摘要
目的以神经心理学量表及磁共振影像学改变作为观察指标，探索颈动脉狭窄支架植入术对认知功能以及脑功能的影响。方法选取自2015年6月至2016年9月在东南大学附属中大医院介入与血管外科行脑血管造影证实单侧或双侧颈内动脉重度狭窄的33例患者，将拟行颈动脉支架植入术的17例患者纳入支架组，拟行药物保守治疗的16例患者纳入对照组，进行神经心理学量表及静息态磁共振血氧水平依赖脑功能成像检查，并在6个月后对其进行随访，比较两组随访结果与基线之间的差异。结果支架组总体认知功能较前有明显改善（P〈0．05），主要体现在反映执行功能、记忆力、注意力等相关量表。而对照组基线与随访结果之间的差异并无统计学意义（P〉0．05）。支架组术后较术前低频振幅（ALFF）信号增加（P〈0．05，Alphasim校正）的脑区包括左侧上内侧额叶（t=5．8613，P〈0．05）、左侧顶叶体感联合皮质（t=5．6012，P〈0．05）、双侧额后部皮质运动前区（t=5．2885，P〈0．05）。支架组术后较术前ALFF信号减低（P〈0．05，Alphasim校正）的脑区包括左侧压后扣带皮质（t=-5．5904，P〈0．05）、左侧岛叶（t=-6．3408，P〈0．05）、右侧岛叶（t=-8．1299，P〈0．05）、左侧背侧前扣带皮质（t=-5．5848，P〈0．05）。对照组随访较基线ALFF无存在统计学意义的差异脑区（P〉0．05，Alpbasim校正）。此外，左侧岛叶的ALFF变化值与听觉词语学习测验变化之间呈负相关（r=-0．591，P=0．033），双侧皮质运动前区ALFF变化值与听觉词语学习测验变化之间呈负相关（r=-0．659，P=0．014），双侧皮质运动前区ALFF变化值与听觉词语学习延迟回忆测验变化之间呈负相关（r=-0．558，P：0．034），右侧岛叶ALFF变化值与额叶功能评定量表之间呈正相关（r=0．638，P=0．025）。结论颈动脉狭窄患者支架术后较药物保守治疗总体认知功能有改善，相应脑区也存在ALFF值的变化，主要体现在默认网络之间的调整，这可能与CAS术后患者神经功能恢复的机制有关。
Objective To investigate the effect of carotid artery stenting （CAS） on cognitive function and brain function based on changes of a battery of neuropsyehological tests and magnetic resonance imaging. Methods Thirty-three patients were included with 17 in the stent-placement group and 16 in the control group （receiving medical treatment）, among whom, the unilateral or bilateral severe internal carotid artery stenosis was confirmed by cerebral vascular angiography in the department of Interventional Radiology and Vascular Surgery of Zhongda Hospital Southeast University from June 2015 to September 2016. Neuropsychological tests and rest-state blood oxygenation level dependent fMRI were performed at the baseline and six months follow-up. The baseline characteristics and follow-up changes were compared in each group. Results The overall cognitive function of the stent-placement group was statistically significantly improved （ P 〈 0. 05 ） compared with control group, mainly in the executive function, memory, attention and other aspects. The value of amplitude of low-frequency fluctuation （ALFF） showed statistically significant increase （P 〈 0. 05, Alphasim correction） in left prefrontal cortex （ t = 5. 861 3, P 〈 0. 05 ）, the somatosensory association cortex in left superior parietal lobe （ t = 5. 601 2, P 〈 0. 05 ） and bilateral motor cortical area in posterior frontal lobe （ t = 5. 288 5, P 〈 0. 05 ）. The ALFF showed statistically significant decrease （ P 〈 0. 05, Alphasim correction） in left retrosplenial cingulate cortex （ t = - 5. 590 4, P 〈 0. 05 ）, left insular cortex （ t = - 6. 340 8,P 〈 O. 05 ）, right insular cortex （ t = - 8. 129 9,P 〈 0. 05 ） and left dorsal anterior cingulate cortex （ t = - 5. 584 8, P 〈 0.05 ）. There was no statistically significant difference （ P 〉 O. 05 ,Alphasim correction）between baseline and follow-up results in control group. Besides, the ALFF changes of the left insular cortex （r = -0. 591 ,P = 0. 033 ） and bilateral motor cortical area （r = -0. 659, P =0. 014） were negatively correlated with auditory verb learning test （AVLT） score changes. The ALFF change of bilateral motor cortical area was negatively correlated with the AVLT-delay score change （ r = -0. 588,P= 0. 034）. And the ALFF change on right insular cortex and the frontal assessment battery （FAB） score change was positively correlated （r = 0. 638 ,P = 0. 025 ）. Conclusions The overall cognitive function of patients with carotid artery stenosis significantly improve after CAS compared with medical treatment. The change of ALFF value in related brain area is also statistically significant. ALFF Change most in area of Default Mode Network may suggest a mechanism of postoperative neurological recovery in patients with carotid arterystenosis.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第39期3093-3098,共6页
National Medical Journal of China
关键词
颈动脉狭窄
血管成形术
认知
磁共振成像
Carotid artery stenosis
Angioplasty
Cognition
Magnetic resonanee imaging
