成人短暂性脑缺血发作型烟雾病患者认知功能状态的影响因素分析

Study on the clinical risk factors related to cognitive functional status of adult moyamoya disease patients presenting with transient ischemic attack

目的探讨成人短暂性脑缺血发作型烟雾病(TIA-MMD)患者认知功能状态的相关影响因素。方法回顾性分析2020年3月至2022年6月复旦大学附属华东医院神经外科收治的72例未行血运重建术的成年TIA-MMD烟雾病患者的临床资料。通过蒙特利尔认知量表(MoCA)评分对患者进行认知功能评价,并根据评分将TIA-MMD患者分为功能正常组(MoCA≥26分)与认知障碍组(MoCA<26分)。患者住院期间行3.0 T MRI并分析脑白质高信号体积(WMHV),同时行头颅CT灌注成像(CTP)。通过单因素分析比较两组间临床资料及WMHV和CTP相关参数的差异;进一步将单因素分析中差异具有统计学意义的因素纳入多因素logistic回归模型中进行分析。结果根据MoCA量表评估,该队列患者认知功能评分为(24.85±3.95)分(17~30分),其中功能正常组35例,认知障碍组为37例。根据单因素分析,认知障碍组患者较功能正常组患者低教育水平者占比高(P=0.002)、WMHV增大(P<0.001),左侧颞区感兴趣区的平均通过时间(MMT)、对比剂达峰时间(TTP)和残余功能峰值时间(Tmax)均延长(均P<0.001)。多因素logistic回归分析结果显示,MRI WMHV增大是影响TIA-MMD患者认知障碍的独立危险因素(OR=1.33,95%CI:1.03~1.74,P=0.032)。结论MRI WMHV增大是TIA-MMD烟雾病患者认知功能障碍的独立危险因素,可作为烟雾病患者临床常规监测指标之一。

Objective To explore the clinical risks associated with cognitive function status in adults patients of moyamoya disease presenting with transient ischemic attack(TIA-MMD).Methods The clinical data of 72 adult patients with TIA-MMD who did not undergo revascularization and admitted to the Neurosurgery Department of Huadong Hospital Affiliated to Fudan University from March 2020 to June 2022 were retrospectively analyzed.The cognitive function of the patients was evaluated through the Montreal Cognitive Assessment(MoCA)score,and based on the scores,TIA-MMD patients were divided into a normal cognitive function group and a cognitive impairment group.During the patient′s hospitalization,3.0T MRI was performed to analyze the white matter hyperintensity volume(WMHV),and brain CT perfusion imaging(CTP)was also performed.The differences in clinical data and WMHV and CTP-related parameters between the two groups were compared by univariate analysis.Furthermore,the statistically significant factors in the univariate analysis were included in multivariate regression analysis.Results According to the MoCA scale,the cognitive function score of this cohort of patients was 24.85±3.95 points(17-30 points),including 35 patients in the normal function group(MoCA≥26 points)and 37 patients in the cognitive impairment group(MoCA<26 points).According to univariate analysis,patients in the cognitive dysfunction group had a higher proportion of people with low education level(P=0.002),higher WMHV(P<0.001),and longer mean transit time(MTT),time to peak(TTP),time to maximum(Tmax)at the left temporal point of interest(all P<0.001).The results of multivariate logistic regression analysis showed that increased WMHV was an independent risk factor for cognitive impairment in patients with TIA-MMD(OR=1.33,95%CI:1.03-1.74,P=0.032).Conclusion Increased volume of WMHV on MRI is an independent risk factor for cognitive impairment in patients with TIA-MMD,and can be used as one of the routine clinical monitoring indicators for patients with MMD.