无症状颈动脉狭窄患者认知功能障碍评估及其危险因素研究

发布时间：2018-08-09 10:39

【摘要】：目的采用事件相关电位P300(ERP-P300)、简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估无症状颈动脉狭窄(ACS)患者的认知功能,并分析其认知功能障碍的危险因素。方法选取2015年于首都医科大学附属北京安贞医院神经内科住院和门诊就诊的ACS患者179例为研究对象,根据颈动脉狭窄程度分级,30%为无狭窄组(90例),30%~69%为轻中度狭窄组(49例),70%~99%为重度狭窄组(40例)。收集患者临床资料,检测血清同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)、低密度脂蛋白胆固醇(LDL-C)、血尿酸(UA)、空腹血糖水平;采用MMSE、MoCA评价患者认知功能,采用Keypoint肌电图诱发电位仪进行ERP-P300检测,记录潜伏期和波幅;采用Fazekas评分评价脑白质病变程度。结果各组吸烟、高血压检出率比较,差异均有统计学意义(P0.05)。各组MMSE评分、ERP-P300波幅比较,差异无统计学意义(P0.05)。各组MoCA评分、ERP-P300潜伏期、Fazekas评分比较,差异均有统计学意义(P0.05);其中,轻中度狭窄组MoCA评分低于无狭窄组,重度狭窄组MoCA评分低于无狭窄组、轻中度狭窄组;轻中度狭窄组ERP-P300潜伏期长于无狭窄组,重度狭窄组ERP-P300潜伏期长于无狭窄组、轻中度狭窄组(P0.05)。MMSE对ACS患者认知功能障碍的检出率为16.8%(15/89),低于MoCA的检出率43.8%(39/89)(χ~2=18.892,P0.001)。多因素Logistic回归分析显示,高血压[OR=2.671,95%CI(1.877,3.609)]、ERP-P300潜伏期延长[OR=5.014,95%CI(2.983,8.429)]、颈动脉重度狭窄[OR=3.232,95%CI(1.134,9.208)]是ACS患者认知功能障碍的危险因素。结论 ACS患者可早期出现认知功能障碍,且与高血压、颈动脉狭窄程度有关;MoCA和ERP-P300在预测ACS患者认知功能障碍中较为敏感,可作为评价ACS患者认知功能障的辅助检查手段。
[Abstract]:Objective to evaluate the cognitive function of patients with asymptomatic carotid artery stenosis (ACS) by using event-related potential (ERP-P300) and mini-intelligence state check scale (MMSE),) Montreal Cognitive Assessment scale (MoCA) and to analyze the risk factors of cognitive dysfunction. Methods 179 ACS patients who were admitted to the Department of Neurology and outpatient Department of Neurology, Beijing Anzhen Hospital affiliated to Capital Medical University in 2015 were selected as the study subjects. According to the degree of carotid artery stenosis, 30% was no stenosis group (90 cases), 30 69% was mild to moderate stenosis group (49 cases), 70 99% was severe stenosis group (40 cases). Serum homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP), low density lipoprotein cholesterol (LDL-C), serum uric acid (UA), fasting blood glucose were collected, and the cognitive function was evaluated by MMSE MoCA. Keypoint electromyography evoked potentiometer was used to detect ERP-P300, to record latency and amplitude, and Fazekas score was used to evaluate the degree of white matter lesions. Results there were significant differences in smoking and hypertension detection rate in all groups (P 0.05). There was no significant difference in ERP-P300 amplitude of MMSE score in each group (P0.05). There were significant differences in MoCA score and ERP-P300 latency Fazekas score among them, the MoCA score of mild to moderate stenosis group was lower than that of non-stenosis group, the MoCA score of severe stenosis group was lower than that of non-stenosis group, and that of mild to moderate stenosis group was lower than that of non-stenosis group. The latency of ERP-P300 in mild to moderate stenosis group was longer than that in non-stenosis group, and ERP-P300 latency in severe stenosis group was longer than that in non-stenosis group. The detection rate of cognitive dysfunction in mild to moderate stenosis group (P0.05) .MMSE was 16.8% (15 / 89), which was lower than that in MoCA group (43.8%) (39 / 89) (蠂 ~ 2 + 18.892P0.001). Multivariate Logistic regression analysis showed that hypertension [ORO 2.671 卤95CI (1.877 卤3.609)] prolonged latent period of ERP-P300 [ORV 5.014995 CI (2.983 卤8.429)], severe carotid artery stenosis [ORN 3.232 卤95CI (1.1349.208)] were risk factors of cognitive dysfunction in ACS patients. Conclusion the patients with ACS may have early cognitive dysfunction, which is related to the degree of hypertension and carotid artery stenosis. MoCA and ERP-P300 are more sensitive in predicting the cognitive dysfunction in ACS patients, and can be used as an auxiliary examination method to evaluate the cognitive dysfunction in ACS patients.
【作者单位】：首都医科大学附属北京安贞医院神经内科;北京市密云县医院神经内科;
【分类号】：R543.4

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