颈动脉狭窄患者的认知功能和磁共振波谱改变

The changes of cognitive function and MRS in patients with carotid artery stenosis

目的探讨颈动脉狭窄患者的认知功能和额叶白质区磁共振波谱(MRS)改变。方法在1000例有血管损害因素患者采用颈动脉B超测定颈动脉狭窄程度,并依此分为中重度狭窄组(颈动脉狭窄>50%)、轻度狭窄组(颈动脉狭窄<50%)和颈动脉正常组;另选200例健康人作为对照组。对颈动脉狭窄伴或不伴有认知功能障碍各30例行MMSE认知功能评分,并检测额叶白质区MRS。结果有血管损害因素患者颈动脉狭窄发生率为22.0%(220/1000),明显高于对照组的9.0%(18/200)(P<0.01)。轻度狭窄组的MMSE评分与正常组相仿[(28.80±4.21)分vs.(29.75±3.10)分](P>0.05)。但中重度狭窄组的MMSE评分(22.50±4.00)分则明显低于正常组(P<0.01)。中重度颈动脉狭窄者狭窄侧MRS的NAA/Cr明显低于其对侧、轻度狭窄颈动脉和对照组(P<0.01)。结论有血管损害因素患者颈动脉狭窄发生率高;颈动脉中重度狭窄者认知功能下降,早期可用额叶白质区MRS评估。

Objective To explore the changes of cognitive function and magnetic resonance spectroscopy（MRS） of the white area of cerebral cortex in patients with carotid artery（CA） stenosis. Methods The CA stenosis was measured by B ultrasonography in 1000 patients with the risk factors such as hypertension,diabetes,hyperlipidemia or asymptomatic cerebral infarction for vascular injury,based on which the patients were divided into groups of A（with moderate or severe CA stenosis）,B（with mild stenosis） and C（without stenosis）.Another 200 healthy people were taken as the controls.The minimental state examination（MMSE） score was recorded in 30 CA stenosis cases with cognitive imparement（CI） and 30 CA stenosis cases without CI.The MRS of the white area of cerebral cortex was examined as well. Resules The incidence of CA stenosis was 22.0%（220/1000） in the patients with the risk factors for vascular injury,which was significantly higher than 9.0%（18/200） in the controls（P0.01）.The MMSE score was lower in the cases with moderate or severe CA stenosis than that without stenosis[（22.50±4.00）points vs.（29.75±3.10）points]（P0.01）,which of the cases with mild CA stenosis [（28.80±4.21）points] was similar to that without stenosis（P0.05）.The NAA/Cr of MRS was significantly lower on the stenosis side of cases with moderate or severe CA stenosis than that on the opposite side or the cases with mild CA stenosis （P0.01）. ConclusionThe incidence of CA stenosis is higher in the patients with the risk factors for vascular injury.The cognitive function is declined in the cases with moderate or severe CA stenosis,which may be evaluated with MRS in the early stage.