合并脑白质损害的颈动脉狭窄患者支架成形术后认知功能改变

Effectiveness of carotid artery stenting on cognitive function in patients with carotid artery stenosis and white matter lesions

目的比较合并脑白质损害(white matter lesions,WML)的颈动脉狭窄患者颈动脉支架成形术(carotid artery stenting,CAS)治疗前后的认知功能,以了解CAS是否有利于合并WML的颈动脉狭窄患者认识功能的改善。方法纳入颈动脉狭窄患者166例,根据磁共振影像学表现,无脑白质损害的患者纳入对照组,共30例,合并有脑白质损害的患者纳入脑白质损害组,共136例,行CAS治疗,其中WML组有2例患者因导丝不能通过放弃支架治疗,2例患者随访期间死亡,最终完成随访共162例,对照组30例,脑白质损害组132例,观察患者围手术期安全及疗效,评估CAS术前、术后患者认知功能情况。结果 CAS术前,脑白质损害组MMSE、数字广度(顺/倒背)测验、语言流畅性测验、ADAS-Cog及Mo CA评分为(21.8±3.3)、(6.3±2.1)、(4.1±1.0)、(15.1±3.6)、(15.1±3.3)、(20.6±3.1),对照组分别为(24.3±3.9)、(7.3±2.6)、(4.7±1.8)、(17.7±5.2)、(12.7±3.3)、(22.7±4.2),两组间评分差异有统计学意义,P=0.000、0.026、0.039、0.012、0.000、0.011。CAS术后3个月WML组在MMSE、数字广度顺背测验及Mo CA评分、术后6个月数字广度倒背测验评分(23.7±3.6,7.5±2.4,23.1±6.9,4.9±2.8)较术前(21.8±4.3,6.3±2.1,20.6±4.1,4.1±2.2)显著升高,术后3个月ADAS-Cog评分较术前下降[(13.2±4.9)对(15.1±4.3)],有统计学意义(P<0.05);CAS术后1年,合并WML的颈动脉狭窄患者认知功能改善程度在MMSE、数字广度顺背测验、ADAS-Cog及Mo CA评分(3.5±1.3,1.6±0.6,-2.6±0.8,3.6±1.1)较对照组(2.7±1.8,1.2±0.8,-2.0±1.3,2.7±1.5)明显(P<0.05)。结论合并WML的颈动脉狭窄患者CAS术后认知功能改善较不合并WML的颈动脉狭窄患者明显。

Objective To compare the cognitive function of patients with carotid stenosis combined with white matter lesions(WML)after carotid artery stenting(CAS).Methods Total 166 patients with carotid artery stenosis were collected.According to MRI imaging,30 patients with no white matter lesions were included in the control group and 136 patients with white matter lesions were included in the white matter lesions group.They were treated with carotid artery stenting and underwent evaluation on the safety and efficacy of perioperative surgery.CAS failed in two patients because of the inability of guidewire crossing in WML group.Two patients died after CAS(one for cardiac death and one for traumatic accident)in WML group.162 patients received 1 year follow-up.Cognitive function was assessed before and after CAS.Results Before CAS,WML group's MMSE,digit span forward/backward test,verbal fluency test and MoCA scores(21.8±3.3、6.3±2.1、4.1±1.0、15.1±3.6、20.6±3.1)were lower compared with control(24.3±3.9、7.3±2.6、4.7±1.8、17.7±5.2、22.7±4.2)and ADAS-Cog score was higher compared with control((15.1±3.3)vs.(12.7±3.3)),P=0.000、0.026、0.039、0.012、0.000、0.011.Three months after CAS,the MMSE,digit span forward test and MoCA scores(23.7±3.6,7.5±2.4,23.1±6.9)was higher significantly than those before treatment(21.8±4.3,6.3±2.09,20.6±4.13),P<0.05.And the scores of ADAS-Cog was lower((13.2±4.)vs.(15.1±4.3),P<0.05).The scores of digit span backward test in 6 months after treatment was significant higher than those before treatment(4.9±2.8,4.1±2.2,P<0.05).After 1 year of CAS,the improvement in scores of MMSE,digit span forward test,ADAS-Cog and MoCA in patients with carotid stenosis complicated with WML(3.5±1.3,1.6±0.6,-2.6±0.8,3.6±1.1)was higher significant than control(2.7±1.8,1.2±0.8,-2.0±1.3,2.7±1.5),P<0.05.Conclusion CAS can improve cognitive function in Patients with carotid artery stenosis complicated with WML than those who without WML.