颅内动脉粥样硬化性狭窄与认知功能的关系研究 Relationship between Intracranial Atherosclerotic Stenosis and Cognition

目的 探索颅内动脉粥样硬化性狭窄（intracranial atherosclerotic stenosis，ICAS）患者的认知功能改变。方法 本研究连续入组2021年12月—2022年12月就诊于北京协和医院神经内科门诊诊断为ICAS（狭窄＞50%）的患者，根据既往是否有狭窄侧血管负责的急性缺血性卒中或TIA，分为症状性ICAS组和无症状性ICAS组。同时纳入年龄及受教育年限相匹配的对照组。进行整体认知和各认知域（包括记忆、执行功能、语言功能、视空间结构功能）的测评。比较组间传统脑血管病危险因素、脑大小血管病负荷、脑萎缩、载脂蛋白E（apolipoprotein E，ApoE）基因型差异，筛选认知功能可能的影响因素，采用协方差分析控制混杂因素，比较3组间整体认知和各认知域Z分差异。 结果 本研究共纳入170例ICAS患者，其中无症状性ICAS患者103例[男性52例，平均年龄（55.86±11.78）岁]，症状性ICAS患者67例[男性44例，平均年龄（57.49±10.75）岁]，同时纳入91例对照[男性39例，平均年龄（56.21±9.70）岁]。症状性ICAS组较无症状性ICAS组后循环狭窄比例更高（40.3% vs. 22.3%，P=0.016），尤其是椎动脉狭窄（22.4% vs. 9.7%，P=0.028），脑白质高信号（Fazekas分级≥2级）（40.3% vs. 16.5%，P=0.001）和颞叶内侧萎缩[medial temporal atrophy（MTA）分级≥2级]的比例也更高（17.9% vs. 5.8%，P=0.020）。校正了年龄、受教育年限、性别、脑血管病危险因素（高血压、糖尿病、高脂血症、冠心病和吸烟史）、脑白质高信号和颞叶内侧萎缩的影响，发现无症状性ICAS组较对照组MoCA评分[（25.79±0.30）分 vs.（27.15±0.36）分，P=0.017]及语言功能Z分[（0.60±0.12）分 vs.（1.10±0.14）分，P=0.030]下降，症状性ICAS组较对照组MoCA评分[（24.18±0.39）分 vs.（27.15±0.36）分，P＜0.001]、语言功能Z分[（0.02±0.15)分 vs.（1.10±0.14）分，P＜0.001]下降更显著，症状性ICAS组较无症状性ICAS组MoCA评分[（24.18±0.39)分 vs.（25.79±0.30）分，P=0.003]及语言功能Z分[（0.02±0.15)分 vs.（0.60±0.12）分，P=0.006]、执行功能Z分[(-0.45±0.15)分 vs.（0.12±0.11）分，P=0.006]更低。 结论 症状性和无症状性ICAS患者均存在整体认知和语言功能的下降，同时症状性ICAS还存在执行功能下降。症状性ICAS的认知下降明显，独立于传统脑血管病危险因素、脑白质高信号和颞叶内侧萎缩。 Objective To evaluate the cognitive function changes in patients with intracranial atherosclerotic stenosis (ICAS) . Methods The patients diagnosed with ICAS (stenosis>50%) in Department of Neurology of Peking Union Medical College Hospital from December 2021 to December 2022 were consecutively enrolled in this study. Based on the presence or absence of previous ischemic stroke or transient ischemic attacks (TIA) caused by ICAS, they were classified into symptomatic or asymptomatic ICAS group. The healthy people matched for age and education were included in the control group. Global cognition and four cognitive domains (including memory, executive function, language function, visuospatial function) were evaluated in all the subjects. The differences in traditional cerebrovascular risk factors and cerebrovascular disease burden, brain atrophy and apolipoprotein E (ApoE) genotype were compared among the three groups, to screen the possible cognitive influencing factors. The global cognition and average Z-score of each cognitive domain were compared among the groups by covariance analysis controlling the confounders. Results A total of 170 patients with ICAS, including 103 patients with asymptomatic ICAS [52 males, mean age of (55.86±11.78) years] and 67 patients with symptomatic ICAS [44 males, mean age of (57.49±10.75) years], and 91 controls [39 males, mean age of (56.21±9.70) years] were included in this study. Compared with patients with asymptomatic ICAS, patients with symptomatic ICAS had a higher incidence of posterior circulation stenosis (40.3% vs. 22.3%, P=0.016) , especially vertebral artery stenosis (22.4% vs. 9.7%, P=0.028) , as well as higher incidence of white matter hyperintensities (Fazekas grade≥2) (40.3% vs. 16.5%, P=0.001) and medial temporal lobe atrophy [medial temporal atrophy (MTA) grade≥2] (17.9% vs. 5.8%, P=0.020) . After adjusting for age, gender, education years, cerebrovascular risk factors (hypertension, diabetes, hyperlipidemia, coronary heart disease and smoking) , white matter hyperintensities and medial temporal lobe atrophy, patients with asymptomatic and symptomatic ICAS had lower MoCA score (25.79±0.30 vs. 27.15±0.36, P=0.017; 24.18±0.39 vs. 27.15±0.36, P<0.001) and Z-score of language function (0.60±0.12 vs. 1.10±0.14, P=0.030; 0.02±0.15 vs. 1.10±0.14, P<0.001) compared with the controls; patients with symptomatic ICAS had lower MoCA score (24.18±0.39 vs. 25.79±0.30, P=0.003) and Z-score of language (0.02±0.15 vs. 0.60±0.12, P=0.006) and executive function (-0.45±0.15 vs. 0.12±0.11, P=0.006) than those with asymptomatic ICAS. Conclusions Patients with symptomatic or asymptomatic ICAS presented with declined global cognition and language function, and patients with symptomatic ICAS also showed declined executive function. The patients with symptomatic ICAS had more severe cognition decline, independent of traditional cerebrovascular risk factors, white matter hyperintensities, and medial temporal lobe atrophy.

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