基于烟雾血管分级的成人烟雾病患者脑认知功能障碍初步研究

A preliminary evaluation of cognitive dysfunction based on moyamoya vessels in adult patients with moyamoya disease

目的探讨基于数字减影血管造影(DSA)的烟雾血管分级对成人烟雾病(MMD)患者术前脑认知功能障碍的预测价值。方法前瞻性选择2018年12月至2019年6月首都医科大学附属北京天坛医院收治的成人MMD患者43例(MMD组),选择同期性别、年龄及受教育时间相匹配的22名健康志愿者作为健康对照组。对2组受试者进行简易韦氏成人智力量表测试、前瞻性记忆(PM)测试(中文版剑桥PM测试量表)、神经心理状态测试(RBANS)、Stroop测试、威斯康星卡片分类测试(WCST)、连线测试A(TMT-A)测试,评定2组受试者脑认知功能。所测项目超过3项异常时即诊断为脑认知功能减退。同时对MMD患者进行DSA检查,根据左侧大脑半球烟雾血管浓集程度分为无(n=11)、稀疏(n=20)、浓集(n=12)3组,比较3组患者脑认知功能。结果14例患者(32.6%)出现脑认知功能减退。有脑认知功能减退的MMD组患者与无脑认知功能减退的MMD组患者比较,左侧大脑半球烟雾血管浓集程度差异有统计学意义(P=0.007)。Spearman相关分析结果显示,烟雾血管产生后(剔除无烟雾血管的MMD患者),脑认知功能减退与烟雾血管浓集程度存在相关性(r=-0.522,P=0.002)。左侧大脑半球烟雾血管不同浓集程度的MMD组患者基于时间的PM(EBPM)、PM总分,执行功能的Stroop字义干扰时间、WCST的完成分类数(CC)和TMT-A差异均有统计学意义(P均<0.05),以烟雾血管稀疏组MMD患者得分最低,而无烟雾血管、烟雾血管浓集组MMD患者得分相对较高。进一步组间两两比较结果显示,无烟雾血管与烟雾血管稀疏组MMD患者EBPM、PM总分、WCST的CC、TMT-A差异均有统计学意义(P均<0.05),而烟雾血管稀疏组与烟雾血管浓密组MMD患者EBPM、PM总分、Stroop字义干扰时间、TMT-A差异均有统计学意义(P均<0.05)。结论成人MMD患者左侧大脑半球烟雾血管可一定程度预测术前脑认知功能减退,且烟雾血管产生后越浓集,认知功能减退越不容易发生。烟雾血管稀疏组MMD患者的脑认知功能最差,明显低于无烟雾血管和烟雾血管浓密组患者,尤其是PM和执行功能维度。因此,烟雾血管形成潜能可能是成人MMD患者脑认知功能损伤的一个重要标志。

ObjectiveTo explore whether moyamoya vessels based on digital subtraction angiography(DSA)could be used to predict cognitive dysfunction for adults with moyamoya disease(MMD).MethodsFrom December 2018 to June 2019,43 adult cases of MMD were admitted to the Beijing Tiantan Hospital,Capital Medical University(MMD group);and 22 patients undergoing physical examination who matched the gender,age and education level were included as a healthy control group.Both groups were required to take cognitive assessment,including Webster's adult intelligence scale(WAIS)test,prospective memory(PM)test,repeatable battery neuropsychological status(RBANS),Stroop test,Wisconsin card sorting test(WCST),and trail making test A(TMT-A).The participant was diagnosed with cognitive dysfunction when three or more cognition tests were abnormal.Moreover,MMD patients were examined by DSA and evaluated by an experienced neurosurgeon.According to the density of smoke vessels in the left cerebral hemisphere,patients with MMD were divided into"none"(11 cases),"sparse"(20 cases),and"dense"(12 cases)subgroups whose cognitive function were compared.ResultsFourteen of the 43 adult MMD patients(32.6%)had cognitive dysfunction.When comparing MMD patients with and without cognitive dysfunction,significant difference in smoke vessels arising from left hemisphere could be found(P=0.007).Correlation analysis(excluding patients with"none"smoke vessel subgroup)had shown that there was a moderate correlation between cognitive dysfunction and smoke vessels(r=-0.522,P=0.002).Quantitative analysis of cognitive function based on the density of smoke vessels in left cerebral hemisphere showed that there were significant differences in the event based prospective memory(EBPM),PM,word interference of Stroop test,categories completed of WCST and TMT-A(P<0.05).Based on the comparison of cognitive function among three subgroups,significant differences were present in EBPM,PM,WCST-CC,and TMT-A between"none"and"sparse"subgroups.However,significant difference could only be found in time based prospective memory,word interference and TMT-A between"sparse"and"dense"subgroup.ConclusionSmoke vessels arising from the left hemisphere could predict the cognitive dysfunction for adult MMD patients without surgery.The more moyamoya vessels,the less cognitive dysfunction.Cognitive dysfunction in"sparse"subgroup was the most serious,especially in PM and executive function.Therefore,"potential of moyamoya vascularization"might be an important sign of cognitive function in adults with MMD.