CAJ | 학술논문

脑梗死%认知障碍%血流动力学%超声检查,多普勒,经颅%体层摄影术,发射型计算机,单光子%腔隙性脑梗死%血管运动反应性%脑血流灌注腦梗死%認知障礙%血流動力學%超聲檢查,多普勒,經顱%體層攝影術,髮射型計算機,單光子%腔隙性腦梗死%血管運動反應性%腦血流灌註
뇌경사%인지장애%혈류동역학%초성검사,다보륵,경로%체층섭영술,발사형계산궤,단광자%강극성뇌경사%혈관운동반응성%뇌혈류관주
Braininfarction%Cognitiveimpairment%Hemodynamics%Ultrasound,Doppler,transcranial%Tomography,emission-computed,single-photon%Lacunar infarction%Vascular motor reactivity%Cerebral blood flow perfusion

目的：探讨腔隙性脑梗死患者发病后2周内认知功能及脑血流动力学的变化。方法前瞻性连续纳入腔隙性脑梗死患者19例作为病例组，将性别、年龄匹配同期住院的无缺血性脑血管病的住院患者或门诊体检的健康志愿者23例作为对照组。应用经颅多普勒超声（TCD）“屏气试验”及单光子发射体层摄影（SPECT）“静息显像＋腺苷负荷试验”评价脑血流动力学特征；同时进行神经心理学测试，采用蒙特利尔认知评估量表（MoCA）对认知功能进行评价，包括执行能力、结构能力、记忆力（包括听觉记忆力、视觉记忆力和逻辑记忆力）、信息处理速度及视空间能力检查。结果（1）两组在受教育年限、高血压、糖尿病、高脂血症、冠心病及吸烟等方面比较，差异无统计学意义（均P＞0.05）。病例组MoCA评分、视觉记忆、执行功能、结构能力及信息处理速度与对照组差异有统计学意义（均P＜0.05）。（2）SPECT静息显像＋腺苷负荷试验共完成19例（对照组12例，病例组7例），病例组与对照组右侧基底节区放射性摄取比值（UR）[分别为8.91（－2.48～15.87）与－6.21（－10.39～5.42）]及左侧额叶UR[分别为11.62（2.93～16.87）与1.04（－10.17～3.82]比较，差异均有统计学意义（均P＜0.05）。（3）TCD屏气试验完成26例（对照组与病例组各13例），病例组的血管运动反应性[左侧（13±5）；右侧（21±7）]和呼吸抑制指数[左侧（0.66±0.26）；右侧（1.0±0.4）]与对照组的血管运动反应性[左侧（24±11）；右侧（30±9）]和呼吸抑制指数[左侧（1.21±0.57）；右侧（1.5±0.4）]比较，差异均有统计学意义（均P＜0.05）。结论腔隙性脑梗死早期已经存在不同程度的认知功能障碍和脑血流动力学的改变。
목적：탐토강극성뇌경사환자발병후2주내인지공능급뇌혈류동역학적변화。방법전첨성련속납입강극성뇌경사환자19례작위병례조，장성별、년령필배동기주원적무결혈성뇌혈관병적주원환자혹문진체검적건강지원자23례작위대조조。응용경로다보륵초성（TCD）“병기시험”급단광자발사체층섭영（SPECT）“정식현상＋선감부하시험”평개뇌혈류동역학특정；동시진행신경심이학측시，채용몽특리이인지평고량표（MoCA）대인지공능진행평개，포괄집행능력、결구능력、기억력（포괄은각기억력、시각기억력화라집기억력）、신식처리속도급시공간능력검사。결과（1）량조재수교육년한、고혈압、당뇨병、고지혈증、관심병급흡연등방면비교，차이무통계학의의（균P＞0.05）。병례조MoCA평분、시각기억、집행공능、결구능력급신식처리속도여대조조차이유통계학의의（균P＜0.05）。（2）SPECT정식현상＋선감부하시험공완성19례（대조조12례，병례조7례），병례조여대조조우측기저절구방사성섭취비치（UR）[분별위8.91（－2.48～15.87）여－6.21（－10.39～5.42）]급좌측액협UR[분별위11.62（2.93～16.87）여1.04（－10.17～3.82]비교，차이균유통계학의의（균P＜0.05）。（3）TCD병기시험완성26례（대조조여병례조각13례），병례조적혈관운동반응성[좌측（13±5）；우측（21±7）]화호흡억제지수[좌측（0.66±0.26）；우측（1.0±0.4）]여대조조적혈관운동반응성[좌측（24±11）；우측（30±9）]화호흡억제지수[좌측（1.21±0.57）；우측（1.5±0.4）]비교，차이균유통계학의의（균P＜0.05）。결론강극성뇌경사조기이경존재불동정도적인지공능장애화뇌혈류동역학적개변。
Objective Toinvestigatethechangesofcognitiveimpairmentandcerebralhemodynamics inpatientswithacutelacunarcerebralinfarctionwithin2weeksafteronset.Methods Nineteenpatients with lacunar cerebral infarction (a patient group)were consecutive enrolled in the study. Twenty-three sex-and age-matched inpatients without ischemic cerebrovascular disease or healthy volunteers of outpatient department over the same period were used as a control group. The cerebral hemodynamic features were evaluated with transcranial Doppler (TCD)"breath-holding test" and single photon emission computed tomography (SPECT)"resting + adenosine stress imaging". Simultaneously,the neuropsychological tests were performed,the Montreal cognitive assessment (MoCA)was performed including executive capacity, structural capacity,memory (including auditory memory,visual memory,and logic memory ),information processing speed,and visual-spatial ability. Results (1 )There were no significant differences in the years of education,hypertension,diabetes,hyperlipidemia,coronary heart disease,and smoking between the 2 groups (all P>0. 05). Compared with the control group,there were significant differences in the MoCA score,visual memory,executive function,structural capacity,and information processing speed of the patient group (all P<0. 05). (2)19 patients completed the SPECT resting + load test (12 in the control group and 7 in the patient group). There were significant differences in the uptake ratio (UR)in the right basal ganglia (8. 91[-2. 48 - 5. 87]and -6. 21 [-10. 39 - 5. 42 respectively])and left frontal lobe UR (11. 62 [2. 93-16. 87]and 1. 04 [-10. 17- 3. 82]respectively)between the patient group and the control group (P<0. 05). (3)26 patients completed the breath-holding test + head-up tilt table test (n=13 in each group]. The vascular motor reactivities were 13 ± 5 on the left and 21 ± 7 on the right, and the breath-holding indexes were 0. 66 ± 0. 26 on the left and 1. 0 ± 0. 4 on the right in the patient group;the vascular motor reactivities were 24 ± 11 on the left and 30 ± 9 on the right,and the breath-holding indexes were 1. 21 ± 0. 57 on the left and 1. 5 ± 0. 4 on the right in the control group. There were significant differencesbetweenthe2groups(P<0.05).Conclusion Attheearlystageoflacunarinfarction,the patients have presented varying degrees of cognitive impairment and the changes of cerebral hemodynamics.