CAJ | 학술논문

目的探讨颈动脉支架置入术(CAS)对腔隙性脑梗死患者认知功能的影响及相关危险因素.方法采用蒙特利尔认知评价量表(MoCA)、简易精神状态检查(MMSE)分别对43例腔隙性脑梗死患者颈动脉支架置入术前及术后1月、6月、1年、2年进行神经心理学测验,并与41例正常人比较.结果与对照组比较,治疗组患者MMSE评分在术前及术后1月、6月,MoCA评分在术前(19.39±2.17)分、术后1月(19.51±1.99)分,复制立方体在术前,交替连线测验、注意、延迟回忆在术前、术后1月,画钟在术前及术后1月、6月均明显降低,差异有统计学意义(P＜0.05或P＜0.01).与术前比较,治疗组患者MMSE、MoCA评分在术后6月、1年、2年,交替连线测验在术后2年,复制立方体、画钟在术后1年、2年,注意、延迟回忆在术后6月、1年、2年均明显升高,差异有统计学意义(P＜0.05或P＜0.01).在随访2年时Logistic回归分析表明,MoCA评分与患者年龄(OR=50.751,95％ CI1.407 ～ 19.464; P=0.006)、高血压(OR=8.012,95％ CI1.212～27.550; P=0.042)、低教育水平(OR=11.586,95％ CI1.164～16.903; P=0.029)有相关性,与糖尿病、CAS无相关性.结论腔隙性脑梗死患者认知功能损害在CAS 2年后明显改善,且以视空间功能、注意力、延迟回忆为著,但CAS不是认知功能的独立保护因素,高龄、高血压、低教育水平是其独立危险因素.
목적 탐토경동맥지가치입술(CAS)대강극성뇌경사환자인지공능적영향급상관위험인소.방법 채용몽특리이인지평개량표(MoCA)、간역정신상태검사(MMSE)분별대43례강극성뇌경사환자경동맥지가치입술전급술후1월、6월、1년、2년진행신경심이학측험,병여41례정상인비교.결과 여대조조비교,치료조환자MMSE평분재술전급술후1월、6월,MoCA평분재술전(19.39±2.17)분、술후1월(19.51±1.99)분,복제립방체재술전,교체련선측험、주의、연지회억재술전、술후1월,화종재술전급술후1월、6월균명현강저,차이유통계학의의(P＜0.05혹P＜0.01).여술전비교,치료조환자MMSE、MoCA평분재술후6월、1년、2년,교체련선측험재술후2년,복제립방체、화종재술후1년、2년,주의、연지회억재술후6월、1년、2년균명현승고,차이유통계학의의(P＜0.05혹P＜0.01).재수방2년시Logistic회귀분석표명,MoCA평분여환자년령(OR=50.751,95％ CI1.407 ～ 19.464; P=0.006)、고혈압(OR=8.012,95％ CI1.212～27.550; P=0.042)、저교육수평(OR=11.586,95％ CI1.164～16.903; P=0.029)유상관성,여당뇨병、CAS무상관성.결론 강극성뇌경사환자인지공능손해재CAS 2년후명현개선,차이시공간공능、주의력、연지회억위저,단CAS불시인지공능적독립보호인소,고령、고혈압、저교육수평시기독립위험인소.
Objective To explore the influence of the cognitive function and related dangerous factors in patients lacunar infarction(LI) after carotid artery stenting (CAS).Methods Neuropsychological tests (MoCA and MMSE)were conducted in 43 patients with LI before CAS,1 month,6 months,1 year and 2 years after CAS and the scores were compared with those of 41 healthy cases.Results Compared with control group,in therapy group,MMSE scores before CAS,1 month and 6 months after CAS,MoCA scores before CAS(19.39 ±2.17) and 1 month after CAS(19.51 ± 1.99) and the scores of Cube Copying before CAS,Alternating Trail Making Test,attention and delayed recall before CAS,1 month after CAS and Clock Drawing before CAS,1 month and 6 months after CAS all lowered obviously.There were statistical differences(P＜ 0.05 or P ＜ 0.01).Compared with before CAS,in therapy group,MMSE scores and MoCA scores 6 months,1 year and 2 years after CAS,the scores of Alternating Trail Making Test 2 years after CAS,Cube Copying and Clock Drawing 1 year and 2 years after CAS and attention and delayed recall 6 months,1 year and 2 years after CAS all increased obviously.There were statistical differences (P ＜ 0.05 or P ＜ 0.01).In the follow-up of 2 years,the result of Logistic Regression Analysis showed that MoCA scores has correlation with age(OR =50.751,95％ CI 1.407 ～ 19.464; P =0.006),high blood pressure(0R=8.012,95％ CI1.212 ～27.550; P=0.042)and low levels of education(OR=11.586,95％ CI1.164～ 16.903 ; P =0.029) and no correlation with diabetes and CAS.Conclusion Cognitive impairment in patients with LI is improved 2 years after CAS,and visuospatial function,attention and delayed recall are significantly improved.But CAS is not independent protective factors for cognitive functions,and old age,low education levels and high blood pressure are independent risk factors for cognitive impairment in patients with LI.