目的：探讨糖尿病对颈动脉粥样硬化狭窄（CAS）患者颈动脉内膜剥脱术（CEA）术后认知功能的影响。方法回顾性分析2012年4月至2015年4月入院的82例接受CEA手术的CAS患者临床资料，将患者分为糖尿病组（DM组）及非糖尿病组（NDM组），术前1周采用头颅磁共振成像（MRI）、蒙特利尔认知量表（MoCA）及简易精神状态量表（MMSE）评估患者脑灌注及认知情况；术后6周复查MRI及作认知功能评估，对比评价糖尿病对患者的脑灌注及认知的影响。结果82例患者中，DM组38例，NDM组44例；平均年龄（68．2±10．7）岁。两组患者术前MoCA评分比较差异无统计学意义（P＝0．66）， NDM组术后MoCA评分较术前有显著提高（22．48±1．52 vs 20．25±1．39， P＜0．001），而DM组术后MoCA较术前无明显变化（20．40±1．60 vs 20．25±1．39， P＝0．66）。 DM组术后灌注参数项目的改善也较NDM组少。结论糖尿病对CAS患者CEA术后脑灌注及认知功能的改善均有负面影响。%Objective To investigate the effects of diabetes mellitus on cognitive function in patients undergoing carotid endarterectomy (CEA). Method Participants (n=82) with internal carotid artery stenosis (CAS) from April 2012 to April 2015 were retrospectively classified based on whether or not they had complications from diabetes mellitus (DM). CEA was performed on both DM patients (n=38) and Non-DM patients (n=44). The change of cerebral perfusion and the cognitive function were analyzed by the use of MRI and neuropsychological examinations (NPEs). Perfusion-weighted MRI and NPEs, including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), were performed at 1 week before and 6 weeks after the operation. Results After the operation, significant improvement of MoCA scores were found in Non-DM patients (post 22.48±1.52 vs. 20.25±1.39, P<0.001) but not in DM patients. DM patients performed worse after the operation in MoCA tests (DM 21.35±1.31 vs. Non-DM 22.48±1.52, P=0.001). Significantly decreased cerebral perfusion parameters were observed in both DM and Non-DM groups. Conclusion DM had negative influence on the perfusion improvement and cognition improvement in CAS patients undergoing CEA.
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