大脑中动脉不同程度狭窄患者认知功能损害的特点

发布时间：2018-12-07 20:44

【摘要】：目的:旨在观察单侧大脑中动脉狭窄(MCA)程度对患者认知功能的影响,分析比较不同程度狭窄患者认知损害的特点,为大脑中动脉狭窄或闭塞患者认知障碍临床早期诊断提供依据。方法:连续选取2015年12月-2016年8月之间以“头晕、乏力等症状”受检于某军区总医院神经功能检查室符合入选标准的单侧MCA狭窄者98例及正常对照30例,狭窄组按照其狭窄程度分为:轻度狭窄组36例、中度狭窄组30例、重度狭窄或闭塞组32例,所有患者均进行基本信息采集及常规实验室检查,同时采用中文版蒙特利尔认知评估量表(MOCA)及事件相关电位P300评价各组患者认知功能情况,并比较分析各组认知障碍的特点。结果:(1)狭窄组一般临床资料与对照组间比较差异无统计学意义(P0.05)。与对照组相比,狭窄组P300潜伏期延长,波幅降低,差异均有统计学意义(P0.05)。狭窄组的MoCA总分及各认知域得分均较对照组低。在Mo CA总分、视空间/执行功能、注意、语言、抽象、延迟记忆得分方面,两组比较差异均有统计学意义(P0.05)。狭窄组在命名、定向力得分虽较对照组低,但差异无统计学意义(P0.05)。(2)轻度狭窄组、中度狭窄组、重度狭窄或闭塞组、对照组四组间事件相关电位P300潜伏期、波幅比较,差异均有统计学意义(P0.05)。轻度狭窄组、中度狭窄组、重度狭窄或闭塞组较对照组P300潜伏期延长、波幅降低,差异均有统计学意义(P0.05);中度狭窄组较轻度狭窄组P300潜伏期延长,差异有统计学意义(P0.05),波幅结果近似,差异无统计学意义(P0.05)。重度狭窄或闭塞组较轻度狭窄组、中度狭窄组P300潜伏期延长、波幅降低,差异均有统计学意义(P0.05);(3)轻度狭窄组、中度狭窄组、重度狭窄或闭塞组、对照组四组间MoCA总分、视空间/执行功能、注意、语言、抽象、延迟记忆得分比较,差异均有统计学意义(P0.05)。轻度狭窄组、中度狭窄组、重度狭窄或闭塞组MoCA总分及各认知域得分均较对照组低,但仅在MoCA总分、注意、语言、抽象、延迟回忆方面,差异有统计学意义(P0.05)。中度狭窄组延迟回忆得分较轻度狭窄组低,差异有统计学意义(P0.05),Mo CA总分及其它各认知域得分差异无统计学意义(P0.05)。重度狭窄或闭塞组MoCA总分及各认知域得分均较轻度狭窄组、中度狭窄组低,但仅在Mo CA总分、视空间/执行功能、注意、抽象、延迟回忆方面,差异有统计学意义(P0.05)。结论:(1)单侧MCA狭窄影响患者认知功能,在视空间/执行功能、注意、语言、抽象、延迟记忆几个认知域表现更为明显。(2)不同程度的MCA狭窄损害涉及的认知域不同,且各认知域损害严重程度也不同。
[Abstract]:Objective: to observe the effect of unilateral middle cerebral artery stenosis (MCA) on cognitive function in patients with middle cerebral artery stenosis, and to analyze and compare the characteristics of cognitive impairment in patients with different degrees of stenosis. To provide evidence for early diagnosis of cognitive impairment in patients with middle cerebral artery stenosis or occlusion. Methods: from December 2015 to August 2016, 98 patients with unilateral MCA stenosis and 30 normal controls who were examined with "dizziness, fatigue and other symptoms" in the neurological functional examination room of a military region General Hospital were selected. According to the degree of stenosis, the stenosis group was divided into three groups: mild stenosis group (n = 36), moderate stenosis group (n = 30), severe stenosis group (n = 32) and severe stenosis group (n = 32). At the same time, the Chinese version of Montreal Cognitive Assessment scale (MOCA) and event-related potential (P300) were used to evaluate the cognitive function of patients in each group, and to compare and analyze the characteristics of cognitive impairment in each group. Results: (1) there was no significant difference in general clinical data between the stenosis group and the control group (P0.05). Compared with the control group, the latency of P300 was prolonged and the amplitude of P300 was decreased in the stenosis group (P0.05). The total score of MoCA and the scores of each cognitive domain in the stenosis group were lower than those in the control group. There were significant differences in the total score of Mo CA, visual space / executive function, attention, language, abstraction, and delayed memory score between the two groups (P0.05). Although the scores of naming and orientation in the stenosis group were lower than those in the control group, there was no significant difference (P0.05) between the mild stenosis group, the moderate stenosis group, the severe stenosis group and the control group. Compared with the amplitude, the differences were statistically significant (P0.05). The latency and amplitude of P300 in mild stenosis group, moderate stenosis group, severe stenosis or occlusion group were significantly longer than those in control group (P0.05). The latency of P300 in moderate stenosis group was longer than that in mild stenosis group, the difference was statistically significant (P0.05), the amplitude of wave was similar, the difference was not statistically significant (P0.05). Severe stenosis or occlusion group than mild stenosis group, moderate stenosis group P300 latency prolonged, wave amplitude decreased, the differences were statistically significant (P0.05); (3) the scores of MoCA, visual space / executive function, attention, language, abstraction and delayed memory in mild stenosis group, moderate stenosis group, severe stenosis or occlusion group and control group were significantly different (P0.05). The scores of MoCA and cognitive domain in mild stenosis, moderate stenosis, severe stenosis or occlusion group were lower than those in control group, but there were significant differences in MoCA total score, attention, language, abstraction and delayed recall (P0.05). The score of delayed recall in moderate stenosis group was lower than that in mild stenosis group, and the difference was statistically significant (P0.05 total score of), Mo CA and scores of other cognitive domains had no statistical significance (P0.05). The scores of MoCA and cognitive domain in severe stenosis or occlusion group were lower than those in mild stenosis group and moderate stenosis group, but there were significant differences only in Mo CA total score, visual space / executive function, attention, abstraction and delayed recall (P0.05). Conclusion: (1) unilateral MCA stenosis affects cognitive function, especially in visual space / executive function, attention, language, abstraction, and delayed memory. (2) different degree of MCA stenosis is involved in different cognitive domains. And the severity of cognitive domain damage is different.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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