Correlation of carotid artery color Doppler ultrasound examination indexes, white matter lesions and cognitive function changes
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摘要:
目的 探讨双侧颈动脉内膜-中层厚度、斑块的数量和狭窄程度与脑白质病变（WML）及认知功能改变的相关性。 方法 纳入2020年1月~2021年1月就诊于连云港市第一人民医院神经内科的146例患者作为研究对象，其中73例WML患者作为WML组，73例非WML患者作为非WML组，采取前瞻性观察性队列研究方法，对患者进行认知功能评分、颈部血管彩超、头颅MRI的WML程度评分，分析颈动脉病变各指标与WML程度量表评分、认知功能量表评分的关联性，探索颈动脉病变与WML和认知功能障碍的关系。 结果 WML组患者颈动脉内膜-中层厚度、斑块的数量总分和狭窄程度总分高于非WML组（1.97± 0.83 mm vs 0.87±0.12 mm，6±3.28分vs 4±1.96分，4.83±1.17分vs 2.89±1.05分，P < 0.05）；WML组患者MoCA量表评分高于非WML组（18±6.82分vs 10±5.67分，P < 0.01）。对WML组患者颈动脉彩超指标与WML程度评分的相关性分析发现，WML组患者颈动脉内膜-中层厚度（r=0.828，P=0.020）、狭窄程度（r=0.897，P=0.010）和WML程度评分相关；而斑块的数量和WML程度评分之间无相关关系（P > 0.05）。对WML组患者颈动脉彩超指标与MoCA评分的相关性分析发现，WML组患者颈动脉内膜-中层厚度（r=-0.793，P=0.020）、狭窄程度（r=-0.873，P=0.010）和MoCA量表评分相关，而斑块的数量和MoCA评分不相关（P > 0.05）。WML组患者MoCA量表评分与WML程度评分呈负相关（r=-0.837，P < 0.01）。 结论 颈部血管彩超的颈动脉内膜-中层厚度以及血管狭窄程度与WML程度、认知功能障碍相关，WML程度与认知功能障碍程度呈负相关，颈动脉彩超对于临床诊断和预测WML和认知功能障碍具有一定的指导作用。 Abstract:Objective To investigate the correlation between the intima-media thickness of the bilateral carotid arteries, the number of plaques and the degree of stenosis, white matter lesions (WHL) and cognitive function changes. Methods A total of 146 patients in our hospital from January 2020 to January 2021 were selected. Among the patients, 73 patients with WHL were treated as WHL group, and 73 non-WHL patients were treated as non-WHL group. For patients with WHL, a prospective observational cohort study method was performed. Cognitive function scores, cervical vascular color Doppler ultrasound, and head MRI WHL were scored for each case, and various indicators of carotid artery lesions and WHL scales were analyzed. The correlation between score and cognitive function scale score, to explore the relationship between carotid artery disease and WHL and cognitive dysfunction. Results The intima-media thickness, total number of plaque points and total stenosis degree points in WML group were higher than those in non-WML group (1.97±0.83 mm vs 0.87±0.12 mm, 6±3.28 vs 4±1.96, 4.83±1.17 vs 2.89±1.05, P < 0.05). The MoCA score of WML group was significantly higher than that of non-WML group (18±6.82 vs 10±5.67, P < 0.01). The correlation analysis of carotid artery color doppler ultrasound index and WML degree score showed that carotid intima-media thickness (r=0.828, P=0.020), stenosis degree (r=0.897, P=0.010) and WML degree score were correlated. The number of plaques and the WML degree showed no correlation (P > 0.05). The correlation analysis of carotid artery color doppler ultrasound index and MoCA score in the WML group showed that intima-media thickness (r=-0.793, P=0.020), stenosis degree (r=-0.873, P=0.010) and MoCA scale score were correlated in the WML group. There was no correlation between plaque number and MoCA score (P > 0.05). The correlation analysis of the MoCA scale score and the WHL degree score of the WHL group showed that the MoCA scale score and the WHL degree score of the WHL group were negatively correlated (r=-0.837, P < 0.01). Conclusion The carotid intima-media thickness and the degree of vascular stenosis of cervical vascular color Doppler ultrasound are related to the degree of WHL and cognitive dysfunction. The degree of WHL is negatively correlated with the degree of cognitive dysfunction. Carotid artery color Doppler ultrasound is useful for clinical diagnosis. And predict WML and cognitive dysfunction has a certain guiding role. -
图 1 58岁男性患者的头颅MRI检查，T1WI（A）、T2WI（B）、轴位弥散加权成像（C）、T2液体衰减反转恢复序列（D）
Figure 1. Head MRI images of a 58-year-old male patient. T1WI (A), T2WI (B), axial diffusion weighted imaging (C) and T2 fluid attenuation inversion recovery sequence (D).
图 2 患者的颈部彩超图
A: 非WML组典型病例患者, 女, 62岁; B: WML组典型病例患者, 女, 65岁.
Figure 2. Neck color Doppler ultrasound images of two patients.
图 3 WML患者患者WML程度与MoCA评分的散点图
Figure 3. Scatter plot of white matter damage and MoCA score in patients with WML.
表 1 两组颈动脉内膜-中层厚度、斑块的数量和狭窄程度及MoCA量表评分比较
Table 1. Comparison of carotid intima-media thickness, plaque number and degree of stenosis and MoCA score between two groups (n=73, Mean±SD)
组别 颈动脉内膜-中层厚度（mm） 斑块的数量总分 狭窄程度总分 MoCA量表评分 WML组 1.97±0.83 6±3.28 4.83±1.17 18±6.82 非WML组 0.87±0.12 4±1.96 2.89±1.05 10±5.67 t 8.70 15.34 10.58 7.89 P 0.010 0.040 0.020 < 0.01 WML: 脑白质病变. 
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表 2 WML患者颈动脉彩超指标与WML程度的相关性
Table 2. Correlation between carotid artery color Doppler ultrasound and white matter damage in WML patients
项目 r P 颈动脉内膜-中层厚度 0.828 0.020 斑块的数量 0.162 0.203 颈动脉狭窄程度 0.897 0.010
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表 3 WML患者颈动脉彩超指标与MoCA评分的相关性
Table 3. Correlation between carotid artery color Doppler ultrasound and MoCA score in WML patients
项目 r P 颈动脉内膜-中层厚度 -0.793 0.020 斑块的数量 0.089 0.360 颈动脉狭窄程度 -0.873 0.010
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