无症状性颈动脉狭窄老年患者认知功能减退与皮质萎缩的相关性CSCD

Objective To analyze the correlation between cognitive impairment and cortical atrophy in elderly patients with asymptomatic carotid artery stenosis (ACAS). Methods In this cross‑sectional study, 40 consecutive elderly patients with ACAS treated in the Department of Neurology, Northern Jiangsu People′s Hospital from July 1, 2020 to June 30, 2021 (ACAS group), and 40 elderly healthy controls who accepted physical examination during the same period (control group) were included. Cognitive assessment was performed using the Mental State Examination Scale (MMSE) and the Montreal Cognitive Assessment Scale (MoCA), and brain magnetic resonance imaging scanning was performed in the ACAS group. The artificial intelligence technique was applied for brain lobe segmentation and cortical volume calculation. The χ2‑test, independent sample t‑test and Wilcoxon non‑parametric test were used to analyze the difference of clinical data and cognitive scores between the two groups. In the ACAS group, the cortical volumes of the side with carotid stenosis was compared with that of the normal side, and Spearman′s correlation analysis was used to assess the correlation between cognitive scores and cortical atrophy. Results Compared with the control group, the ACAS group got significantly lower scores of MMSE and MoCA, as well as lower scores of visuospatial executive function, attention and calculation, language function, abstraction ability and delayed recall [(25.60±2.49) vs (27.18±1.01), (22.05±3.59) vs (25.60±1.43), (2.73±1.04) vs (4.08±0.62), (4.53±0.93) vs (5.03±0.66), 2.00 (0.00) vs 3.00 (0.00), 1.00 (1.00) vs 2.00 (0.00), and (2.95±0.96) vs (3.35±0.62)] (all P<0.05). There was not significant differences in naming and orientation ability between the two groups (both P>0.05). The volume of cortical, temporal lobe, frontal lobe, parietal lobe and insular lobe on the side with carotid stenosis in the ACAS group were significantly smaller than those on the normal side [186.23 (177.97, 202.53) vs 194.67 (185.65, 204.82) cm3, 54.74 (50.66, 56.95) vs 55.61 (51.24, 58.49) cm3, 72.98 (70.76, 78.34) vs 75.27 (72.34, 80.66) cm3, 53.66 (51.11, 57.86) vs 56.59 (52.80, 60.09) cm3, 6.57 (6.35, 7.07) vs 6.72 (6.46, 7.34) cm3] (all P<0.05). The MoCA score in the ACAS group was positively related to the cortical volume ratio of the two sides (r=0.427, P<0.01). The attention (r=0.353) and abstraction (r=0.226) ability scores were positively correlated with the temporal lobe volume ratios of the two sides (both P< 0.05). The visuospatial executive (r=0.187) and language (r=0.373) ability scores were positively correlated with frontal lobe volume ratios of the two sides (both P<0.05), and visuospatial executive (r=0.386), naming (r=0.344), language (r=0.517), abstraction (r=0.335) and delayed recall (r=0.333) ability scores were positively correlated with parietal lobe volume ratios of the two sides (all P< 0.05). Conclusion In elderly patients with ACAS, the cognitive impairment and cortical atrophy on the sides with carotid stenosis are significant and a positive correlation is detected between them. © 2023 Chinese Journal of Health Management. All rights reserved.     

无症状性颈动脉狭窄患者血脑屏障通透性变化的研究

目的 使用动脉自旋标记(ASL)灌注成像技术、动态对比增强磁共振成像(DCE-MRI)技术及人工智能脑结构分析平台，探讨无症状性颈动脉狭窄(ACAS)患者脑灌注、血脑屏障(BBB)通透性、灰质体积的变化及相关性。方法 对纳入研究的40例ACAS患者进行MRI检查，通过ASL技术评估患者两侧大脑半球脑血流灌注的情况，通过DCE-MRI技术评估两侧大脑半球BBB通透性(用容积转运常数Ktrans值表示)的变化，并通过人工智能脑结构分析平台计算颈动脉供血区域的灰质体积。将以上数据以及患者的临床资料进行统计分析和检验。结果 与对侧相比，ACAS患者颈动脉狭窄侧的脑灌注降低(P<0.001),且Ktrans值升高(P<0.05)。除此之外，ACAS患者颈动脉狭窄侧大脑皮质灰质的体积小于对侧(P<0.001),其中颞叶、额叶、顶叶及岛叶灰质体积相比差异均具有统计学意义(均P<0.05)。相关性分析结果显示，ACAS患者颈动脉狭窄侧的Ktrans值与CBF值之间具有负相关关系(r=-0.334,P<0.05)。结论 ACAS患者存在狭窄侧颈动脉供血区的低灌注及BBB通透...