万鸿平等

[摘要] 目的 探讨无症状性颈动脉狭窄（ACS）患者认知功能障碍的特点，研究支架植入联合药物治疗和单纯药物治疗对ACS患者认知功能的影响。 方法 选取湖北省中山医院神经内科ACS患者192例（ACS组）和颈动脉无狭窄患者100例（对照组），ACS组按狭窄程度分为轻度、中度、重度三组，比较认知功能的差异；将重度狭窄患者随机分为A组（支架植入联合药物治疗）、B组（药物治疗），检测A、B组在治疗前、治疗后1个月、治疗后3个月、治疗6个月认知功能的变化。 结果 ①ACS组与对照组、A组与B组的基线情况比较差异无统计学意义（P > 0.05）；②ACS组与对照组比较认知功能下降（P < 0.05）；③ACS组中度狭窄与轻度狭窄患者的认知功能比较差异有统计学意义（P < 0.05），重度狭窄患者较轻度、中度狭窄患者的认知功能显著下降（P < 0.05）；④对于ACS组重度狭窄患者的认知功能，A组患者治疗后1、3、6个月较治疗前有明显改善，治疗后3、6个月与治疗后1个月，治疗后6个月与治疗后3个月比较明显改善（P < 0.05）；B组患者药物治疗后1、3、6个月较治疗前均无明显变化，治疗后3个月与治疗后1个月、治疗后6个月与治疗后3个月比较差异无统计学意义（P > 0.05）。A组较B组治疗后1、3、6个月认知功能改善更明显（P < 0.05）。 结论 ACS患者存在认知功能障碍，狭窄程度越重认知功能损害越明显，对于重度狭窄患者，支架植入+药物治疗可改善认知功能。

[关键词] 无症状性颈动脉狭窄；支架植入；药物治疗；认知功能

[中图分类号] R543.5 [文献标识码] A [文章编号] 1673-7210（2015）05（b）-0057-05

Changes of cognitive function in patients with asymptomatic carotid stenosis

WAN Hongping DENG Xiaorong DU Min KE Wei

The First Department of Neurology， Zhongshan Hospital， Hubei Province， Wuhan 430031， China

[Abstract] Objective To investigate the features of cognitive impairment in patients with asymptomatic carotid stenosis and to research effect of treatment on cognitive functions by stenting implantation combined with drug therapy and simple drug. Methods 192 case of patients with ACS in Department of Neurology， Zhongshan Hospital （ACS group） and 100 cases of patients without carotid stenosis （control group ） were chosen. ACS group was divided into mild， moderate and severe groups according to the degree of stenosis. The cognitive function of all cases was compared. ACS patients with severe stenosis were randomly divided into group A （stenting combined drug therapy） and group B （drug therapy）. The change of cognitive function in group A and B before treatment and 1， 3 and 6 months after treatment was compared. Results ①The baseline of ACS group and control group， group A and group B had no significant differences （P > 0.05）. ②Compared with control group， the cognitive function of ACS group decreased obviously （P < 0.05）. ③Cognitive function of moderate stenosis and mild stenosis had significant difference （P < 0.05）. Cognitive function in patients with severe stenosis was decreased significantly compared with moderate， mild stenosis （P < 0.05）. ④Cognitive function of ACS patients with severe stenosis in the group A 1， 3 and 6 months after treatment was better than before treatment. After 3， 6 months of treatment， cognitive function was better than after treatment for 1 month， cognitive function after treatment for 6 months was better than 3 months after treatment （P < 0.05）. Cognitive function of group B after treatment for 1， 3 and 6 months showed no significant changes compared with before treatment. Cognitive function in 3 months after treatment had no significant change compared with 1 month after treatment. Cognitive function after treatment for 6 months had no significant difference compared with 3 months after treatment （P > 0.05）. The cognitive function of group A after treatment for 1， 3 and 6 months was improved obviously than group B （P < 0.05）. Conclusion ACS patients have cognitive impairment， the higher the degree of stenosis is， the more obvious the severe cognitive impairment is. Stenting with drug therapy can improve cognitive function in patients with severe stenosis.

[Key words] Asymptomatic carotid stenosis； Stent implantation； Drug treatment； Cognitive function

颈动脉狭窄是指颈总动脉狭窄和颈内动脉狭窄，是缺血性卒中的重要危险因素之一。当颈动脉狭窄伴有视网膜或脑缺血症状时，称为有症状性颈动脉狭窄；当缺乏上述表现时，则称为无症状性颈动脉狭窄（asymptomatic carotid stenosis，ACS）。ACS患者虽然“无症状”，但其存在颈动脉狭窄，而颈动脉狭窄与认知功能障碍明确相关[1-3]。本研究旨在探讨ACS患者认知功能障碍的特点，并研究支架植入治疗和药物治疗对无症状性重度颈动脉狭窄患者认知功能的影响，希望能给临床工作提供一定的指导意义。

1 资料与方法

1.1 一般资料

病例组：选取2013年1月～2014年12月在湖北省中山医院（以下简称“我院”）神经内科住院的ACS患者192例，男99例，女93例，平均年龄……