一侧大脑前动脉病变时脑部血流动力学改变与患者神经功能缺损和认知障碍的相关性研究  

Changes of Cerebral Hemodynamics and Collateral Circulation in Patients with Unilateral Anterior Cerebral Artery Lesionsand Its Relationship with Neurological Deficit and Cognitive Impairment

作　　者：姬卫东[1] 王春玉[1] 周海云[1] 李春燕[1] JI Weidong;WANG Chunyu;ZHOU Haiyun;LI Chunyan(The First People’s Hospital of Shangqiu,Shangqiu 476000,China)

机构地区：[1]商丘市第一人民医院神经内科,河南商丘476000

出　　处：《湖北民族大学学报（医学版）》2022年第1期32-35,共4页Journal of Hubei Minzu University(Medical Edition)

基　　金：河南省科技公关计划项目(152102310233)。

摘　　要：目的探讨大脑前动脉(ACA)中重度狭窄(≥50%)或闭塞的脑梗死患者颅内血流动力学改变及侧支循环的代偿情况,并探讨与患者神经功能缺损、认知障碍的相关性。方法选择一侧大脑前动脉(ACA)中重度狭窄或闭塞的脑梗死患者(58例)为病例组,依据ACA的狭窄部位不同,分为A1段狭窄组(21例)和A2段狭窄组(37例),同期经TCD和彩色多普勒超声排除颅内外血管病变的健康体检者(54例)为对照组,计算病例组双侧大脑中动脉(MCA)、双侧大脑后动脉(PCA)峰流速及其比值(R_(MCA)、R_(PCA)),并与对照组比较;计算两组蒙特利尔认知评估(MoCA)量表评分,并与对照组比较。观察病例组R_(MCA)、R_(PCA)值与NIHSS评分之间的相关性。结果①病例组MCA、PCA血流速度代偿性增快,以MCA代偿为主(87.5%)。②病例组R_(MCA)高于对照组(P<0.05),病例组R_(PCA)高于对照组,但差异无统计学意义(P>0.05)。A1段狭窄组与A2段狭窄组之间R_(MCA)及R_(PCA)比较,差异无统计学意义(P>0.05)。③病例组MoCA评分均低于正常对照组(P<0.05),A1段狭窄组MoCA评分低于A2段狭窄组,差异无统计学意义(P>0.05)。④病例组R_(MCA)与NIHSS评分呈负相关(P<0.01),R_(PCA)与NIHSS无明显相关性(P>0.05)。结论①单侧ACA中重度狭窄或闭塞的脑梗死患者中,ACA与MCA间皮质软脑膜侧支吻合血管开放成为主要的侧支循环,且其代偿程度与患者神经功能缺损程度明显相关。②R_(MCA)可作为观察ACA狭窄或闭塞时皮质软脑膜血管侧支循环功能状况的指标,为治疗选择和预后判断提供客观依据。③ACA严重狭窄或闭塞造成脑梗死时,对患者的认知障碍影响较大,皮质软脑膜侧支吻合血管开放程度有限,不足以代偿患者的认知功能损害。Objective To investigate the changes of intracranial hemodynamics and compensation of collateral circulation in patients with cerebral infarction with moderate and severe stenosis(≥50%)or occlusion of anterior cerebral artery(ACA),and to explore its relationship with neurological deficit and cognitive impairment.Methods The case group consisted of 58 patients with moderate to severe cerebral infarction with unilateral anterior cerebral artery(ACA)stenosis or occlusion.All patients were diagnosed by head MRI and head and neck CT angiography(CTA).The control group consisted of healthy subjects(54 cases)who were excluded from intracranial and intracranial vascular lesions by TCD and color Doppler ultrasound during the same period.The patients in the case group were divided into A1 segment stenosis group(21 cases)and A2 segment stenosis group(37 cases)according to the different stenosis parts of ACA.Through transcranial Doppler(TCD)examination,the peak flow velocity of bilateral middle cerebral artery(MCA),bilateral posterior cerebral artery(PCA)and their ratios(R_(MCA),R_(PCA))were calculated and compared with the normal control group.The differences in Montreal Cognitive Assessment(MoCA)scale scores in the two groups of patients in the case group were calculated and compared with those in the normal control group.The correlation between the R_(MCA) and R_(PCA) values of the case group and the NIHSS score of the patients was observed.Results Among the selected 58 patients with cerebral infarction with moderate to severe stenosis or occlusion of unilateral ACA:①The blood flow velocity of MCA and PCA in the case group increased compensatively,and MCA compensation was the main component(87.5%);②When the stenosis of ACA was different,the R_(MCA) of the two groups was higher than that of the normal control group(P<0.05).③The MoCA scores of the two groups were lower than those of the normal control group(P<0.05),and the MoCA scores of A1 segment stenosis were lower than those of the A2 segment stenosis group,but t

关 键 词：大脑前动脉 血流动力学 侧支循环 神经功能缺损 认知障碍 

分 类 号：R743.1[医药卫生—神经病学与精神病学]