支架植入术对认知功能障碍伴大脑中动脉狭窄患者认知功能的影响
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摘要
目的探讨支架植入术对轻中度认知功能障碍伴单侧大脑中动脉(MCA)M1段重度狭窄患者认知功能的影响。方法将28例轻中度认知功能障碍伴单侧MCA M1段重度狭窄患者分为治疗组(n=13,接受支架植入术)及对照组(n=15)。对治疗组术前1周、术后6、12个月及对照组同期进行简易智力状态检查(MMSE)评分、蒙特利尔认知评估(MoCA)评分及事件相关电位P300检测。对治疗组中5例于术前1周及术后1个月行CT灌注成像(CTP),计算患侧与健侧脑血流量(CBF)和脑血容量(CBV)比值(rCBF和rCBV)、平均通过时间(MTT)和达峰时间(TTP)差值(dMTT和dTTP),并进行统计学分析。结果术前1周2组间MMSE、MoCA评分、事件相关电位P300的潜伏期及波幅差异均无统计学意义(P均>0.05)。治疗组术后6、12个月相关评分及指标与对照组同期比较差异均有统计学意义(P均<0.05)。治疗组中,术前1周、术后6、12个月MMSE、MoCA评分差异均有统计学意义(P均<0.05),两两比较显示术后12个月MMSE、MoCA评分均高于术前1周(P均<0.05),术后6个月MoCA评分高于术前1周(P=0.010)。2组间术前1周事件相关电位P300潜伏期及波幅差异均无统计学意义(P均>0.05),治疗组术后6、12个月潜伏期均短于对照组同期指标(P均<0.01),波幅均大于对照组同期指标(P均<0.05)。治疗组术前1周、术后6、12个月潜伏期、波幅差异均有统计学意义(P均<0.05);与术前1周比较,术后6、12个月潜伏期缩短(P均<0.01),波幅增大(P均<0.05);与术后6个月比较,术后12个月潜伏期缩短(P=0.010)。治疗组中,有无脑血管病危险因素患者间术前1周、术后6、12个月MMSE、MoCA评分差异均无统计学意义(P均>0.05);5例接受CTP检查者术后1个月rCBF高于术前1周(P<0.01),rCBV、dMTT及dTTP均低于术前1周(P均<0.05)。结论支架植入术可改善轻中度认知功能障碍伴单侧MCA M1段重度狭窄患者脑组织血流灌注,从而改善其认知功能。事件相关电位P300检测指标潜伏期可早于MMSE评分发现认知功能改变。
Objective To investigate the impact of stent implantation on cognitive function in patients with mild-tomoderate cognitive dysfunction associated with severe stenosis of unilateral middle cerebral artery(MCA)M1 segment.Methods According to whether stent implantation,28 patients with mild-to-moderate cognitive dysfunction associated with unilateral MCA M1 severe stenosis were divided into treatment group(n=13)and control group(n=15).The examinations of mini-mental state examination(MMSE)score,Montreal cognitive assessment(MoCA)score and the event-related potential P300 were performed on all patients in treatment group 1 week before stent implantation and 6,12 months after implantation,as well as in control group during the same period.Totally 5 patients in treatment group underwent CT perfusion imaging(CTP)1 week before stent implantation and 1 month after implantation.Cerebral blood flow(CBF)and cerebral blood volume(CBV)were measured and the ratios of CBF and CBV between the affected side and contralateral side(rCBF and rCBV)were calculated.Meanwhile,mean transit time(MTT),peak time(TTP)and the differences of between the two sides(dMTT and dTTP)were obtained,and then statistical analysis was performed.Results There was no significant difference of MMSE and MoCA scores,nor the latency and amplitude of P300 between the two groups 1 week before stent implantation(all P>0.05).However,6 and 12 months after implantation and the corresponding period,the differences were statistically significant between the two groups(all P<0.05).In treatment group,the differences of the scores of MMSE and MoCA were statistically significant 1 week before stent implantation,6 and 12 months after implantation(all P<0.05).The pairwise comparison showed that the scores of MMSE and MoCA 12 months after stent implantation were higher than those 1 week before implantation(both P<0.05),and the score of MoCA 6 months after implantation was higher than that 1 week before implantation(P=0.010).There was no significant difference of the latency and amplitude of P300 between the two groups 1 week before stent implantation(both P>0.05).The latencies in treatment group were shorter than those in control group 6 and 12 months after stent implantation(both P<0.01),while the amplitude were higher than those in control group(both P<0.05).In treatment group,the latency and amplitude of P300 were statistically significant 1 week before stent implantation,6 and 12 months after implantation(all P<0.05).The pairwise comparison showed that the latencies of 6 and 12 months after stent implantation were shortened(both P<0.01),while the amplitude increased compared with those on 1 week before implantation(both P<0.05).Compared with 6 months after stent implantation,the latency on 12 months after implantation was shortened(P=0.010).In treatment group,no matter whether there were risk factors or not,no significant difference of the scores of MMSE nor MoCA among 1 week before stent implantation,6 and 12 months after implantation(all P>0.05).Of5 patients underwent CTP examination in treatment group,rCBF 1 month after stent implantation was higher than that 1 week before stent implantation(P <0.01),while rCBV,dMTT and dTTP were lower than those 1 week before implantation(all P <0.05).Conclusion Stent implantation can improve cognitive function in patients with severestenosis of MCA M1 segment through increasing blood flow of cerebral artery.Cognitive function changes can be detected earlier by latency of P300 than by MMSE score.
Objective To investigate the impact of stent implantation on cognitive function in patients with mild-tomoderate cognitive dysfunction associated with severe stenosis of unilateral middle cerebral artery(MCA)M1 segment.Methods According to whether stent implantation,28 patients with mild-to-moderate cognitive dysfunction associated with unilateral MCA M1 severe stenosis were divided into treatment group(n=13)and control group(n=15).The examinations of mini-mental state examination(MMSE)score,Montreal cognitive assessment(MoCA)score and the event-related potential P300 were performed on all patients in treatment group 1 week before stent implantation and 6,12 months after implantation,as well as in control group during the same period.Totally 5 patients in treatment group underwent CT perfusion imaging(CTP)1 week before stent implantation and 1 month after implantation.Cerebral blood flow(CBF)and cerebral blood volume(CBV)were measured and the ratios of CBF and CBV between the affected side and contralateral side(rCBF and rCBV)were calculated.Meanwhile,mean transit time(MTT),peak time(TTP)and the differences of between the two sides(dMTT and dTTP)were obtained,and then statistical analysis was performed.Results There was no significant difference of MMSE and MoCA scores,nor the latency and amplitude of P300 between the two groups 1 week before stent implantation(all P>0.05).However,6 and 12 months after implantation and the corresponding period,the differences were statistically significant between the two groups(all P<0.05).In treatment group,the differences of the scores of MMSE and MoCA were statistically significant 1 week before stent implantation,6 and 12 months after implantation(all P<0.05).The pairwise comparison showed that the scores of MMSE and MoCA 12 months after stent implantation were higher than those 1 week before implantation(both P<0.05),and the score of MoCA 6 months after implantation was higher than that 1 week before implantation(P=0.010).There was no significant difference of the latency and amplitude of P300 between the two groups 1 week before stent implantation(both P>0.05).The latencies in treatment group were shorter than those in control group 6 and 12 months after stent implantation(both P<0.01),while the amplitude were higher than those in control group(both P<0.05).In treatment group,the latency and amplitude of P300 were statistically significant 1 week before stent implantation,6 and 12 months after implantation(all P<0.05).The pairwise comparison showed that the latencies of 6 and 12 months after stent implantation were shortened(both P<0.01),while the amplitude increased compared with those on 1 week before implantation(both P<0.05).Compared with 6 months after stent implantation,the latency on 12 months after implantation was shortened(P=0.010).In treatment group,no matter whether there were risk factors or not,no significant difference of the scores of MMSE nor MoCA among 1 week before stent implantation,6 and 12 months after implantation(all P>0.05).Of5 patients underwent CTP examination in treatment group,rCBF 1 month after stent implantation was higher than that 1 week before stent implantation(P <0.01),while rCBV,dMTT and dTTP were lower than those 1 week before implantation(all P <0.05).Conclusion Stent implantation can improve cognitive function in patients with severestenosis of MCA M1 segment through increasing blood flow of cerebral artery.Cognitive function changes can be detected earlier by latency of P300 than by MMSE score.
引文
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[10]杨鹤云.慢性脑供血不足患者局部脑血流异常与认知功能障碍的关系研究.中国当代医药,2015,22(1):12-14.
[11] Lin C,Chang F,Chou K,et al.Intervention versus aggressive medical therapy for cognition in severe asymptomatic carotid stenosis.AJNR Am J Neuroradiol,2016,37(10):1889-1897.
[12]夏章勇.颈动脉支架置入术对伴有腔隙性脑梗死的脑白质变性患者认知功能的影响及相关因素分析.济南:山东大学,2017:25-27.
[13]杨敏,钟文波,宋永斌,等.大脑中动脉搏动指数与腔隙性脑梗死认知损害的相关性.中国脑血管病杂志,2016,13(12):634-637.
[14]张剑平,姜冬梅,石国锋,等.基底节区腔隙性脑梗死患者认知功能障碍分析.中风与神经疾病杂志,2017(3):250-253.
[15]陶一鸣.脑血管介入术后发生造影剂相关急性肾损伤的危险因素和预后分析的临床研究.广州:南方医科大学,2016:14-19.
[2] Mattsson N,Tosun D,Insel PS,et al.Association of brain amyloid-βwith cerebral perfusion and structure in Alzheimer's disease and mild cognitive impairment.Brain,2014,137(5):1550-1561.
[3]杜娟,蔡艺灵,吴铮,等.无症状单侧颈内动脉重度狭窄患者认知障碍与脑血流灌注的改变.中国脑血管病杂志,2015,12(10):625-630.
[4]邓一鸣,高峰,张雪蕾,等.低灌注性血管性认知障碍的研究进展.中国卒中杂志,2017,12(11):1013-1022.
[5]朱睿明.脑血流低灌注所致脑白质损伤在帕金森病认知障碍中的作用及机制研究.广州:南方医科大学,2015:9-11.
[6]李丽,张馨,李淞,等.脑血管储备功能对伴大脑中动脉狭窄的轻度血管性痴呆患者预后的影响.中国老年学杂志,2015,35(7):1731-1732.
[7] Sivakumar L,Kate M,Jeerakathil T,et al.Serial montreal cognitive assessments demonstrate reversible cognitive impairment in patients with acute transient ischemic attack and minor stroke.Stroke,2014,N6(V45):1709-1715.
[8] Shen Y,Wang W,Huang F,et al.The use of MMSE and MoCA in patients with acute ischemic stroke in clinical.Int J Neurosci,2016,126(5):442-447.
[9]高薇薇,薛蓉,程焱.血管性认知功能障碍脑血流灌注的临床研究.中国卒中杂志,2012,7(4):284-289.
[10]杨鹤云.慢性脑供血不足患者局部脑血流异常与认知功能障碍的关系研究.中国当代医药,2015,22(1):12-14.
[11] Lin C,Chang F,Chou K,et al.Intervention versus aggressive medical therapy for cognition in severe asymptomatic carotid stenosis.AJNR Am J Neuroradiol,2016,37(10):1889-1897.
[12]夏章勇.颈动脉支架置入术对伴有腔隙性脑梗死的脑白质变性患者认知功能的影响及相关因素分析.济南:山东大学,2017:25-27.
[13]杨敏,钟文波,宋永斌,等.大脑中动脉搏动指数与腔隙性脑梗死认知损害的相关性.中国脑血管病杂志,2016,13(12):634-637.
[14]张剑平,姜冬梅,石国锋,等.基底节区腔隙性脑梗死患者认知功能障碍分析.中风与神经疾病杂志,2017(3):250-253.
[15]陶一鸣.脑血管介入术后发生造影剂相关急性肾损伤的危险因素和预后分析的临床研究.广州:南方医科大学,2016:14-19.
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