颈内动脉狭窄对Binswanger病患者脑白质病变和认知功能的影响

The effect of internal carotid stenosis on white matter lesion and cognition function of Binswanger disease

目的探讨不同程度颈内动脉狭窄对Binswanger病的脑白质病变及认知功能的影响。方法收集2012年12月至2014年6月于齐鲁医院老年神经内科住院且合并颈内动脉粥样硬化Binswanger病（BD）患者108例，随访过程中6例发生急性脑血管病结束随访，剩余人数根据颈内动脉狭窄程度分为无狭窄组（〈10％）39例、轻度狭窄组（10％～49％）31例、中度狭窄组（50％～70％）32例。所有患者均行颈动脉超声及颅脑磁共振成像（MRI）、磁共振血管造影（MRA）检查，探测颈内动脉内膜中层厚度（IMT）、斑块指数、收缩期峰值流速（PSV）及狭窄率；行简易智能精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MOCA）评估患者认知功能改变；改良Schehens量表评估脑白质病变；评估颈内动脉IMT、PSV及斑块指数与脑白质病变及认知功能的关系，随访1年后，观察患者认知功能变化。结果轻、中度狭窄组IMT、斑块指数、PSV、改良Schehens量表得分较无狭窄组差异有统计学意义（均P〈0．05）；中度狭窄组IMT（1．11±0．17）mm，明显高于轻度狭窄组（1．04±0．10）mm（P〈0．05），轻、中度狭窄组间斑块指数、PSV、改良Schehens量表差异无统计学意义（均P〉0．05）。改良Scheltens量表得分与狭窄处PSV呈正相关（r=0．630、P=0．020），MMSE得分与狭窄处PSV呈负相关（r=-0．970、P=0．040）。随诊1年后，无狭窄组、轻度狭窄组、中度狭窄组BD患者MMSE得分较前分别下降（0.61±1．05）分、（0．70±0．60）分、（1．06±0．68）分，MOCA较前分别下降（0．68±0．81）分、（0．93±0．69）分、（1．13±0．76）分，且中度狭窄组MMSE、MOCA得分下降幅度最大，较无狭窄组差异明显，有统计学意义（均P〈0．05），较轻度狭窄组差异无统计学意义（均P〉0．05）。结论颈内动脉狭窄为BD患者认知功能损伤的危险因素，其中IMT和PSV与BD患者脑白质及认知功能损伤关系密切。

Objective To investigate the influence of the different degree of internal carotid stenosis on the white matter lesion and cognition of Binswanger disease. Methods A total of 108 elderly patients with Binswanger disease from Department of Geriatric Neurology of Qilu Hospital were recruited during December 2013 and June 2014. At the end of follow-up, 6 eases showed acute cerebrovascular disease, 39 （ 〈 10 % ） had no internal carotid stenosis, 31 （ 10%-49%） had mild internal carotid stenosis, 32 （50%-70%）had moderate internal carotid stenosis through B ultrasound examination and MRI and MRA examination on internal carotid artery and brain. The B ultrasound examination of internal carotid artery included intima-media thickness （IMT）, plaque index and the peak systolic velocity （PSV）. Cognitive function of Binswagner disease was assessed by Mini-Mental State Examination （MMSE） and Montreal Cognitive Assessment （MOCA）. The white matter lesion was assessed by reformed visual Scheltens scale. The relationship among IMT, plaque index, PSV, white matter lesion, and cognitive function was investigated. The variation of cognition was observed after 1 year. Results There were statistically significant differences in IMT, PSV, plaque index, reformed Scheltens scale scores between groups of non, mild, moderate internal carotid stenosis （all P〈0.05）. The IMT was thicker in moderate internal carotid stenosis group than in mild internal carotidstenosis group （P〈0.05）. The differences in PSV, plaque index, and reformed Scheltens scale scores between mild and moderate internal carotid stenosis groups were not significant （P〉0. 05）. There were positive correlation between PSV and reformed Sehehens scale scores （r= 0. 630, P= 0. 020）. There were negative correlation between PSV and MMSE scores （r= -0. 970, P= 0. 040）. The scores of MMSE and MOCA both were declined after 1 year in three groups （0.61±0.60, 0. 68±0. 81） , （0.70±0.60, 0.93±0.69）,（1.06±0.68,1.13±0.76）. The declination of MMSE and MOCA of BD patients was higher in moderate internal carotid stenosis group than in non internal carotid stenosis group （P〈0.05）. The differences in the declination of MMSE and MOCA between moderate and mild internal carotid stenosis groups were not significant （P〉0.05）. Conclusions Internal carotid stenosis is one of risk factors for the cognitive impairment of BD, the abnormal IMT and PSV are both correlated with white matter lesion and cognitive impairment in BD. Early standardized therapy can postpone the rate of cognitive impairment in BD.