颈内动脉重度狭窄或闭塞患者脑血管反应性和认知功能的相关性研究

目的 探讨不同部位颈内动脉重度狭窄或闭塞患者的脑血管反应性(cerebral vascular reactivity,CVR)和认知功能改变的特点及两者的相关性。方法 选取颈内动脉重度狭窄或闭塞患者58例为病例组,按照狭窄部位分为左侧狭窄组、右侧狭窄组和双侧狭窄组,另选取正常人20例为对照组,采用经颅多普勒超声(transcranial Doppler,TCD)结合屏气试验分别检测各组屏气指数(breath-holding index,BHI),用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评估各组的认知功能。结果 病例组的BHI均低于对照组,双侧狭窄组低于左、右侧狭窄组; 右侧狭窄组的MoCA视空间/执行得分低于左侧狭窄组和对照组,左侧狭窄组的延迟记忆得分低于右侧狭窄组和对照组,双侧狭窄组的视空间/执行、延迟记忆和语言功能得分均低于对照组,且MoCA总分低于左、右侧狭窄组; 病例组内的BHI与MoCA总分呈正相关(r=0.411,0.474,0.868,P<0.05)。结论(1)颈内动脉重度狭窄或闭塞患者的BHI明显降低,认知功能也有不同程度损害;(2)颈内动脉重度狭窄或闭塞患者的BHI和MoCA总分有明显关系,将两者结合可更全面地反映认知功能。

The study on relationship between cerebral vascular reactivity and cognitive function in patients with severe stenosis or occlusion of internal carotid artery

ObjectiveTo analyze the change of characteristics of cerebral vascular reactivity(CVR),cognitive function and their relativity.Methods 58 patients with severe stenosis or occlusion of the internal carotid artery were selected as case group,and were divided into left stenosis group,right stenosis group and bilateral stenosis group,while 20 controls of them were enrolled.Using transcranial Doppler(TCD)and breath-holding technique to observe breath-holding index(BHI)and Montreal Cognitive Assessment(MoCA)to assess cognitive function of each group.Results The BHI in the case group was lower than that in controls,and the BHI in bilateral stenosis group was lower than left and right stenosis group.The scores of visual space and executive of MoCA in right stenosis group were lower than left stenosis group and control group,and the delayed recall scores in left stenosis group were lower than right stenosis group and control group.The scores of visual space and executive,delayed recall,and language in bilateral stenosis group were all lower than the control group,while the total scores of MoCA in bilateral stenosis group were lower than left and right stenosis group.The BHI in the case group was positively correlated with the total scores of MoCA(r=0.411,0.474,0.868,P<0.05).Conclusion(1)The BHI in patients with severe stenosis or occlusion of the internal carotid artery was significantly lower,and the cognitive function impaired to different degrees.(2)The BHI in patients with severe stenosis or occlusion of the internal carotid artery was apparently correlated with the total scores of MoCA,and the combination of the two could reflect the cognitive function more comprehensively.