大脑中动脉微栓子数量与急性脑梗死患者血管性认知障碍的关系研究

摘要

Objective To investigate the correlation between microembolus amount of middle cerebral artery and vas­ cular cognitive impairment in patients with acute cerebral infarction. Methods From January 2013 to March 2014 in Jiujiang Hospital Affiliated to Nanchang University,100 patients with acute cerebral infarction were selected as case group,30 healthy cases were selected as control group. Case group given standardized treatment for stroke,and carried out MRI,TCD examina­ tions within 24 to 48 hours after onset;control group given routine physical examinations. According to systolic blood flow veloci­ ty of middle cerebral artery,patients of case group were divided into groups A(with 95% to 99% stenosis,n﹦19),B(with 70% to 94% stenosis,n﹦49),C(with 50% to 69% stenosis,n﹦32). Montreal Cognitive Assessment(MoCA)scale was used to evaluate the degree of cognitive impairment of case group and control group. Results In case group,28 cases detected microembolus(123 microembolus),no one detected microembolus in control group,the detection rate of microembolus of case group was higher than that of control group(P < 0. 05). There were significant differences of detection rate of microembolus and degree of cognitive impairment among groups A,B,C and control. Linear correlation analysis results showed that,microembolus amount of middle cerebral artery was positively correlated with the degree of stenosis( r﹦0. 869,P < 0. 05),was negatively correlated with MoCA scale score(r﹦- 0. 858,P < 0. 05). Conclusion The more severe of middle cerebral artery stenosis, the more severe of degree of cognitive impairment in patients with acute cerebral infarction,and microembolus amount of middle cerebral artery is positively correlated with the degree of stenosis,is negatively correlated with MoCA scale score.%目的：探讨大脑中动脉微栓子数量与急性脑梗死患者血管性认识障碍的关系。方法选取南昌大学附属九江医院神经内科2013年1月—2014年3月收治的急性脑梗死患者100例作为病例组，选取同期在南昌大学附属九江医院体检健康者30例作为对照组。病例组患者按卒中单元规范化治疗方案进行治疗，并在发病24~48 h 内完成颅脑MRI 检查、经颅多普勒超声（TCD）检查；对照组受试者进行常规体检。根据大脑中动脉收缩期血流速度将病例组患者分为极重度狭窄组（管腔狭窄程度95％~99％）19例、重度狭窄组（管腔狭窄程度70％~94％）49例、中度狭窄组（管腔狭窄程度50％~69％）32例。采用蒙特利尔认知评估（MoCA）量表评估病例组患者和对照组受试者认知功能损害程度。结果病例组中共28例（28％）患者检出大脑中动脉微栓子，共123个微栓子，对照组中无一例检出微栓子；病例组患者大脑中动脉微栓子检出率高于对照组（P ＜0.05）。对照组、中度狭窄组、重度狭窄组、极重度狭窄组受试者大脑中动脉微栓子检出率及认知功能损害程度比较，差异均有统计学意义（P ＜0.05）。直线相关分析结果显示，大脑中动脉微栓子数量与管腔狭窄程度呈正相关（ r ﹦0.869，P ＜0.05），与 MoCA 量表评分呈负相关（ r ﹦-0.858，P ＜0.05）。结论大脑中动脉管腔狭窄程度越重，急性脑梗死患者认知功能损害程度越重；急性脑梗死患者大脑中动脉微栓子数量与管腔狭窄程度呈正相关，与 MoCA 量表评分呈负相关。