单侧颈内动脉重度狭窄或闭塞后侧支循环开放对认知功能的影响

摘要

目的 应用经颅多普超声(TCD)研究单侧颈内动脉重度狭窄或闭塞后侧支循环开放情况及其对各认知领域功能的影响. 方法 利用TCD评估176例单侧颈内动脉重度狭窄或闭塞后侧支循环情况.根据侧支循环开放情况将研究对象分成单支组、多支组、无侧支组,为了研究各单支对认知功能的影响,又把单支组分为前交通组、后交通组和眼动脉组,同时设对照组.对各组间进行中文版蒙特利尔(MoCA)评分,比较各组的MoCA总评分及子项目评分. 结果 154例(87.5％)有侧支循环开放,单支开放80例(45.5％),多支开放74例(42.1％),无侧支循环开放22例(12.5％).与对照组比较,多支组、单支组、无侧支组MoCA总评分(24.2±1.7)分、(21.9±2.3)分、(19.0±2.4)分、执行与视空间评分(3.9±0.7)分、(3.2±0.8)分、(2.4±0.6)分、抽象思维评分(1.7±0.5)分、(1.6±0.5)分、(1.3±0.5)分、延迟记忆评分(2.9±0.8)分、(1.9±0.8)分、(1.6±0.5)分均明显低于对照组(26.3±1.1)分、(4.7±0.5)分、(2.0±0.0)分、(3.6±1.0)分(F=80.52、63.21、12、48.99,均P＜0.05),单支组和无侧支循环组计算与注意力评分(4.6±0.6)分、(4.3±0.7)分明显低于对照组(5.2±0.7)分(P＜0.05),无侧支循环组定向力评分(4.7±0.7)分明显低于对照组(5.7±0.5)分(P＜0.05).与多支组比较,单支组和无侧支循环组MoCA总评分(21.9±2.3、19.0±2.4)、执行与视空间评分(3.2±0.8)分、(2.4±0.6)分、注意力评分(4.6±0.6)分、(4.3±0.7)分均明显低于多支组(24.2±1.7、3.9±0.7、5.1±0.5)(均P＜0.05),无侧支循环组抽象思维评分(1.3±0.5)分、延迟记忆评分(1.6±0.5)分、定向力评分(4.7±0.7)分明显低于多支组(1.7±0.5)分、(2.9±0.8)分、(5.7±0.5)分(均P＜0.05).与单支组比较,无侧支组MoCA总评分(19.0±2.4)、执行与视空间评分(2.4±o.6)分、定向力评分(4.7±o.7)分均明显低于单支组(21.9±2.3)分、(3.2±0.8)分、(5.7±0.6)分(均P＜0.05).单支组中,前交通组MoCA评分(22.9±1.7)分高于后交通组(21.2±2.7)分(P＜0.05),前交通组延迟记忆评分(2.2±0.8)分明显高于眼动脉组(1.7±0.6)分(P＜0.05). 结论 单侧颈内动脉重度狭窄或闭塞后,认知功能会受到一定程度损害,尤其在执行与视空间、抽象思维、延迟记忆、计算与注意力方面.但侧支循环开放对认知功能具有保护作用,多支侧支循环保护作用高于单支;单支侧支循环中,前交通动脉对认知功能的保护作用高于眼动脉和后交通动脉,眼动脉和后交通动脉对认知功能的保护作用无明显差异.%Objective To investigate the influence of collateral circulation recruitment on cognitive functions in patients with severe unilateral stenosis or unilateral occlusion of the internal carotid artery by using TCD.Methods A total of 176 patients with severe unilateral stenosis or unilateral occlusion of the internal carotid artery were enrolled and were divided into a single vessel collateral group(n=80,45.5 ％),a multiple vessel collateral group(n=74,42.1％) and a no collateral group(n=22,12.5 ％).In order to study the influence of single vessel collateral circulation on cognitive functions,the single vessel collateral group was further divided into an anterior communicating subgroup(AcoA),a posterior communicating subgroup(PcoA),an ocular artery subgroup(OA),and a normal control subgroup.All patients and 34 normal controls(NC) received MoCA,and scores for the overall assessment and individual domains were analyzed.Results Compared with the control group (26.3± 1.1,4.7 ± 0.5,2.0 ± 0.0,3.6 ± 1.0),the multiple vessel collateral group,the single vessel collateral group and the no collateral group had lower overall scores (24.2 ± 1.7,21.9 ± 2.3,19.0 ± 2.4),lower executive/visuospatial function(3.9 ± 0.7,3.2 ± 0.8,2.4 ± 0.6),lower abstraction (1.7 ± 0.5,1.6±0.5,1.3±0.5),and lower delayed recall(2.9±0.8,1.9±0.8,1.6±0.5)(F=80.52,63.21,12,48.99,all P＜0.05);both collateral groups had lower scores in subtraction and attention (4.6±0.6 vs.5.2±0.7,4.3±0.7 vs.5.2±0.7);the no collateral group had lower scores in orientation(4.7±0.7 vs.5.7±0.5)(P＜0.05).Compared with the multiple vessel collateral group,both the single vessel collateral group and the no collateral group had lower overall scores(21.9±2.3 vs.24.2 ± 1.7,19.0± 2.4 vs.24.2 ± 1.7),executive/visuospatial function (3.2 ± 0.8 vs.3.9 ± 0.7,2.4±0.6 vs.3.9±0.7),subtraction and attention(4.6±0.6 vs.5.1±0.5,4.3±0.7 vs.5.1±0.5) (all P＜ 0.05);the no collateral group had lower scores in abstraction (1.3 ± 0.5 vs.1.7 ± 0.5),delayed recall(1.6 ± 0.5 vs.2.9 ± 0.8) and orientation (4.7 ± 0.7 vs.5.7 ± 0.5) (all P ＜ 0.05).Compared with the single vessel collateral group,the no collateral group had lower overall scores(19.0 ±2.4 vs.21.9±2.3),executive/visuospatial function(2.4±0.6 vs.3.2±0.8)and orientation(4.7± 0.7 vs.5.7 ± 0.6) (all P ＜0.05).In single vessel collateral patients,the AcoA subgroup had higher MoCAscores than the PcoA subgroup(22.9± 1.7 vs.21.2±2.7) (P＜0.05),and the AcoA subgroup had higher scores in delayed recall than the OA subgroup(2.2±0.8 vs.1.7±0.6) (P＜ 0.05).Conclusions Severe unilateral stenosis or unilateral occlusion in the internal carotid artery can result in cognitive impairment,especially in executive/visuospatial function,abstraction,delayed recall,subtraction and attention.However,collateral circulation can protect cognitive function in patients with unilateral internal carotid artery stenosis or occlusion and multiple vessel collateral circulation is more effective than single vessel collateral circulation,and AcoA is more effective than either PcoA or OA,but the difference between PcoA and OA is not significant.