无症状大脑中动脉狭窄患者脑白质病变后认知功能变化特征和相关指标的诊断效能分析  

Cognitive function change characteristics and diagnostic efficiency analysis of related indexes after white matter lesions in patients with asymptomatic middle cerebral artery stenosis

作　　者：左诗怡 刘勇 封羽婷 ZUO Shiyi;LIU Yong;FENG Yuting(Department of Pain and Rehabilitation Medicine,Second Affiliated Hospital of Army Military Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院疼痛与康复医学科,重庆400037

出　　处：《重庆医学》2024年第12期1778-1783,共6页Chongqing medicine

基　　金：国家自然科学基金项目(81771136);重庆市科卫联合医学科研重点项目(2022ZDXM002)。

摘　　要：目的探讨无症状大脑中动脉(MCA)狭窄患者脑白质病变(WMLs)导致的认知功能变化特征,分析相关指标的诊断效能。方法纳入2021-2022年该院神经内科诊断为无症状MCA狭窄且出现WMLs的39例患者为观察组,健康人群34例为对照组。对两组进行简易精神状态检查(MMSE)、蒙特利尔认知评估(MoCA)、连线测验A型(TMT)、数字符号测试(SDMT)、数字广度测试(DST)、画钟测验(CDT)、言语流畅性测验(VFT)等认知功能行为学评估。受试者工作特征(ROC)曲线分析相关指标的诊断效能。结果在单项认知功能评估量表中,观察组TMT评分均明显高于对照组,SDMT、DST、CDT、VFT评分均明显低于对照组,差异有统计学意义(P<0.01)。在综合性认知功能评估量表中,观察组MMSE和MoCA总分均明显低于对照组(P<0.01)。在MMSE各因子得分中,观察组的语言能力评分明显低于对照组(P<0.01),但定向力、记忆力、注意力和计算力、回忆能力评分比较差异无统计学意义(P>0.05);在MoCA各因子得分中,观察组的视空间与执行能力、延迟记忆、语言能力、抽象力评分均明显低于对照组(P<0.01),但命名能力、注意力、定向力评分比较差异无统计学意义(P>0.05)。MoCA和MMSE的ROC曲线下面积(AUC)、灵敏度、特异度分别0.80、0.73,0.52、0.71,0.92、0.74,MoCA对无症状MCA狭窄患者WMLs引起的认知功能障碍的诊断效能更高。结论与单项认知功能评估量表相比,综合性认知功能评估量表能更全面和准确筛查无症状MCA狭窄患者WMLs引起的认知功能障碍,其中MoCA的诊断效能更高。Objective To explore the characteristics of white matter lesions(WMLs)causing cognitive function change in the patients with asymptomatic middle cerebral artery(MCA)stenosis,and to analyze the diagnostic efficiency of related indexes.Methods Thirty-nine patients diagnosed with asymptomatic MCA stenosis and presenting with WMLs in the department of neurology of the hospital from 2021 to 2022 were included as the observation group,and 34 healthy people were included as the control group.The two groups conducted the behavioral assessment of cognitive function,such as the Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),Test of Connectivity Type A(TMT),Digit Symbol Test(SDMT),Digit Breadth Test(DST),Drawing the Clock Test(CDT),and Verbal Fluency Test(VFT).The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of related indicators.Results In the single cognitive function assessment scales,the scores of TMT in the observation group were significantly higher than those in the control group(P<0.01),the scores of SDMT,DST,CDT and VFT in the observation group were significantly lower than those in the control group and the differences were statistically significant(P<0.01).In the comprehensive cognitive function assessment scales,the total scores of MMSE and MoCA in the observation group were significantly lower than those in the control group(P<0.01).In the scores of each factor of the MMSE scale,the verbal ability in the observation group was significantly lower than that in the control group(P<0.01),but the scores of orientation,memory,attention,calculation and recall were had no statistically significant differences between the two groups(P>0.05).In the scores of each factor of MoCA,the visuospatial and executive ability,delayed memory,attention and abstraction ability in the observation group were significantly lower than those in the control group(P<0.01),but the scores of naming ability,attention ability and orientation ability had no statistically diffe

关 键 词：大脑中动脉狭窄 无症状 认知功能评估 蒙特利尔认知评估量表 简易精神状态检查量表 

分 类 号：R743[医药卫生—神经病学与精神病学]