腔隙性脑梗死认知障碍与颈动脉易损斑块的相关性研究
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摘要
目的探讨腔隙性脑梗死(lacunar infarction, LI)认知障碍与颈动脉易损斑块的关系。方法回顾性分析2017年1月至2018年11月就诊于北京市海淀医院(北京大学第三医院海淀院区)神经内科的符合LI诊断标准的患者171例,参照蒙特利尔认知评估量表(Montreal cognitive assessment, MoCA)进行评分,分为认知障碍组和无认知障碍组,均接受颈动脉超声检查,对颈动脉斑块与认知障碍之间的关系进行多因素logistic回归分析。结果颈动脉斑块数≥2个的患者的认知功能障碍患病率较高(OR=2.843, 95%CI:1.301～6.216,P=0.008),颈动脉易损斑块数≥2个的患者的认知功能障碍患病率较高(OR=2.870, 95%CI:1.339～6.153,P=0.007)。结论颈动脉斑块数、颈动脉易损斑块数与LI认知障碍呈正相关,随着斑块数量的增多,认知障碍呈现增加的趋势。
Objective To investigate the relationship between cognitive impairment of lacunar infarction(LI) and carotid vulnerable plaque. Methods A retrospective analysis of 171 patients with LI in Beijing Haidian Hospital from January2017 to November 2018 was performed. According to the scores of MoCA, the patients were divided into cognitive impairment group and non-cognitive disorder group. Carotid ultrasonography was performed to analyze the relationship between carotid plaque and cognitive impairment by logistic multivariate regression analysis. Results After adjustment for potential confounders, the prevalence of cognitive dysfunction was higher in patients with carotid plaque≥ 2 compared with the patients without carotid plaque(OR = 2.843,95% CI:1.301-6.216, P = 0.008). Patients with carotid vulnerable plaque≥ 2 had a higher prevalence of cognitive dysfunction(OR = 2.870,95% CI:1.339-6.153, P = 0.007). Conclusions The number of carotid plaques is positively correlated with LI cognitive impairment. With the increasement of plaque number, cognitive impairment may increase. The number of carotid vulnerable plaques is positively correlated with cognitive impairment. As the number of vulnerable plaques increases, cognitive impairment may increase.
Objective To investigate the relationship between cognitive impairment of lacunar infarction(LI) and carotid vulnerable plaque. Methods A retrospective analysis of 171 patients with LI in Beijing Haidian Hospital from January2017 to November 2018 was performed. According to the scores of MoCA, the patients were divided into cognitive impairment group and non-cognitive disorder group. Carotid ultrasonography was performed to analyze the relationship between carotid plaque and cognitive impairment by logistic multivariate regression analysis. Results After adjustment for potential confounders, the prevalence of cognitive dysfunction was higher in patients with carotid plaque≥ 2 compared with the patients without carotid plaque(OR = 2.843,95% CI:1.301-6.216, P = 0.008). Patients with carotid vulnerable plaque≥ 2 had a higher prevalence of cognitive dysfunction(OR = 2.870,95% CI:1.339-6.153, P = 0.007). Conclusions The number of carotid plaques is positively correlated with LI cognitive impairment. With the increasement of plaque number, cognitive impairment may increase. The number of carotid vulnerable plaques is positively correlated with cognitive impairment. As the number of vulnerable plaques increases, cognitive impairment may increase.
引文
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[26]Berman SE,Wang X,Mitchell CC,et al.The relationship between carotid artery plaque stability and white matter ischemic injury[J].Neuroimage Clin,2015,9:216-222.
[2]Lal BK,Dux MC,Sikdar S,et al.Asymptomatic carotid stenosis is associated with cognitive impairment[J].J Vasc Surg,2017,66:1083-1092.
[3]李耘,张亚欣,马丽娜.老年人轻度认知功能障碍与抑郁关系的研究进展[J].北京医学,2019,41:139-141.
[4]Makin SD,Turpin S,Dennis MS,et al.Cognitive impairment after lacunar stroke:systematic review and meta-analysis of incidence,prevalence and comparison with other stroke subtypes[J].J Neurol Neurosurg Psychiatry,2013,84:893-900.
[5]Wang X,Jackson DC,Varghese T,et al.Correlation of cognitive function with ultrasound strain indices in carotid plaque[J].Ultrasound Med Biol,2014,40:78-89.
[6]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29:379-380.
[7]勇强,张蕾,王丽娟,等.颈动脉斑块风险等级的超声评价[J].血管与腔内血管外科杂志,2016,2:278-281.
[8]Tsai CF,Thomas B,Sudlow CL.Epidemiology of stroke and its subtypes in Chinese vs white populations:a systematic review[J].Neurology,2013,81:264-272.
[9]Wang W,Jiang B,Sun H,et al.Prevalence,incidence,and mortality of stroke in China:results from a nationwide population-based survey of480 687 adults[J].Circulation,2017,135:759-771.
[10]Grau-Olivares M,Arboix A,Bartrés-Faz D,et al.Neuropsychological abnormalities associated with lacunar infarction[J].J Neurol Sci,2007,257:160-165.
[11]Edwards JD,Jacova C,Sepehry AA,et al.A quantitative systematic review of domain-specific cognitive impairment in lacunar stroke[J].Neurology,2013,80:315-322.
[12]Fure B,Bruun Wyller T,Engedal K,et al.Cognitive impairments in acute lacunar stroke[J].Acta Neurol Scand,2006,114:17-22.
[13]Lv P,Jin H,Liu Y,et al.Comparison of risk factor between lacunar stroke and large artery atherosclerosis stroke:a cross-sectional study in China[J].PLoS One,2016,11:e0149605.
[14]Wang A,Liu X,Chen G,et al.Association between carotid plaque and cognitive impairment in Chinese stroke population:the SOS-stroke study[J].Sci Rep,2017,7:3066.
[15]Rundek T,Arif H,Boden-Albala B,et al.Carotid plaque,a subclinical precursor of vascular events:the northern Manhattan study[J].Neurology,2008,70:1200-1207.
[16]Wang A,Chen G,Su Z,et al.Carotid intima-media thickness and cognitive function in a middle-aged and older adult community:a cross-sectional study[J].J Neurol,2016,263:2097-2104.
[17]Xiang J,Zhang T,Yang QW,et al.Carotid artery atherosclerosis is correlated with cognitive impairment in an elderly urban Chinese non-stroke population[J].J Clin Neurosci,2013,20:1571-1575.
[18]Bates ER,Babb JD,Casey DE,et al.ACCF/SCAI/SVMB/SIR/ASITN2007 clinical expert consensus document on carotid stenting:a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents(ACCF/SCAI/SVMB/SIR/ASITNClinical Expert Consensus Document Committee on Carotid Stenting)[J].J Am Coll Cardiol,2007,49:126-170.
[19]Brinjikji W,Huston J,Rabinstein AA,et al.Contemporary carotid imaging:from degree of stenosis to plaque vulnerability[J].J Neurosurg,2016,124:27-42.
[20]Mathiesen EB,Johnsen SH.Ultrasonographic measurements of subclinical carotid atherosclerosis in prediction of ischemic stroke[J].Acta Neurol Scand,2009,120:68-72.
[21]Hollander M,Bots ML,Del Sol AI,et al.Carotid plaques increase the risk of stroke and subtypes of cerebral infarction in asymptomatic elderly:the Rotterdam study[J].Circulation,2002,105:2872-2877.
[22]Arntzen KA,Schirmer H,Johnsen SH,et al.Carotid atherosclerosis predicts lower cognitive test results:a 7-year follow-up study of 4,371 stroke-free subjects-the Troms?study[J].Cerebrovasc Dis,2012,33:159-165.
[23]Gupta A,Baradaran H,Schweitzer AD,et al.Carotid plaque MRI and stroke risk:a systematic review and meta-analysis[J].Stroke,2013,44:3071-3077.
[24]Dempsey RJ,Vemuganti R,Varghese T,et al.A review of carotid atherosclerosis and vascular cognitive decline:a new understanding of the keys to symptomology[J].Neurosurgery,2010,67:484-493.
[25]Horie N,Morikawa M,Ishizaka S,et al.Assessment of carotid plaque stability based on the dynamic enhancement pattern in plaque components with multidetector CT angiography[J].Stroke,2012,43:393-398.
[26]Berman SE,Wang X,Mitchell CC,et al.The relationship between carotid artery plaque stability and white matter ischemic injury[J].Neuroimage Clin,2015,9:216-222.