药物治疗联合支架置入对症状性颅内动脉粥样硬化性狭窄的疗效及短期预后评价

Efficacy of drug therapy combined with stenting in symptomatic intracranial atherosclerotic stenosis and evaluation in short-term prognosis

目的分析药物治疗联合支架置入对症状性颅内动脉粥样硬化性狭窄(SICAS)患者脑血流灌注、认知功能及短期预后的影响。方法选择住院治疗的124例SICAS患者为研究对象,依据治疗方案不同分为单纯组(60例,予以单纯药物治疗)和联合组(64例,在药物治疗基础上联合支架置入术)。治疗前、治疗第10天时,采用CT脑灌注成像分析局部脑血流速度(rCBF)、局部脑血容积(rCBV)、平均通过时间(MTr)。治疗前和治疗后3、14 d,记录2组蒙特利尔认知评估量表(MoCA)评分、美国国立卫生研究院卒中量表(NIHSS)评分。随访12个月,比较2组患者并发症发生率。结果与治疗前比较,联合组治疗后rCBF、rCBV均不同程度升高,MTr下降,差异有统计学意义(P<0.05);治疗后,2组CBF、rCBV、MTr比较,差异有统计学意义(P<0.05)。治疗后,2组MoCA评分均升高,且2组治疗后3、14 d MoCA评分比较,差异有统计学意义(P<0.05)。治疗后3、14 d,2组NIHSS评分下降,且联合组NIHSS评分低于单纯组,差异均有统计学意义(P<0.05)。联合组并发症总发生率低于单纯组,差异有统计学意义(P<0.05)。结论药物治疗联合支架置入治疗SICAS能较好地改善脑血流和认知功能,提高神经功能,降低并发症发生率。

Objective To analyze the effect of drug therapy combined with stent implantation on cerebral perfusion,cognitive function and short-term prognosis in patients with symptomatic intracranial atherosclerotic stenosis(SICAS).Methods A total of 124 hospitalized patients with SICAS were collected and divided into therapy-alone treatment group(60 cases,medicinal therapy only)and combination group(64 cases,medicinal therapy combined with stenting)according to the therapeutic methods.Regional cerebral blood flow(rCBF),regional cerebral blood volume(rCBV),and mean transit time(MTr)were analyzed by CT cerebral perfusion imaging before and 10 d after treatment.Montreal Cognitive Assessment Scale(MoCA)score and National Institutes of Health Stroke Scale(NIHSS)score were compared between two groups 3 and 14 days after treatment.The complication rate was compared between two groups after 12-month follow-up.Results Compared with before treatment,rCBF and rCBV of the combination group were increased,while MTr was decreased after treatment(P<0.05).After treatment,there were significant differences in CBF,rCBV and MTr between two groups(P<0.05).After treatment,the MoCA scores of the two groups were increased,and MoCA scores 3 and 14 days after treatment showed significant differences between the two groups(P<0.05).The NIHSS scores 3 and 14 days after treatment of two groups were significantly decreased,and the NIHSS score of the combination group was significantly lower than the therapy-alone treatment group(P<0.05).The incidence rate of complications of the combination group was significantly lower than that of the therapy-alone treatment group(P<0.05).Conclusion Stenting combined with medicinal therapy can improve the cerebral perfusion volume and cognitive function for SICAS,improve the nerve function,and decrease the incidence of complication.