大脑中动脉搏动指数与腔隙性脑梗死认知损害的相关性

Correlation study of middle cerebral artery pulsatility index and cognitive impairment in lacunar infarction

目的探讨大脑中动脉搏动指数与腔隙性脑梗死患者认知功能障碍之间的关系,为卒中后认知功能障碍提供更多早期诊断方法。方法回顾性连续纳入2015年10月到2016年5月新疆军区总医院神经内科门诊及住院的急性腔隙性脑梗死患者60例为腔梗组,同期行脑血管功能检查无脑梗死的对照人群30例为对照组,所有患者进行基本信息采集及经颅多普勒超声检查,记录大脑中动脉搏动指数,同时采用事件相关电位P300、画钟测验、连线测验A和B评价两组患者认知功能并进行比较。结果腔梗组患者搏动指数较对照组增高(1.14±0.63比0.89±0.24),差异有统计学意义(P<0.05);两组认知功能比较,腔梗组较对照组事件相关电位潜伏期延长[(351±34)ms比(321±15)ms]、波幅降低[(5.0±1.4)μV比(7.9±2.6)μV],连线测验A、B测试时间延长[(81±7)s比(64±8)s,(166±18)s比(105±25)s],差异均有统计学意义(均P<0.05)。搏动指数与事件相关电位潜伏期和连线测验A、B测试时长呈正相关(r分别为0.517、0.393、0.637;均P<0.05),与事件相关电位波幅呈负相关(r=-0.324,P=0.007)。结论大脑中动脉搏动指数与腔隙性脑梗死患者的认知功能损害有关,高搏动指数可提示一些认知域的障碍;经颅多普勒超声检查可视为卒中后早期诊断认知功能障碍的辅助工具之一。

Objectives To investigate the relationship between middle cerebral artery pulsatility index（ PI） and cognitive impairment in patients with lacunar infarction and to provide more early diagnostic methods for cognitive impairment after stroke. Methods From October 2015 to May 2016,All sixty consecutive outpatient and inpatient patients with acute lacunar infarction（ lacunar infarction group） at the Department of Neurology,General Hospital of Xin Jiang Military Area Command were enrolled retrospectively,and 30 non-cerebral infarction cases for conducting cranial magnetic resonance imaging examinations at the same time period were used as a normal control group. The basic information of all patients was collected and transcranial Doppler ultrasonography was performed. The PI of the middle cerebral artery was documented.At the same time,the cognitive function of both groups was evaluated by event related potential P300,clock drawing test,and trail making test A and B. Results PI of the patients in the lacunar infarction group was higher than the normal control group（ 1. 14 ± 0. 63 vs. 0. 89 ± 0. 24）. There was significant difference（ P 〈0. 05）. Comparing the cognitive function of both groups,the event-related potential latency of the lacunar infarction group was longer than that of the normal control group（ 351 ± 34 ms vs. 321 ± 15 ms）,the amplitudewas decreased（ 5. 0 ± 1. 4 μV vs. 7. 9 ± 2. 6 μV）,and the trail making test A and B test time was prolonged（ 81 ± 7 s vs. 64 ± 8 s,166 ± 18 s vs. 105 ± 25 s）. There were significant differences（ all P 〈0. 05）. PI was positively correlated with the event-related potential latency and the duration of the trail making test A and B（ r = 0. 517,0. 393,and 0. 637,respectively; all P 〈0. 05）,and it was negatively correlated with the amplitude of the event-related potential latency（ r =- 0. 324; P = 0. 007）. Conclusion PI of middle cerebral artery is associated with the cognitive impairment in patients with lacunar infarction. The elevated PI may suggest the impairments in some cognitive domains. Transcranial Doppler ultrasonography can be regarded as one of the auxiliary tools for early diagnosis of cognitive impairment after stroke.