脑小血管病不同分型伴非痴呆型血管性认知功能障碍程度比较及尼莫地平干预分析

Comparison of vascular cognitive impairment of non-dementia type small cerebral vascular disease and effect of nimodipine

目的分析脑小血管病不同分型伴非痴呆型血管性认知功能障碍程度及尼莫地平干预价值。方法选取2014年4月—2016年8月四川省科学城医院神经内科诊治的脑小血管病伴非痴呆型血管性认知功能障碍者184例作为研究对象,其中腔隙性病灶者82例,脑白质疏松102例。参考随机数字表法,按照1∶1比例将184例脑小血管病伴非痴呆型血管性认知功能障碍者分为观察组和对照组,每组92例。2组患者均给予基础治疗,观察组加用尼莫地平40 mg/次,每天3次,治疗6个月。比较观察组和对照组患者治疗前后认知功能、MMSE和Mo CA评分变化和随访6个月进展为痴呆率。结果腔隙性病灶者语义分类流畅测试、WAIS-RC数字符号测试、韦氏记忆量表逻辑记忆亚测试、韦氏记忆量表再生亚测试评分、MMSE和Mo CA评分高于脑白质疏松者,Stroop测试低于脑白质疏松者,差异均有统计学意义(t=3.509、3.698、3.441、3.205、3.187、3.120、3.004,P=0.042、0.040、0.043、0.045、0.046、0.048、0.048)。画钟试验、WAIS-RC积木测试、韦氏成人智力量表数字广度顺背测试与脑白质疏松者比较,差异无统计学意义(P>0.05)。观察组治疗前后Stroop测试、画钟试验、韦氏成人智力量表数字广度顺背测试、韦氏记忆量表再生亚测试、MMSE、Mo CA评分比较,差异有统计学意义(t=3.458、3.100、3.326、3.239、3.652、3.332,P=0.040、0.046、0.043、0.045、0.041、0.043),而对照组治疗前后各项测试比较,差异无统计学意义(P>0.05)。治疗后,观察组画钟试验、韦氏成人智力量表数字广度顺背测试、韦氏记忆量表再生亚测试评分、MMSE、Mo CA评分高于对照组(t=3.100、3.296、3.174、3.006、3.001,P=0.047、0.045、0.046、0.047、0.049),Stroop测试评分低于对照组(t=3.385,P=0.044)。治疗后,观察组MCAVs、MCAVm高于对照组,PI低于对照组(t=3.122、3.006、3.658,P=0.046、0.049、0.040)。观察组进展为血管性痴呆4例(4.35%),低于对照组的18例(19.57%)(χ~2=4.100,P=0.038)。结论加强脑小血管不同类型伴非痴呆型血管性认知功能障碍程度比较研究,能掌握血管性认知功能障碍本质特征,明确高危人群,重点监控,从而及时予以尼莫地平阻断病情演变,降低痴呆发生率。

Objective To analyze the degree of non-dementia vascular cognitive impairment and the effect of nimodipine in patients with cerebrovascular disease.Methods One hundred and eighty-four cases of cerebrovascular disease with non-dementia type vascular cognitive impairment were selected,including luminal lesions in 82 cases,102 cases of leukoaraiosis.According to the random number table method,the 184 cases of cerebrovascular disease with non-dementia type vascular cognitive disorder were divided into the observation group and the control group,92 cases each group.The changes of cognitive function,MMSE and MoCA scores in the observation group were compared with those of the control group.Results WAIS RC digital sign test,Wechsler memory scale sub test of memory,Wechsler memory scale regimen,Wechsler memory scale test,MMSE and MoCA scores in patients with luminal lesions were higher than those patients with leukoaraiosis,stroop test in patients with luminal lesions was lower than that of leukoaraiosis,the difference were statistically significant(t=3.509,t=3.698,t=3.441,t=3.205,t=3.187,t=3.120,t=3.004;P=0.042,P=0.040,P=0.043,P=0.045,P=0.046,P=0.048,P=0.048).The difference was not statistically significant in WAIS-RC building block test,Wechsler Adult Intelligence Scale digital breadth test of the two groups(P>0.05).There were significant differences in the Stroop test,the clock test,the digital breadth of the Wechsler Adult Intelligence Scale,the Wechsler Memory Scale Regenerative Sub test,the MMSE and MoCA scores before and after the treatment(t=3.458,t=3.100,t=3.326,t=3.239,t=3.652,t=3.332,P=0.040,P=0.046,P=0.043,P=0.045,P=0.041,P=0.043).After treatment,the MMSE and MoCA scores in the observation group were significantly higher than those in the control group(t=3.100,t=3.296,t=3.174,t=3.006,t=3.001,P=0.047,P=0.045,P=0.046,P=0.047,P=0.049),Stroop(t=3.385,P=0.044).Stroop Test score of observation group was lower than the control group,the difference was statistically significant(t=3.385,P=0.044).After treatment,the MCAVs and MCAVm of the observation group were higher than the control group,PI was lower than the control group,the difference was statistically significant(t=3.122,t=3.006,t=3.658,P=0.046,P=0.049,P=0.040).4 cases(4.35%)in the observation group and 18 cases(19.57%)in the control group were progressed to dementia,the difference was statistically significant(χ2=4.100,P=0.038).Conclusion It is beneficial to grasp the essential characteristics of vascular cognitive impairment and to identify the high risk population,and to monitor the severity of vascular dementia with different types of cerebral vasculature with non-dementia vascular cognitive impairment,so as to timely using Nimodipine to reduce the disease progression to dementia.