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中华脑血管病杂志(电子版) ›› 2025, Vol. 19 ›› Issue (02) : 94 -99. doi: 10.3877/cma.j.issn.1673-9248.2025.02.003

论著

无症状大脑后动脉粥样硬化性狭窄与认知功能的关系
程安琪1, 邹胤曦1, 司倩倩1, 范晓媛2, 张晓倩2, 李明利2, 冯逢2, 刘彩燕1,(), 徐蔚海1,()   
  1. 1. 100730 中国医学科学院北京协和医院神经科
    2. 100730 中国医学科学院北京协和医院放射科
  • 收稿日期:2024-11-22 出版日期:2025-04-01
  • 通信作者: 刘彩燕, 徐蔚海
  • 基金资助:
    国家杰出青年科学基金项目(82025013)中央高水平医院临床科研项目(2022-PUMCH-C-001,2022-PUMCH-D-007)北京市自然科学基金项目(7222131)

Association between asymptomatic posterior cerebral artery therosclerotic stenosis and cognitive function

Anqi Cheng1, Yinxi Zou1, Qianqian Si1, Xiaoyuan Fan2, Xiaoqian Zhang2, Mingli Li2, Feng Feng2, Caiyan Liu1,(), Weihai Xu1,()   

  1. 1. Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
    2. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2024-11-22 Published:2025-04-01
  • Corresponding author: Caiyan Liu, Weihai Xu
引用本文:

程安琪, 邹胤曦, 司倩倩, 范晓媛, 张晓倩, 李明利, 冯逢, 刘彩燕, 徐蔚海. 无症状大脑后动脉粥样硬化性狭窄与认知功能的关系[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(02): 94-99.

Anqi Cheng, Yinxi Zou, Qianqian Si, Xiaoyuan Fan, Xiaoqian Zhang, Mingli Li, Feng Feng, Caiyan Liu, Weihai Xu. Association between asymptomatic posterior cerebral artery therosclerotic stenosis and cognitive function[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2025, 19(02): 94-99.

目的

探讨无症状大脑后动脉粥样硬化性狭窄(aPCAS)患者的整体认知和各认知域测试变化特征。

方法

选择2021年2月至2024年7月于北京协和医院神经内科门诊诊断为aPCAS(狭窄>50%)的患者19 例,同时纳入年龄、性别及受教育年限相匹配的对照组53 例。使用线性回归比较2 组患者的各认知域(包括记忆、注意、执行、视空间、语言、计算)Z 分及认知测试[包括简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)及各认知域对应测验]结果差异,并校正人口学信息。P 值经Bonferroni 矫正。

结果

与对照组相比,aPCAS 组的MoCA 分数[(23.11±4.25)分vs(26.47±3.03)分,β=-3.46,95%CI:-4.88~-2.03,P<0.001]显著降低,记忆域[(-0.94±0.73)分vs(-0.27±0.73)分,β=-0.67,95%CI:-1.07~-0.28,P=0.001]、语言域[(-0.09±0.88)分 vs(0.83±0.85)分,β=-0.91,95%CI:-1.37~-0.46,P<0.001]和计算域[(-0.82±0.91)分 vs(0.02±0.92)分,β=-0.84,95%CI:-1.34~-0.33,P=0.001]Z 分显著降低。

结论

aPCAS 患者虽然无卒中发作,但在脑皮层萎缩和脑白质高信号病变负荷较低的情况下仍存在认知功能损害,应被视作痴呆高风险人群。

Objective

To explore the characteristics of global cognitive function and domain-specific cognitive test performance in patients with asymptomatic posterior cerebral artery atherosclerotic stenosis (aPCAS).

Methods

A total of 19 patients diagnosed with aPCAS (stenosis >50%) at the Neurology Department of Peking Union Medical College Hospital between February 2021 and July 2024 were enrolled, along with 53 age-, sex-, and education-matched control subjects.Linear regression models were used to compare Z-scores across cognitive domains (including memory, attention, executive function, visuospatial ability, language, and calculation) and cognitive test results [including the mini-mental state examination (MMSE), Montreal cognitive assessment(MoCA), and domain-specific subtests] between the two groups, with demographic variables statistically adjusted.P-values were corrected using the Bonferroni method.

Results

Compared to the control group, the aPCAS group exhibited significantly lower MoCA scores [(23.11±4.25) vs(26.47±3.03), β=-3.46, 95% CI: -4.88 to -2.03, P<0.001], as well as reduced Z-scores in the memory[(-0.94±0.73) vs (-0.27±0.73), β=-0.67, 95% CI:-1.07 to -0.28, P=0.001], language [(-0.09±0.88) vs(0.83±0.85), β=-0.91, 95% CI: -1.37 to -0.46, P<0.001], and calculation [(-0.82±0.91) vs (0.02±0.92),β=-0.84, 95% CI: -1.34 to -0.33, P=0.001].

Conclusion

Despite the absence of stroke episodes,aPCAS patients demonstrate cognitive impairment even with mild cortical atrophy and low white matter hyperintensity burden, indicating that they should be considered a high-risk population for dementia.

表1 aPCAS 组和对照组人口学、血管危险因素和影像学特征[例(%)]
表2 aPCAS 组与对照组整体认知及各认知测验检测结果的比较
表3 aPCAS 组与对照组各认知域Z 分的比较
表4 亚组分析aPCAS 患者各认知域Z 分的比较
亚组别 记忆 注意 执行 视空间 语言 计算
P2 或P3 段重度狭窄(6 例) -0.95±0.97 0.10±0.58 -0.06±0.78 1.18±0.41 -0.08±1.10 -0.57±0.58
P1 段重度狭窄(13 例) -0.94±0.64 -0.18±0.62 -0.33±0.71 -0.01±2.93 -0.09±0.80 -0.94±1.04
β(95% CI)P1 vs P2或P3 段重度狭窄 0.01(-0.77~0.79) -0.28(-0.91~0.36) -0.27(-1.04~0.49) -1.18(-3.77~1.40) -0.01(-0.95~0.93) -0.36(-1.34~0.61)
R 2 <0.001 0.047 0.032 0.056 <0.001 0.037
P 0.970 0.371 0.462 0.346 0.976 0.442
无非PCA 颅内动脉狭窄(9 例) -1.23±0.61 -0.21±0.43 -0.37±0.68 0.81±0.79 -0.46±0.97 -0.66±0.68
有非PCA 颅内动脉狭窄(10 例) -0.68±0.76 0.02±0.74 -0.14±0.78 0.05±3.23 0.25±0.66 -0.94±1.08
β(95% CI)有 vs 无非PCA颅内动脉狭窄 0.54(-0.13~1.21) 0.23(-0.37~0.82) 0.23(-0.48~0.95) -0.76(-3.25~1.74) 0.72(-0.08~1.51) -0.28(-1.22~0.65)
R 2 0.147 0.037 0.027 0.025 0.175 0.025
P 0.105 0.432 0.501 0.528 0.075 0.530
无胚胎型大脑后动脉或后交通开放(14 例) -1.09±0.77 -0.03±0.52 -0.19±0.74 0.11±2.84 -0.21±0.97 -0.95±0.98
胚胎型大脑后动脉或后交通开放(5 例) -0.51±0.36 -0.27±0.85 -0.40±0.72 1.09±0.37 0.26±0.42 -0.46±0.64
β(95%CI)有 vs 无胚胎型大脑后动脉或后交通开放 0.59(-0.18~1.35) -0.24(-0.92~0.43) -0.21(-1.02~0.61) 0.98(-1.77~3.73) 0.47(-0.49~1.43) 0.49(-0.52~1.51)
R 2 0.133 0.033 0.017 0.034 0.059 0.062
P 0.125 0.458 0.598 0.461 0.317 0.320
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