手术与药物治疗对成年烟雾病患者认知功能的影响

Infl uence of Cognitive Function in Surgical and Drug Treatment for Adult Patients with Moyamoya Disease

目的探讨手术以及药物治疗对成年烟雾病患者认知功能的影响。方法选择52例成年烟雾病患者,按照治疗方式不同分为手术组和对照组。对照组采用阿司匹林肠溶缓释片、低分子右旋糖酐、奥拉西坦以及地塞米松保守治疗;手术组采用手术治疗(直接血管搭桥术及间接血管搭桥术)。观察2组患者治疗前认知功能情况及治疗后6个月后改善情况。结果治疗前2组患者认知功能比较无显著差异。随访6个月后,采用蒙特利尔认知功能量表(Montreal cognitive assessment,Mo CA)检测,手术组(t=2.092,P=0.009)和对照组(t=2.814,P=0.007)Mo CA评分与本组治疗前比较有显著改善,手术组治疗改善情况显著优于对照组(t=2.642,P=0.03)。采用简明精神状态量表(mini-mentalstateexamination,MMSE)评分检测,手术组明显优于治疗前(t=2.706,P=0.005),对照组无显著性改善。临床疗效比较,手术组治疗后有效率较对照组高,差异有显著性(96.15%vs 84.62%,χ2=10.15,P<0.05)。结论采用手术治疗烟雾病患者相比药物治疗能够更好地改善患者认知功能及提高临床疗效。

Objective To investigate the inlfuence of surgical and pharmacological therapies on the cognitive function of patients with adult moyamoya disease. Methods A total of 52 patients with adult moyamoya disease were included, and were divided into a surgical group and a control group according to their treatment plans. Patients in the control group were treated with conservative therapy using aspirin enteric-coated sustained release tablets, dextran 40, oxiracetam, and dexamethasone. Patients in the surgical group received surgical therapies （direct bypass operations and indirect bypass operations）. The cognitive functions of patients in the two groups were assessed before treatments and 6 months after treatments to evaluate the improvement in patients’ cognitive functions. Results There was no significant difference in patients’ cognitive functions between the two groups before treatments. At 6-month follow-up, Montreal cognitive assessment（MoCA） of the patients showed that patients’ cognitive functions of the surgical group （t=2.092,P=0.009） and the control group （t=2.814,P=0.007） had improved signiifcantly compared to those before treatments, respectively. Assessments using mini-mental state examination（MMSE） showed significant improvement in the surgical group （t=2.706,P=0.005） while the control group had no signiifcant improvement. Comparison of the curative effects between the two groups showed that the rate of therapeutic effectiveness was higher in the surgical group than in the control group, which is statistically signiifcant （96.15%vs 84.62%,χ2=10.15,P〈0.05）. Conclusion Surgical therapy for moyamoya disease can better improve patients’ cognitive functions and clinical curative effects than pharmacological therapy.