头颅CT灌注成像和ERP相关电位在症状性大脑中动脉狭窄支架置入术后并发认知功能障碍评估的价值  

Value of cerebral CT perfusion imaging and event-related potential in assessment of cognitive dysfunction after stent implantation for symptomatic middle cerebral artery stenosis

作　　者：贾倩 陈秀晓 董中君 JIA Qian;CHEN Xiu-xiao;DONG Zhong-jun(Department of Neurology,Xingtai Third Hospital,Xingtai054000,Hebei,China)

机构地区：[1]邢台市第三医院神经内科,河北邢台054000

出　　处：《生物医学工程与临床》2024年第5期654-660,共7页Biomedical Engineering and Clinical Medicine

基　　金：邢台市重点研发计划项目(2020ZC280)。

摘　　要：目的探讨头颅CT灌注成像和事件相关电位(ERP)在症状性大脑中动脉狭窄患者Neuroform EZ支架置入术后并发认知功能障碍评估的应用。方法选择2019年1月至2021年10月在邢台市第三医院收治的126例症状性大脑中动脉狭窄患者,其中男性94例,女性32例;年龄41~61岁,平均年龄51.18岁;汉族117例,其他民族9例;高血压18例,糖尿病20例,高血脂16例,心房颤动9例;饮酒史33例,吸烟史39例;文化程度初中及以下31例,中专或高中54例,大专及以上41例;身体质量指数21.60~28.50 kg/m^(2),平均身体质量指数24.63 kg/m^(2);术前大脑中动脉狭窄程度70%~80%61例,81%~99%65例;侧支循环通路93例(73.81%);患侧左侧73例,右侧53例。所有患者均行Neuroform EZ支架置入术,应用蒙特利尔认知评估量表,将患者分成认知功能障碍组(<26分)和正常组(≥26分)。比较两组患者头颅CT灌注成像[达峰值时间(TTP)、平均通过时间(MTT)、脑血流量(CBF)和脑血容量(CBV)]和ERP(P300潜伏期和波幅)等指标。单因素和Logistic回归分析确定认知功能障碍影响因素,受试者工作特性(ROC)曲线评估头颅CT灌注成像和ERP指标对认知功能障碍的诊断效能。结果126例患者手术均获得成功。术后12个月,根据蒙特利尔认知评估量表,将患者分成认知功能障碍组(<26分)36例和正常组(≥26分)90例。认知功能障碍组与正常组患者年龄、民族、高血压、糖尿病、高血脂、心房颤动、饮酒史、吸烟史、文化程度、身体质量指数、术前大脑中动脉狭窄程度、患侧和侧支循环通路等参数差异均无统计学有意义(χ^(2)/t=0.569、1.197、0.233、0.481、0.716、0.108、0.066、0.628、0.401、2.547、0.918、0.411、0.737,P=0.570、0.274、0.629、0.488、0.398、0.743、0.798、0.428、0.818、0.280、0.338、0.522、0.391>0.05)。认知功能障碍组CBF[(12.32±3.55)mL/(100 g·min)vs(22.42±2.47)mL/(100 g·min);t=15.625,P=0.000]和CBV[(0.81±0.21)mL/100 g vs(1.45Objective To investigate the application of cerebral CT perfusion imaging and event-related potential(ERP)in assessment of cognitive dysfunction after Neuroform EZ stent implantation in patients with symptomatic middle cerebral artery stenosis.Methods From January 2019 to October 2021,a total of 126 patients with symptomatic middle cerebral artery stenosis were enrolled,which included 94 males and 32 females,aged 41-61 years old with mean age of 51.18 years old;117 cases of Han nationality and 9 of others;18 cases of hypertension,20 of diabetes,16 of hyperlipidemia and 9 of atrial fibrillation;33 cases of drinking history and 39 of smoking history;31 cases of junior high school and below,54 of secondary school or high school and 41 of college and above;body mass index was 21.60-28.50 kg/m^(2)with mean body mass index of 24.63 kg/m^(2);preoperative middle cerebral artery stenosis was 70%-80%in 61 cases and 81%-99%in 65;93 cases of collateral circulation pathway(73.81%);affected side was located on the left side in 73 cases and on the right side in 53.All of them underwent Neuroform EZ stent implantation and divided into cognitive dysfunction group(<26 scores)and normal group(≥26 scores)by Montreal cognitive assessment scale.The cerebral CT perfusion imaging[time to peak(TTP),mean transit time(MTT),cerebral blood flow(CBF)and cerebral blood volume(CBV)]and ERP(P300 latency and amplitude)were compared between 2 groups.The univariate and Logistic regression analysis were used to determine the influencing factors of cognitive impairment,and receiver operating characteristic(ROC)curve was used to evaluate diagnostic efficacy of cerebral CT perfusion imaging and ERP indicators for cognitive dysfunction.Results The operation of 126 patients were successful.Twelve-month post operation,all patients were divided into cognitive dysfunction group(n=36)and normal group(n=90)according to Montreal cognitive assessment scale.There was no significant difference in age,nationality,hypertension,diabetes,hyperlipidemia,atrial fibri

关 键 词：头颅CT灌注成像 事件相关电位 大脑中动脉狭窄 Neuroform EZ支架置入术 认知功能障碍 影响因素 

分 类 号：R651.12[医药卫生—外科学] R741.044[医药卫生—临床医学] R814.42