颈动脉支架置入术对颈动脉狭窄所致脑白质疏松与认知功能改变的影响

doi:10.3969/j.issn.2095-9400.2019.01.006

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摘要目的：探讨颈动脉狭窄与脑白质疏松（LA）、认知功能障碍的相关性及颈动脉支架置入术（CAS）后LA与认知功能的变化。方法：选取2014年8月至2017年8月在温州医科大学附属舟山医院经数字减影血管造影检查确诊颈动脉狭窄大于70%的住院患者共44例，支架组、对照组各22例。于治疗前、治疗后6个月行头颅MRI检查，治疗前及治疗后1个月、6个月分别行MMSE、WAIS-RC测验，比较2组的基线及随访结果。结果：控制相关危险因素后，LA体积仍与颈动脉狭窄程度相关（r=0.473，P＜0.05），MMSE得分仍与颈动脉狭窄程度相关（r=-0.330，P＜0.05）。治疗后，支架组LA体积、MMSE得分较对照组明显改善（P＜0.05）。CAS后WAIS-RC得分较术前明显改善，主要体现在算术、数字广度、数字符号、木块图测验。结论：颈动脉狭窄与LA、认知功能相关，狭窄程度越重，LA体积越大，认知障碍越明显。CAS后LA体积缩小，认知功能改善。

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	周琳
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	唐维国

关键词 ：颈动脉狭窄, 脑白质疏松, 认知, 颈动脉支架置入术

Abstract：Objective: To investigate the correlation between carotid artery stenosis and leukoaraiosis (LA) and cognitive impairment, and the changes of LA and cognitive function after carotid artery stenting (CAS). Methods: The study included 44 hospitalized patients with carotid artery stenosis greater than 70% which were confirmed by digital subtraction angiography from Zhoushan Hospital Affiliated to Wenzhou Medical University during August 2014 to August 2017. All the patients were divided into two groups, with 22 cases in both stenting group and the control group. The Cranial MRI examination was performed at the baseline and six-month follow-up. Before treatment, 1 month after treatment and 6 months after treatment, neuropsychological tests were performed, including Mini-Mental State Examination (MMSE) and Wechsler Adult Intelligence Scale-RC (WAIS-RC). The baseline characteristics and follow-up results were compared in each group. Results: After controlling other risk factors, the volume of LA lesions was still related to the degree of carotid artery stenosis (r=0.473, P<0.05), the score of MMSE was still related to the degree of carotid artery stenosis (r= -0.330, P<0.05). Compared with the control group, the volume of LA lesions and the score of MMSE were both significantly ameliorated in the stent implantation group after treatment (P<0.05). The score of WAIS-RC was significantly improved after operation compared with preoperative, mainly in the arithmetic, digit span, digit symbol, block design test. Conclusion: ①Carotid artery stenosis was related to LA and cognitive dysfunction. The more serious the stenosis is, the greater volume of LA lesions and the more severe of cognitive impairment. ②LA and cognitive function was ameliorated after CAS.

Key words： carotid artery stenosis leukoaraiosis cognition carotid artery stenting

基金资助:浙江省医药卫生平台计划重点资助项目（2014ZDA 026）。

通讯作者: 唐维国，主任医师，教授，Email：tangweiguo2003@ 163.com。

作者简介: 周琳（1982-），女，浙江舟山人，主治医师，硕士。

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https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2019.01.006 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I1/24

[1] HACHINSKI V C, POTTER P, MERSKEY H. Leuko-araio-sis[J]. H Arch Neurol, 1987, 44(1): 21-23.
[2] LIN J, WANG D, LAN L. Multiple factors involved in the pathogenesis of white matter lesions[J]. Biomed Res Int, 2017, 2017: 9372050.
[3] KREISEL S H, BLAHAK C, BÄZNER H, et al. Deterioration of gait and balance over time: the effects of age-related white matter change-the LADIS study[J]. Cerebrovasc Dis, 2013, 35(6): 544-553.
[4] ARBA F, MAIR G, CARPENTER T, et al. Cerebral white matter hypoperfusion increases with small-vessel disease burden. Data from the third international stroke trial[J]. J Stroke Cerebrovasc Dis, 2017, 26(7): 1506-1513.
[5] LAMBERT C, SAM NAREAN J, BENJAMIN P, et al. Characterising the grey matter correlates of leukoaraiosis in cerebral small vessel disease[J]. Neuroimage Clin, 2015, 9: 194-205.
[6] 吕洋辉, 何松彬, 唐维国, 等. 头颈部大动脉粥样硬化与脑白质疏松相关性分析[J]. 温州医科大学学报, 2014, 44(12): 872-876.
[7] PENDLEBURY S T, ROTHWELL P M. Prevalence, incidence and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis[J]. Lancet Neurol, 2009, 8(11): 1006-1018.
[8] North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress[J]. Stroke, 1991, 22(6): 711-720.
[9] DEMIRTAS H, ÖZKAYNAK C, DURMAZ M S. Leukoaraiosis and carotid artery stenosis: evaluation with CT angiog-raphy[J]. J Comput Assist Tomogr, 2013, 37(3): 327-332.
[10] WAHLUND L O, BARKHOF F, FAZEKAS F, et al. A new rating scale for age-related white matter changes applicable to MRI and CT[J]. Stroke, 2001, 32(6): 1318-1322.
[11] DEBETTE S, BOMBOIS S, BRUANDET A, et al. Subcortical hyperintensities are associated with cognitive decline in patients with mild cognitive impairment[J]. Stroke, 2007, 38(11): 2924-2930.
[12] NONAKA H, AKIMA M, HATORI T, et al. Microvasculature of the human cerebral white matter arteries of the deep white matter[J]. Neuropathology, 2003, 23(2): 111-118.
[13] LEE D K, KIM J S, KWON S U, et al. Lesion patterns and stroke mechanism in atherosclerotic middle cerebral artery disease: early diffusion-weighted imaging study[J]. Stroke, 2005, 36(12): 2583-2588.
[14] 钟婷婷, 周华东. 脑白质疏松症发病机制及临床特点的研究进展[J]. 中华解剖与临床杂志, 2017, 22(2): 171-175.
[15] LI L, WANG Y J, YAN J C, et a1. Clinical predictors of cognitive decline in patients with mild cognitive impairment: the Chongqing aging study[J]. J Neurol, 2012, 259(7): 1303-1311.
[16] 路迪, 毕齐. 血管性认知功能障碍研究进展[J]. 中国全科医学, 2011, 14(35): 4003-4006.
[17] SUN Q, XIA Z, QU C, et al. Carotid artery stenting ameliorates the cognitive impairment in patients with leukoaraiosis, the ischemic change of cerebral white matter[J]. Tohoku J Exp Med, 2014, 233(4): 257-264.
[18] MENDIZ O A, SPOSATO L A, FABBRO N, et al. Improvement in executive function after unilateral carotid artery stenting for severe asymptomatic stenosis[J]. J Neurosurg, 2012, 116(1): 179-184.
[19] LATTANZI S, CARBONARI L, PAGLIARICCIO G, et al. Neurocognitive functioning and cerebrovascular reactivity after carotid endarterectomy[J]. Neurology, 2018, 90(4): e307-e315.
[20] 陈克强, 刁士元, 左克扬, 等. 颈动脉狭窄合并认知功能障碍患者支架植入后脑血流动力学变化的初步研究[J]. 海南医学, 2014, 25(15): 2196-2198.
[21] 戴洁, 宋为群. 血管性认知功能障碍的治疗进展[J]. 中华物理医学与康复杂志, 2009, 31(10): 709-712.
[22] ZLOKOVIE B Y, GHISO J, MACKIE J B. Blood brain arrier transport of circulating Alzheimer’s amyloid beta[J]. Biochem Biophys Res Commun, 1993, 197(11):1034-1040.
[23] GRUNWALD I Q, PAPANAGIOTOU P, REITH W, et al. Influence of carotid artery stenting on cognitive function[J]. Neuroradiology, 2010, 52(1):61-66.
[24] SHIBATA M, YAMASAKI N, MIYAKAWA T, et al. Selective impairment of working memory in a mouse model of chronic cerebral hypoperfusion[J]. Stroke, 2007, 38(10): 2826-2832.
[25] GAUDET J G, MEYERS P M, MCKINSEY J F, et al. Incidence of moderate to severe cognitive dysfunction in patients having carotid artery stenting[J]. Neurosurgery, 2009, 65(2): 325-330.
[26] CHENG Y, WANG Y J, YAN J C, et a1. Effects of carotid artery stenting on cognitive function in patients with mild cognitive impairment and carotid stenosis[J]. Exp Ther Med, 2013, 5(4): 1019-1024.