药卫生—临床医学]