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目的探讨不同部位颈内动脉重度狭窄或闭塞患者的脑血管反应性(cerebral vascular reactivity,CVR)和认知功能改变的特点及两者的相关性。方法选取颈内动脉重度狭窄或闭塞患者58例为病例组,按照狭窄部位分为左侧狭窄组、右侧狭窄组和双侧狭窄组,另选取正常人20例为对照组,采用经颅多普勒超声(transcranial Doppler,TCD)结合屏气试验分别检测各组屏气指数(breath-holding index,BHI),用蒙特利尔认知评估量表(Montreal Cognitive Assessment,Mo CA)评估各组的认知功能。结果病例组的BHI均低于对照组,双侧狭窄组低于左、右侧狭窄组;右侧狭窄组的Mo CA视空间/执行得分低于左侧狭窄组和对照组,左侧狭窄组的延迟记忆得分低于右侧狭窄组和对照组,双侧狭窄组的视空间/执行、延迟记忆和语言功能得分均低于对照组,且Mo CA总分低于左、右侧狭窄组;病例组内的BHI与Mo CA总分呈正相关(r=0.411,0.474,0.868,P<0.05)。结论 (1)颈内动脉重度狭窄或闭塞患者的BHI明显降低,认知功能也有不同程度损害;(2)颈内动脉重度狭窄或闭塞患者的BHI和Mo CA总分有明显关系,将两者结合可更全面地反映认知功能。
Objective To investigate the characteristics of cerebral vascular reactivity (CVR) and cognitive function in patients with severe stenosis or occlusion of internal carotid artery in different regions and their correlation. Methods Fifty-eight cases with severe stenosis or occlusion of internal carotid artery were selected as the case group. According to the stenosis, they were divided into left stenosis group, right stenosis group and bilateral stenosis group. 20 normal subjects were selected as control group, The breath-holding index (BHI) of each group was detected by transcranial Doppler (TCD) combined with breath holding test. The cognitive function of each group was evaluated by Montreal Cognitive Assessment (MoCA). Results The BHI in the case group was lower than that in the control group, and the bilateral stenosis group was lower than that in the left and right stenosis group. The Mo CA visual acuity / exercise score in the right stenosis group was lower than that in the left stenosis group and the control group, The delayed memory score was lower than the right stenosis group and the control group. The scores of visual space / performance, delayed memory and speech function in the bilateral stenosis group were lower than those in the control group, and the scores of Mo CA were lower than those in the left and right stenosis group. There was a positive correlation between BHI and total score of MoCA in case group (r = 0.411, 0.474, 0.868, P <0.05). Conclusions (1) Patients with severe stenosis or occlusion of internal carotid artery have significantly lower BHI and cognitive impairment with different degrees of impairment. (2) The total score of BHI and Mo CA in patients with severe stenosis or occlusion of internal carotid artery has a significant relationship. Combination can more fully reflect cognitive function.