颈内动脉形态学改变对认知功能影响的研究

Effect of morphological changes of the internal carotid artery on cognition

摘要:

目的：探讨颈内动脉（in internal carotid artery，ICA）形态学改变（血管迂曲及狭窄）对认知功能的影响。方法：收集2017年10月至2018年6月于本院就诊患者39例及对照组20例，根据头颈CT血管造影（CT angiography，CTA）、头颈MR血管造影（MR angiography，MRA）结果将病例组分为颈内动脉迂曲组23例、颈内动脉狭窄组16例。各组分别使用简易精神状态量表（mini mental state examination，MMSE）、蒙特利尔认知评估量表（Montreal cognitive assessment，MOCA）评定其认知功能。依据Fazekas分级对各组间脑白质病变进行分级评分，计算各组间腔隙灶数量。结果：MOCA评分迂曲组27（24，29）分；狭窄组28（25，29）分；对照组29（28，30）分；迂曲组评分低于对照组（P＜0.05）。3组间MMSE评分未有明显的统计学差异。迂曲组、狭窄组较对照组Fazekas分级评分均存在统计学差异（P<0.05）；狭窄组腔隙灶（9例）较对照组（2例）及迂曲组（1例）存在显著统计学差异（P<0.05）。狭窄组吸烟、饮酒、高血压及高脂血症等发生率明显高于其他2组（P<0.05）。结论：颈内动脉形态学改变（血管迂曲及狭窄）与脑白质病变发生相关，且造成一定程度的认知功能下降。

Abstract:

Objective：To investigate the effect of morphological changes（tortuosity and stenosis） of the internal carotid artery（ICA） on cognition. Methods：A total of 39 patients who visited our hospital from October 2017 to June 2018 and 20 subjects as controls were included in the study. The above 39 patients were subdivided into ICA tortuosity group（23 cases） and ICA stenosis group（16 cases） according to the results of cranial-cervical computed tomography angiography（CTA） and cranio-cervical magnetic resonance angiog－raphy（MRA）. Mini-mental state examination（MMSE） and Montreal cognitive assessment（MOCA） were used to evaluate the cogni－tive function in each group. Cerebral white matter lesions were evaluated by the Fazekas scale，and the number of lacunes was calcu－lated for each group. Results：The MOCA score was 27（24，29） for the ICA tortuosity group，28（25，29） for the ICA stenosis group，and 29（28，30） for the control group，with a significant lower score observed in the ICA tortuosity group than in the control group（P<0.05）. There were no significant differences in MMSE score between the three groups. The ICA tortuosity group and ICA stenosis group had significantly different Fazekas scale scores compared with the control group（P<0.05）；the ICA stenosis group had a signifi－cantly larger number of lacunes than the control group and the ICA tortuosity group（9 cases vs 2 cases/1 case，P<0.05）. Compared with the other two groups，the ICA stenosis group had significantly higher prevalence of smoking，drinking，hypertension，and hyper－lipidemia（P<0.05）. Conclusion：Morphological changes（tortuosity and stenosis） of the ICA are related to cerebral white matter lesions，and can lead to a certain degree of cognitive decline.