短暂性脑缺血发作患者认知能力与单光子发射断层扫描脑血流显像的关系

SPECT cerebral blood flow and cognitive ability in patients with transient ischemic attack

目的探讨脑单光子发射断层扫描(SPECT)血流检测对短暂性脑缺血发作(TIA)患者认知障碍判断的价值。方法根据简易智力状态量表(MMSE)评估65例最后一次发作在72 h内的TIA患者的认知能力状况,同时用SPECT观察患者TIA发作间歇期的脑血流灌注显像。根据脑SPECT显像特点,比较不同程度低灌注组的TIA发作次数、认知能力及发作时的临床神经功能缺失评分;分析TIA患者脑SPECT、TIA发作次数与患者认知能力的关系。结果①所有患者的脑SPECT灌注显像均有不同程度的低灌注区域,其中轻度、中度、重度低灌注各为21、26、18例,且脑SPECT灌注显像低灌注区范围越大,TIA发作次数越多(rs=0.751,P<0.01),患者的临床神经功能缺损程度越重(rs=0.470,P<0.01);②TIA患者的MMSE评分明显低于对照组,且与脑SPECT灌注显像呈负相关(rs=-0.308,P<0.05)。结论TIA患者存在认知障碍,其程度与TIA发作次数及患者脑血流状况相关;SPECT可作为评价TIA患者认知能力的良好手段。

Objective To explore the value of single photon emission computed tomography （SPECT） cerebral blood flow in detecting the cognitive ability of patients with transient ischemic attack （TIA）. Methods According to the mini-mental state examination （MMSE）, cognitive ability of 65 patients with TIA was assessed within 72 hours after the final attack of TIA, and the cerebral blood flow on SPECT was observed in the intermittent period of TIA. The TIA frequency, clinical neural function deficit and cognitive ability in each hypoperfusion group were compared, and the relationship among three factors was analyzed. Results （1） All patients with TIA episode showed variable focal hypoperfusion on SPECT, including 21 mild cases, 26 moderate cases and 18 severe cases. With the increase of TIA frequency, the larger hypoperfusion region was （rs = 0. 751, P〈0.01）, and the more severe of CSS was （rs =0. 470, P〈0.01）. （2） The score of MMSE was significantly lower in TIA cases than that in controls, which had close negative relation with SPECT images （rs =- 0. 308, P〈0.05）. Conclusion Cognitive dysfunction exists in patients with TIA. And the degree of cognitive dysfunction correlates with cerebral blood flow on SPECT. SPECT may be a better method to evaluate the cognitive dysfunction in patients with TIA.