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目的：探讨伴颈动脉狭窄的腔隙性脑梗死患者介入治疗术后认知功能的变化及其影响因素。方法对60例接受介入治疗的伴颈动脉狭窄的腔隙性脑梗死患者（介入治疗组）及68例不伴颈动脉狭窄的腔隙性脑梗死患者（药物治疗组），分别在入组时及入组1、6、12个月进行神经心理学测验，并与60例健康体检者（对照组）进行比较，观察不同时间患者的认知变化。神经心理学测验包括简易智能状态检查量表（MMSE）、蒙特利尔认知评价量表（MoCA）及认知域测验。结果介入治疗组和药物治疗组入组时除执行功能中Stroop测验C部分和韦氏成年人智力量表（WAIS-RC）图片排列分测验外，各项评分与对照组比较差异有统计学意义（P＜0.05）。药物治疗组与介入治疗组入组时各项评分比较差异无统计学意义（P＞0.05）。介入治疗组入组12个月MMSE评分，MoCA总分，Rey-Osterrieth复杂图形记忆测验（ROCFT），听觉词语学习测验（AVLT），执行功能中WAIS-RC图片排列分测验、语义分类流畅性测验、WAIS-RC数字广度倒背分测验均较入组时明显改善，差异有统计学意义（P＜0.05）；其中入组6个月MMSE评分，MoCA总分，ROCFT中长时延迟记忆，AVLT中即刻记忆、长时延迟记忆和短时延迟记忆，执行功能中语义分类流畅性测验和WAIS-RC数字广度倒背分测验已较入组时明显改善[（27.8±2.2）分比（26.4±1.9）分、（20.7±2.3）分比（19.3±2.0）分、（12.4±3.2）分比（10.8±2.6）分、（54.3±10.6）分比（49.9±10.9）分、（12.4±2.0）分比（11.2±2.8）分、（12.9±2.0）分比（10.6±2.6）分、（17.5±4.0）分比（15.4±3.4）分、（4.0±0.9）分比（3.5±0.9）分]，差异有统计学意义（P＜0.05）。药物治疗组入组1、6个月各项评分与入组时比较差异无统计学意义（P＞0.05）；入组12个月MMSE评分，MoCA总分，ROCFT，AVLT中即刻记忆、长时延迟记忆、短时延迟记忆，执行功能中WAIS-RC图片排列分测验、语义分类流畅性测验和WAIS-RC数字广度倒背分测验较入组时明显改善，差异有统计学意义（P＜0.05）。介入治疗组与药物治疗组入组12个月各项评分比较差异无统计学意义（P>0.05）。Logistic回归分析结果显示，介入治疗组患者MoCA总分与年龄、高血压及低受教育程度相关（P＜0.01或＜0.05），而MoCA总分与吸烟、糖尿病、介入治疗无关（P＞0.05）。结论伴颈动脉狭窄的腔隙性脑梗死急性期认知损害比较广泛而严重，介入治疗后12个月内大多数可恢复正常。

Objective To analyze the cognitive changes and influencing factors in patients with lacunar cerebral infarction after carotid artery intervention therapy. Methods Sixty lacunar cerebral infarction combined with carotid stenosis patients treated with artery intervention therapy (intervention therapy group) and 68 lacunar cerebral infarction without carotid stenosis patients treated with drug therapy (drug therapy group) were selected. The neuropsychological test was completed at entry and 1, 6, 12 months after entry, and the results were compared with 60 healthy controls (control group). The cognitive changes were observed. The neuropsychological test included mini mental state examination (MMSE), Montreal cognitive assessment scale (MoCA) and cognitive field test. Results There were statistical differences in other scores except the Stroop test C section and Wechsler adult intelligence scale (WAIS-RC) picture arrangement subtest at entry in intervention therapy group and drug therapy group compared with control group (P<0.05). There were no statistical differences in the all scores at entry between drug therapy group and intervention therapy group (P>0.05). In intervention therapy group, the MMSE scores, MoCA total score, Rey-Osterrieth complex figure test (ROCFT), auditory verb learning test (AVLT), and the WAIS-RC picture arrangement subtest, verbal fluency test, WAIS-RC digit span backwards subtest of performing function 12 months after entry were significantly better than those at entry, and there were statistical differences (P<0.05). MMSE score, MoCA total score, long-time delayed recall of ROCFT, the immediate recall, long-time delayed recall and short delayed recall of AVLT, semantic category fluency test of performing function and digit span backwards subtest of WAIS-RC 6 months after entry were significantly better than those at entry:(27.8 ± 2.2) scores vs. (26.4 ± 1.9) scores, (20.7 ± 2.3) scores vs. (19.3 ± 2.0) scores, (12.4 ± 3.2) scores vs. (10.8 ± 2.6) scores, (54.3 ± 10.6) scores vs. (49.9 ± 10.9) scores, (12.4 ± 2.0) scores vs. (11.2 ± 2.8) scores, (12.9 ± 2.0) scores vs. (10.6 ± 2.6) scores, (17.5 ± 4.0) scores vs. (15.4 ± 3.4) scores and (4.0 ± 0.9) scores vs. (3.5 ± 0.9) scores, and there were statistical differences (P<0.05). In drug therapy group, there were no statistical differences in the all scores 1 and 6 months after entry, compared with that at entry (P>0.05);the MMSE score, MoCA total score, ROCFT, the immediate recall, long-time delayed recall and short delayed recall of AVLT, WAIS-RC picture arrangement subtest, verbal fluency test, WAIS-RC digit span backwards subtest of performing function and digit span backwards subtest of WAIS-RC 12 months after entry were significantly better than those at entry, and there were statistical differences (P<0.05). There were no statistical differences in all scores 12 months after entry between intervention therapy group and drug therapy group (P>0.05). In patients intervention therapy group, Logistic regression analysis showed that the MoCA score was related with age, hypertension and low education level (P<0.01 or<0.05), but was not related with smoking, diabetes and interventional treatment (P>0.05). Conclusions Cognitive impairment in patients with lacunar cerebral infarction and carotid stenosis is severe and extensive, but most cognition disorders can improve to normal level 12 months after artery intervention therapy.