短暂性脑缺血发作对智力影响的临床研究

The influence of transient ischemic attack on memory function

目的(1)探讨短暂性脑缺血发作(TIAs)患者在临床症状消失后是否遗留智力障碍;(2)探讨颈内动脉与椎-基底动脉系统TIAs患者智力改变的差异;(3)探讨TIAs发作病程、次数及持续时间与智力之间的相关性。方法对78例TIAs患者末次发作后7～14d及30例对照分别进行修订韦氏成人智力量表(WAIS-RC)测查。结果(1)颈内动脉和椎-基底动脉系统TIAs患者在相似性、数字符号、图片排列、图形拼凑各项评分均明显低于正常对照组(P<0.05);(2)椎-基底动脉系统TIAs在图画填充、图片排列、图形拼凑的评分与颈内动脉系统TIAs比较有显著性差异(P<0.01);(3)颈内动脉系统TIAs患者的病程与WAIS-RC各项等值量表分之间均无相关性(P>0.05)。而发作次数与数字符号等值量表分,每次发作持续时间与知识、领悟、相似性、图片排列、VIQ、PIQ、FIQ各项等值量表分之间均有负相关性(P<0.05)。结论(1)颈内动脉和椎-基底动脉系统TIAs患者在临床症状恢复后,仍存在不同程度的认知功能障碍;椎-基底动脉系统TIAs更容易出现视觉记忆和短时记忆障碍。(2)颈内动脉系统TIAs患者的发作次数对学习、书写速度、视知觉、视觉扫描的能力有影响;每次发作持续时间的长短对知识的保持和广度、对实际知识的理解和判断能力、抽象概括能力及故事情节的理解能力均有影响。

Objective To study memory function of the patients with transient ischemic attacks （ TIAs ） in internal carotid artery system（ICAs） and vertebra-basilar artery system（VBAs） when the clinical symptom relieved, and to explore the correlation of memory disability and carotid artery stenosis, course, frequency and time length. Methods 78 patients with TIAs on 7d to 14d after the final attack and 30 health volunteers（ controlled group）were investigated to measure WAIS- RC. Results （ 1 ） The resemblance, digit symbol, picture arrangement and figure together of the both groups were descended significantly than the controlled group（ P 〈 0.05 ）. （2）There was significant difference between the ICAs and VBAs in picture padding,picture arrangement and figure together（P 〈0.01 ）. （3）In ICAS group, there were no significant correlation between course and all items of WAIS-RC （P 〉 0.05 ）, while there was negative correlation between frequency and digit symbol （ P 〈 0.05 ）, and there were negative correlation between time length and knowledge, insight, digit symbol, picture arrangement, VIQ, PIQ and FIQ in WAIS-RC （ P 〈 0.05 ）. Conclusion （ 1 ） Some degree of short-time memory deficits did exist in both TIAs group, especially visual memory and short-term memory disorder in VBAs. （2）In ICAs group, frequency impairs learning, writing velocity, visual perception and vision scanning. Time length impairs knowledge retention, extent, comprehension ,judgment ,abstraction generalization and plot comprehension. So, time length maybe impaired intelligence.