皮质下梗死患者认知障碍与供血动脉狭窄的相关性分析

摘要] 目的：探讨皮质下梗死致血管性认知障碍（vascular cognitive impairment，VCI）患者的颅内血管病变情况，分析VCI的可能病因与机制，为早期诊断与寻找可能的预防和治疗方式提供依据。方法：连续入选我院皮质下梗死的住院患者，排除影响认知测评的患者，根据VCI诊断标准，分为VCI组49例，无认知障碍组(NVCI）42例，收集临床资料及体格检查、实验室检测，蒙特利尔认知评估（the Montreal Cognitive Assessment，MoCA）量表评分，头颅CT血管造影(computed tomography angiography,CTA或磁共振血管造影（magnetic resonance angiography,MRA）评估脑供血动脉。结果：皮质下梗死的VCI患者TOAST分型VCI组大动脉粥样硬化型24例（48.98%），NVCI组大动脉粥样硬化型22例（52.38%），两组无显著差异。CTA或MRA评估血管提示VCI组血管狭窄患者37例（75.51%），颅内血管狭窄占75.25%，其中大脑中动脉28.71%。单一血管病患者18.37%，多血管病变患者57.14%。NVCI组血管狭窄患者80.95%，颅内血管病变60%，其中大脑中动脉32%，单一血管病患者26.19%，多血管病变患者54.76%，与VCI组有统计学差异（P<0.05）。VCI患者每例颅内血管狭窄数目分别为0-6支，平均狭窄数量为（1.51±1.67）支，患者的认知评分与血管狭窄数目成负相关（Rs =-0.283,P=0.048）。结论：大动脉粥样硬化为VCI的最常见原因，且以颅内大动脉病变为主。由于颅内大动脉病变为华人常见脑动脉狭窄部位，且具有可治疗性，为华人的VCI的防治提供了依据。

Relationship between cognitive impairment and cerebrovascular stenosis in patients with subcortical infarction

Objective To investigate the intracranial vascular lesions in patients with subcortical infarction-induced vascular cognitive impairment(VCI), and to investigate the etiology and mechanisms of VCI. Methods Inpatients with subcortical infarction in our hospital were enrolled in this study from Nov. 2012 to Feb. 2014, with those unable to complete the cognitive evaluation eliminated. According to the diagnostic criteria of VCI the patients were divided into two groups: 49 with cognitive impairment (VCI group) and 42 without cognitive impairment (NVCI group). The clinical data, physical examinations, laboratory tests, and the Montreal Cognitive Assessment (MoCA) scale scores were collected. Cerebral blood vessels were assessed by CT angiography or magnetic resonance angiography (MRA). Results The results showed that, according to TOAST classification, VCI group had 24 (48.98%) patients with large artery atherosclerosis (LAA) and NVCI group had 22 (52.38%), showing no significant difference between the two groups. CTA or MRA indicated that 37 (75.51%) patients in VCI group had vascular stenosis, with 75.25% of the 37 patients having intracranial vascular stenosis and 28.71% with middle cerebral artery stenosis. Patients with single cerebral artery stenosis accounted for 18.37% and those with the multiple artery stenosis accounted for 57.14%. CTA or MRA indicated that 34 (80.95%) patients in NVCI group had vascular stenosis, with 60% having intracranial vascular stenosis, including 32% with middle cerebral artery stenosis, 26.19% with single cerebral artery stenosis, and 54.76% with the multiple artery stenosis, with the latter two data being significantly different from the VCI group (P <0.05). In VCI group, the number of intracranial vascular stenosis branches ranged 0-6, with a mean of (1.51±1.67), and a negative relation was found between numbers of stenosis arteries and MoCA scores in patients of VCI group (r_s=-0.283, P <0.05). Conclusion Different from the common causes of small blood vessels, LAA is the most common etiology of subcortical VCI, which implied that exploring the LAA causes of small lesions is crucial for the prevention of VCI in Chinese patients.