无脑梗死重度颈动脉狭窄患者伴血管性认知障碍的特点及影响因素  

Characteristics and influencing factors of infarct-free severe carotid artery stenosis patients with vascular cognitive impairment

作　　者：朱桓 李文杰 王培炯 张启航 张岩[1] Zhu Huan;Li Wenjie;Wang Peijiong;Zhang Qihang;Zhang Yan(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,National Center for Clinical Medical Research of Neurological Diseases,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科、国家神经系统疾病临床医学研究中心,100070

出　　处：《神经疾病与精神卫生》2023年第2期81-85,共5页Journal of Neuroscience and Mental Health

基　　金：国家自然科学基金(81870833);国家科技支撑计划(2015bai12b04)。

摘　　要：目的 探索伴血管性认知障碍(VCI)的无脑梗死重度颈动脉狭窄(CAS)患者的认知受损情况及特点,并分析患者伴VCI的危险因素。方法 选取2020年9月至2021年12月就诊于首都医科大学附属北京天坛医院的55例重度CAS患者为研究对象。根据《2019年中国血管性认知障碍诊治指南》评估患者是否合并VCI。采用连线试验-A(TMT-A)、连线试验-B(TMT-B)、波士顿命名测试第2版(BNT-2)、中文版霍普金斯语言学习测试(HVLT)、画钟试验(CDT)和蒙特利尔认知评估量表(MoCA)比较伴或不伴VCI患者的认知功能。采用多因素Logistic回归分析无脑梗死重度CAS患者合并VCI的影响因素。结果 55例无脑梗死重度CAS患者中,40例(72.7%)患者伴VCI。67.5%(27/40)的伴VCI患者的认知受损维度>3个。单因素分析结果显示,伴或不伴VCI患者的年龄[(64.00±6.61)岁比(58.13±6.66)岁]、受教育年限[9(9,12)年比12(12,16)年]、有椎动脉狭窄占比[65.0%(26/40)比5/15]比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,高龄(OR=1.165,95%CI:1.019~1.332,P<0.05)是CAS患者伴VCI的危险因素,而受教育年限长(OR=0.681,95%CI:0.490~0.947,P<0.05)和Willis环有效代偿(OR=5.531,95%CI:1.027~29.797,P<0.05)是伴VCI的保护因素。结论 无脑梗死重度CAS伴VCI患者存在认知功能下降,受教育年限长、Willis环有效代偿是认知功能受损的保护因素,高龄是认知功能受损的危险因素。Objective To study the cognitive function and characteristics of infarct-free severe carotid artery stenosis(CAS)patients with vascular cognitive impairment(VCI),and to analyze the risk factors for VCI in these patients.Methods A total of 55 severe CAS patients who were treated in Beijing Tiantan Hospital Affiliated to Capital Medical University from September 2020 to December 2021 were included.The patients were assessed by 2019 Chinese Guidelines for Diagnosis and Treatment of VCI.The cognitive function of patients with or without VCI was compared using the Trail Making Test-A(TMT-A),Trail Making Test-B(TMT-B),Boston Naming Test Version 2(BNT-2),Chinese version of Hopkins Verbal Learning Test(HVLT),Clock Drawing Test(CDT)and Montreal Cognitive Assessment Scale(MoCA).The influencing factors of VCI in patients with severe CAS without cerebral infarction were analyzed by multivariate Logistic regression analysis.Results Among 55 patients with severe CAS without cerebral infarction,40 patients(72.7%)were complicated with VCI.67.6%(27/40)of patients with VCI had more the 3 dimensions of cognitive impairment.The results of univariate analysis showed that there was significant difference in the age[(64.00±6.61)years old vs(58.13±6.66)years old],years of education[9(9,12)years vs 12(12,16)years]and vertebral artery stenosis[65.0%(26/40)vs 5/15]of patients with or without VCI(P<0.05).When multifactor correction was applied,advanced age(OR=1.165,95%CI=1.019-1.332)was a risk factor for VCI in patients with carotid stenosis,while higher education(OR=0.681,95%CI=0.490-0.947)and effective Willis loop compensation(OR=5.531,95%CI=1.027-29.797)were then protective factors.Conclusions Severe CAS patients with VCI have extensive cognitive function impairment,higher education and effective Willis loop compensation are protective factors for cognitive function,and advanced age is a risk factor for cognitive impairment.

关 键 词：颈动脉狭窄 血管性认知障碍 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]