老年缺血性心脑血管疾病患者心脑血流与认知功能的相关性

Relationship between cerebral and heart blood flow and cognitive function in the elderly with ischemic cerebrovascular and cardiovascular diseases

目的:应用单光子发射计算机断层显像(singlephotonemissioncomputertomography,SPECT)方法,了解老年冠心病和脑血管疾病合并发生的比率,分析心脑血流灌注相关性及其对认知功能的影响。方法;对68例老年缺血性心脑血管疾病患者犤男3例,女5例,平均年龄(73.95±6.31)岁犦进行了心、脑血流灌注SPECT检查,同时应用简易精神状态量表(MMSE)、中国成人智力量表(CISA)和临床记忆量表评价认知功能。结果:老年心脑血流灌注降低同时发生的比例较高,冠心病组84%,脑血管疾病组58%。相对定量分析发现心脑血流灌注水平之间未见明显相关。左室射血分数与脑血流灌注最低值正相关(r=0.335,P<0.01),而同时患有心、脑血管疾病组的患者中相关系数则更高(r=0.482,P<0.05)。认知功能尤其是记忆功能与部分脑感兴趣区如扣带回、左丘脑、右顶叶灌注呈正相关关系(r=0.396～0.789,P<0.05)。扣带回血流灌注与多项认知功能成绩呈明显正相关(r=0.400～0.807,P<0.05),在脑血管疾病组中更为明显(r=0.402～0.589,P<0.05)。心肌血流灌注与认知功能并无明显相关,而左室射血分数与认知功能尤其是记忆能力呈正相关(r=0.411～0.759,P<0.05),冠心病组较脑血管疾病更为密切。结论:老年心、脑缺血性疾病同时存在比率大。心功能的下降。

AIM:To assay the proportion of co existence of ischemic cardiovasular and cerebrovascular diseases in the elderly with single photon emission computer tomography(SPECT),and to analyze the relationship between cerebral and cardiac blood perfusion and their influence on cognitive function. METHODS:SPECT was used to detect 68 patients with ischemic cerebrovasular and cardiovascular diseases,including 63 males and 5 females with the mean age of(73.95±6.31) years,through cardiac and cerebral blood perfusion.Their cognitive function was assessed with mini mental state examination(MMSE),China intelligence scale for adult(CISA) and clinical memory scale(CMS). RESULTS:The ratio of the coexistence of two diseases was 84%in the patients with coronary heart disease and 58%in the patients with cerbrovascular diseases.There was no remarkable correlation between the heart and brain perfusion in relative quantitative analysis,but left ventricular ejection fraction(LVEF) was positively correlated with the minimal value of brain perfusion(r=0.335,P< 0.01) especially in the patients with both cardiovascular and cerebrovascular diseases(r=0.482,P< 0.05).The blood flow in gyrus cinguli,left thalamus and right parietal lobe was positively related with cognitive function especially memory(r=0.396-0.789, P< 0.05).The blood flow in gyrus cinguli was in positive correlation with many cognitive functions(r=0.400-0.807,P< 0.05),which was more remarkable in the patients with cerebrovascular disease(r=0.402-0.589, P< 0.05).No association was found between myocardiac perfusion and cognitive function, while LVEF had positive correlation with cognitive function,especially with memory function(r=0.411-0.759,P< 0.05),which was more remarkable in the patients with coronary heart disease than in the patients with cerebrovasular disease. CONCLUSION:The coexistence ratio of ischemic cardiovascular and cerebrovascular diseases was high in the elderly patients.The reduction in cardiac function and cerebral blood flow has a great influence on the cognitive function of the elderly patients with ischemic cardiovascular and cerebrovascular diseases.SPECT can be used for evaluating the cognitive function in the elderly patients with ischemic cardiovascular and cerebrovascular diseases.