单侧颈内动脉重度狭窄或闭塞后侧支循环开放对认知功能影响的经颅多普勒超声和P300研究

The influence of collateral circulation on the cognitive functioning of patients with severe unilateral carotid artery stenosis or occlusion

目的TCD联合事件相关诱发电位P300研究单侧颈内动脉重度狭窄或闭塞后侧支循环开放情况及其对认知功能的影响。方法利用TCD评估单侧颈内动脉重度狭窄或闭塞后患者185例侧支循环开放情况，并根据侧支循环开放情况将研究对象分成单支组、多支组和无侧支组，同时设正常对照组。单支组患者再根据侧支循环分为前交通动脉（AcoA）组，眼动脉（OA）组和后交通动脉（PcoA）组。对各组进行蒙特利尔评估表（MoCA）评分和事件相关诱发电位P300检测，并分析MoCA评分与P300潜伏期、P300波幅间的相关性。结果单侧颈内动脉重度狭窄或闭塞患者185例中，有侧支循环开放162例，单支开放83例，多支开放79例，无侧支开放23例。经检测，单支组、多支组、无侧支组的MoCA评分和P300波幅均明显低于对照组，而P300潜伏期较对照组均明显延长，差异均有统计学意义（P〈0．05）；单支组和无侧支组的MoCA评分和P300波幅均明显低于多支组，而P300潜伏期则明显延长，差异均有统计学意义（P〈0．05）；无侧支组的MoCA评分和P300波幅均明显低于单支组（P〈0．05），P300潜伏期较单支组则明显延长（P〈0．05）。单支组中，AcoA组的MoCA评分高于OA组和PcoA组，其P300潜伏期则低于OA组和PcoA组，差异均有统计学意义（P〈0．05），且AcoA组的P300波幅高于PcoA组，差异有统计学意义（P〈0．05）。MoCA评分与P300潜伏期显著负相关（r=-0．74，P〈0．05，）与P300波幅显著正相关（r=0．66，P〈0．05）。结论单侧颈内动脉重度狭窄或闭塞后侧支循环开放对认知功能有保护作用，多支侧支循环保护作用高于单支；单支侧支循环中，AcoA对认知功能的保护作用高于OA和PcoA；MoCA评分与P300潜伏期有显著相关性。

Objective To explore the influence of collateral circulation on the cognition of persons with severe unilateral carotid artery stenosis or occlusion using transeranial Doppler （TCD） imaging combined with P300. Methods A total of 185 patients with stenosis or occlusion of the carotid artery were enrolled and randomly divided into a monoeollateral group （ n = 83） , a muhicollatcral group （ n= 79） and a noncollateral group （ n= 23） .The monocollateral group was further divided into an anterior communicating artery （AcoA） group, an ophthalmic artery （OA） group and a post communicating artery （PcoA） group according to their collateral circulation. All patients and 40 normal controls （NC） were tested using the Montreal cognitive assessment （MoCA） and P300, and the correlation be- tween the MoCA and P300 scores was analyzed. Results Compared with the NC group, all the other three groups had significantly lower average MoCA scores and P300 amplitudes. They also had significantly longer average P300 latency periods. Compared with the multicollateral group, both the monocollateral and noneollateral groups had significantly lower average MoCA scores and P300 amplitudes and longer P300 latencies. Comparing the monocollateral group with the noneollateral group revealed the same trends. Among the monocollateral patients the average MoCA score of the AcoA group was significantly higher than the PcoA and OA group averages, while their average P300 lateney period was significantly shorter and the amplitude significantly greater than the PeoA group＇s average. Correlation analyses showed that the MoCA score was negatively correlated with the P300 latency, but positively correlated with the P300 amplitude. Conclusions Collateral circulation can protect the eognitive funetion of patients with unilateral stenosis or occlusion of the internal carotid artery to some extent, with multicollateral circulation being more effective than monoeollateral and AcoA circulation superior to both PeoA and OA circulation. The MoCA score is significantly correlated with the latency period of P300 in such eases.