颈动脉狭窄程度及狭窄部位与老年无症状性颈动脉狭窄患者认知功能的关系研究

Relationship between Carotid Artery Stenosis Severity, Locations and Cognitive Function in Elderly Patients with Asymptomatic Carotid Artery Stenosis

目的分析颈动脉狭窄程度及狭窄部位与老年无症状性颈动脉狭窄患者认知功能的关系。方法选取2016年9月—2017年8月在上海市普陀区真如镇社区卫生服务中心门诊就诊及住院的老年无症状性颈动脉狭窄患者80例作为观察组,其中轻度狭窄者48例,中度狭窄者23例,重度狭窄者9例;左侧颈内动脉狭窄者27例,右侧颈内动脉狭窄者26例,双侧颈内动脉狭窄者27例。另选取同期体检健康者80例作为对照组。采用简易精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评估两组受试者认知功能。比较两组受试者及不同颈动脉狭窄程度、狭窄部位患者MMSE评分、MoCA评分。结果观察组患者MMSE评分、视空间与执行能力评分、注意力评分、延迟记忆评分及MoCA总分低于对照组(P<0.05);两组受试者命名能力评分、语言能力评分、抽象能力评分及定向力评分比较,差异无统计学意义(P>0.05)。中度狭窄和重度狭窄患者MMSE评分、视空间与执行能力评分、延迟记忆评分及MoCA总分低于轻度狭窄患者,中度狭窄患者命名能力评分、注意力评分、语言能力评分低于轻度狭窄患者(P<0.05);不同颈动脉狭窄程度患者抽象能力评分和定向力评分比较,差异无统计学意义(P>0.05)。右侧颈内动脉狭窄和双侧颈内动脉狭窄患者MMSE评分、语言能力评分及MoCA总分高于左侧颈内动脉狭窄患者,右侧颈内动脉狭窄患者视空间与执行能力评分、定向力评分高于左侧颈内动脉狭窄患者(P<0.05);不同颈动脉狭窄部位患者命名能力评分、注意力评分、抽象能力评分、延迟记忆评分比较,差异无统计学意义(P>0.05)。结论老年无症状性颈动脉狭窄患者存在认知功能损伤,且颈动脉狭窄程度及狭窄部位与患者认知功能损伤程度有关。

Objective To analyze the relationship between carotid artery stenosis severity,locations and cognitive function in elderly patients with asymtomatic carotid artery stenosis. Methods From September 2016 to August 2017,a total of80 elderly outpatients and inpatients with asymtomatic carotid artery stenosis were selected as observation group in Zhenru Town Community Health Service Center,Putuo District,Shanghai,including 48 cases with mild carotid artery stenosis（ served as A1 group）,23 cases with moderate carotid artery stenosis（ served as A2 group） and 9 cases with severe carotid artery stenosis（ served as A3 group）; 27 cases with left internal carotid artery stenosis（ served as B1 group）,26 cases with right internal carotid artery stenosis（ served as B2 group） and 27 cases with bilateral internal carotid artery stenosis（ served as B3）group. Meanwhile a total of 80 healthy people admitted to this hospital for physical examination were selected as control group. Cognitive function in control group and observation group were evaluated by MMSE and Mo CA,MMSE score and Mo CA score were compared between control group and observation group,in A1 group,A2 group and A3 group,in B1 group,B2 group and B3 group. Results MMSE score,visual space and executive ability score,attentiveness score,delayed memory score and total Mo CA score in observation group were statistically significantly lower than those of control group（ P〈0. 05）,while no statistically significant differences of naming skills score,language competence score,abstract ability score or directive force score was found between the two groups（ P〉0. 05）. MMSE score,visual space and executive ability score,delayed memory score and total Mo CA score in A2 group and A3 group were statistically significantly lower than those of A1 group,meanwhile naming skills score,attentiveness score and language competence score in A2 group were statistically significantly lower than those of A1 group（ P〈0. 05）; no statistically significant differences of abstract ability score or directive force score was found in A1 group,A2 group and A3 group（ P〉0. 05）. MMSE score,language competence score and total Mo CA score in B2 group and B3 group were statistically significantly higher than those in B1 group,meanwhile visual space and executive ability score,attentiveness score,abstract ability score and delayed memory score in B2 group were statistically significantly higher than those in B1 group（ P〈0. 05）; no statistically significant differences of naming skills score,attentiveness score,abstract ability score or delayed memory score was found in B1 group,B2 group and B3 group（ P〉0. 05）. Conclusion Cognitive impairment is common in elderly patients with asymtomatic carotid artery stenosis, carotid artery stenosis severity and locations are significantly correlated with the cognitive function.