腔隙性脑梗死患者早期认知功能与脑血流动力学的改变

The changes of early cognitive function and cerebral hemodynamics in patients with lacunar cerebral infarction

目的：探讨腔隙性脑梗死患者发病后2周内认知功能及脑血流动力学的变化。方法前瞻性连续纳入腔隙性脑梗死患者19例作为病例组，将性别、年龄匹配同期住院的无缺血性脑血管病的住院患者或门诊体检的健康志愿者23例作为对照组。应用经颅多普勒超声（TCD）“屏气试验”及单光子发射体层摄影（SPECT）“静息显像＋腺苷负荷试验”评价脑血流动力学特征；同时进行神经心理学测试，采用蒙特利尔认知评估量表（MoCA）对认知功能进行评价，包括执行能力、结构能力、记忆力（包括听觉记忆力、视觉记忆力和逻辑记忆力）、信息处理速度及视空间能力检查。结果（1）两组在受教育年限、高血压、糖尿病、高脂血症、冠心病及吸烟等方面比较，差异无统计学意义（均P＞0.05）。病例组MoCA评分、视觉记忆、执行功能、结构能力及信息处理速度与对照组差异有统计学意义（均P＜0.05）。（2）SPECT静息显像＋腺苷负荷试验共完成19例（对照组12例，病例组7例），病例组与对照组右侧基底节区放射性摄取比值（UR）[分别为8.91（－2.48～15.87）与－6.21（－10.39～5.42）]及左侧额叶UR[分别为11.62（2.93～16.87）与1.04（－10.17～3.82]比较，差异均有统计学意义（均P＜0.05）。（3）TCD屏气试验完成26例（对照组与病例组各13例），病例组的血管运动反应性[左侧（13±5）；右侧（21±7）]和呼吸抑制指数[左侧（0.66±0.26）；右侧（1.0±0.4）]与对照组的血管运动反应性[左侧（24±11）；右侧（30±9）]和呼吸抑制指数[左侧（1.21±0.57）；右侧（1.5±0.4）]比较，差异均有统计学意义（均P＜0.05）。结论腔隙性脑梗死早期已经存在不同程度的认知功能障碍和脑血流动力学的改变。

Objective Toinvestigatethechangesofcognitiveimpairmentandcerebralhemodynamics inpatientswithacutelacunarcerebralinfarctionwithin2weeksafteronset.Methods Nineteenpatients with lacunar cerebral infarction （a patient group）were consecutive enrolled in the study. Twenty-three sex-and age-matched inpatients without ischemic cerebrovascular disease or healthy volunteers of outpatient department over the same period were used as a control group. The cerebral hemodynamic features were evaluated with transcranial Doppler （TCD）＆quot;breath-holding test＆quot; and single photon emission computed tomography （SPECT）＆quot;resting ＋ adenosine stress imaging＆quot;. Simultaneously,the neuropsychological tests were performed,the Montreal cognitive assessment （MoCA）was performed including executive capacity, structural capacity,memory （including auditory memory,visual memory,and logic memory ）,information processing speed,and visual-spatial ability. Results （1 ）There were no significant differences in the＆amp;nbsp;years of education,hypertension,diabetes,hyperlipidemia,coronary heart disease,and smoking between the 2 groups （all P〉0. 05）. Compared with the control group,there were significant differences in the MoCA score,visual memory,executive function,structural capacity,and information processing speed of the patient group （all P〈0. 05）. （2）19 patients completed the SPECT resting ＋ load test （12 in the control group and 7 in the patient group）. There were significant differences in the uptake ratio （UR）in the right basal ganglia （8. 91[-2. 48 - 5. 87]and -6. 21 [-10. 39 - 5. 42 respectively]）and left frontal lobe UR （11. 62 [2. 93-16. 87]and 1. 04 [-10. 17- 3. 82]respectively）between the patient group and the control group （P〈0. 05）. （3）26 patients completed the breath-holding test ＋ head-up tilt table test （n=13 in each group]. The vascular motor reactivities were 13 ± 5 on the left and 21 ± 7 on the right, and the breath-holding indexes were 0. 66 ± 0. 26 on the left and 1. 0 ± 0. 4 on the right in the patient group;the vascular motor reactivities were 24 ± 11 on the left and 30 ± 9 on the right,and the breath-holding indexes were 1. 21 ± 0. 57 on the left and 1. 5 ± 0. 4 on the right in the control group. There were significant differencesbetweenthe2groups（P〈0.05）.Conclusion Attheearlystageoflacunarinfarction,the patients have presented varying degrees of cognitive impairment and the changes of cerebral hemodynamics.