Study On Collateral Circulation And Cognitive Function And TCM Constitution In Patients With Middle Cerebral Artery Severe Stenosis Or Occlusion

Objective1.To study the relationship between collateral circulation,cerebral perfusion and cognitive function and its influencing factors in patients with asymptomatic MCA severe stenosis or occlusion.2.To study the correlation between cerebral infarction or cognitive impairment and TCM constitution in patients with MCA severe stenosis or occlusion.Methods1.Thirty-seven patients with asymptomatic unilateral MCA severe stenosis or occlusion who were admitted to the neurology department of General hospital of the PLA central theater of operations from May 2018 to January 2020 were prospectively included.General data of the enrolled patients were collected.320 CTA combined CTP imaging was used to identify the collateral state and cerebral perfusion of the enrolled patients.According to the collateral state,the patients were divided into good collateral group and bad collateral group.The Mo CA and MMSE scales were used to assess the overall cognition.The multidimensional cognition scale was used to evaluate the multidimensional cognition,including the Auditory words memory test(AVLT-R,AVLT-T), the Stroop color word interference test(Stroop-C,Stroop-W,Stroop-WC),Digit span test(DS-F,DS-B),Verbal fluency test(VFT-F,VFT-V,VFT-A),Boston naming test(BNT),Ray's complex graphics test(RCFT-R,RCFT-C).The cerebral perfusion,overall cognitive function and multidimensional cognitive function in different collateral states will be evaluated and analyzed.2.A total of 121 patients who diagnosed with unilateral MCA severe stenosis or occlusion by 320 CAT examination admitted to the neurology department of the General hospital of the PLA central theater of operations from May2018 to January 2020 were prospectively included.DWI and MRI was used to determine the patient's cerebral infarction.Mo CA cognitive scale was used to measure the cognitive function.The constitution of the patients was measured by traditional Chinese medicine constitution scale.Analyze the correlation between them.Results1.There were 21 patients with asymptomatic unilateral MCA severe stenosis or occlusion in the good collateral group and 16 patients in the bad collateral group.Among the vascular risk factors,there was a significant difference between the good collateral group and the bad collateral group in diabetes(P<0.05),and no significant difference between demographic factors and other vascular risk factors(P>0.05).2.In terms of collateral state and cerebral perfusion,the TTP and MTT of the affected side were significantly prolonged compared with unaffected side both in the good collateral group and the bad collateral group,and the difference was statistically significant(P<0.05).The CBV of the affected side in the bad collateral group was significantly decreased compared with the unaffected side(P<0.05).There was no significant difference in CBF of the affected side in the comparison of unaffected side between the two groups,and there was no significant difference in CBV affected side of in the comparison of unaffected side in the group of good collateral(P >0.05).Compared with the relative value of the affected and unaffected side,r CBV of the good collateral group was higher than that of the bad collateral group,and r TTP and r CBF were lower than that of the bad collateral group,the difference was statistically significant(P < 0.05),while r MTT of the two groups had no statistically significant difference(P>0.05).3.Overall cognitive results: among the 37 patients,there were 7 patients with cognitive impairment detected by MMSE scale.A total of 20 patients with cognitive impairment were detected by Mo CA scale.There was no statistically significant difference in the MMSE scale scores and its contained cognitive domain scores between the good collateral group and the bad collateral group(P > 0.05).Compared with the two groups in the Mo CA scale and its contained cognitive domain scores,the total Mo CA score and memory scores of the group with good collateral decreased significantly compared with the group with bad collateral(P<0.05),and there was no significant difference between the two groups in the scores of other cognitive domains(P>0.05).4.Multidimensional cognitive results: Asymptomatic unilateral MCA severe stenosis or occlusion patients with good collateral group gets a higher score than the bad collateral group in AVLT-R,AVLT-T,VFT-F,VFT-V,VFT-T,VFT-A,RCFT-R,takes shorter set than the collateral bad group in Stroop-W,Stroop-WC,difference had statistical significance(P < 0.05),there was no significant difference in two groups in DS-F,DS-B,BNT,RCFT-C score and time-consuming Stroop-C test(P>0.05).5.121 patients with MCA severe stenosis or occlusion had 33 cases(27.27%)of Tanshi constitution,22 cases(18.18%)of Yinxu constitution,17 cases(14.05%)of Qiyu constitution,14 cases(11.57%)of Qixu constitution,13cases(10.74%)of Xueyu constitution,12 cases(9.93%)of Yangxu constitution,and 10 cases(8.26%)of Shire constitution. 6.Among the 121 patients,68 patients were cognitively impaired and 53 patients were cognitively normal.There were significant differences between the cognitively impaired group and the cognitively normal group in Qixu constitution,Tanshi constitution,Xueyu constitution,Yangxu constitution and Yinxu constitution(P<0.05).Among the 121 patients,there were 84 patients with cerebral infarction and 37 patients without cerebral infarction,and there were significant differences in Qiyu constitution,Tanshi constitution and Yangxu constitution between the two groups(P<0.05).7.Binary logistic regression results showed that Qixu constitution [OR=3.727(95%CI 1.623 ~ 4.935)],Yinxu constitution [OR=2.945(95%CI 1.405 ~5.407)],Tanshi constitution [OR=3.873(95%CI 1.311 ~ 8.474)] were independently and positively correlated with cognitive impairment in patients with MCA severe stenosis or occlusion.Tanshi constitution [OR=4.615(95%CI 1.281~16.626)].Patients with MCA severe stenosis or occlusion had an independent positive correlation with cerebral infarction.Yangxu constitution [OR=0.092(95%CI 0.019~0.454)] was negatively correlated with cerebral infarction in patients with MCA severe stenosis or occlusion.Conclusion1.Diabetes mellitus is adverse to the establishment of collateral circulation in patients with asymptomatic MCA severe stenosis or occlusion.2.Cerebral perfusion decreases in patients with asymptomatic MCA severe stenosis or occlusion,but it is basically in the compensatory period.Good collateral circulation had an improvement on cerebral perfusion.3.Mo CA scale(21 cases)is more sensitive than MMSE scale(7 cases)in the examination of cognitive impairment caused by asymptomatic MCA severe stenosis or occlusion.Good collateral has a protective effect on cognitive function,mainly in the cognitive area of memory.4.Asymptomatic MCA severe stenosis or occlusion patients with bad collateral and low perfusion have primary influence cognitive domain in immediate memory and delayed recall,verbal fluency,performing functions and spatial working memory ability.It could be a after MCA severe stenosis or occlusion,PCA blood supply area compensatory in flows MCA blood flow area,PCA and MCA blood supply to a reduction in ipsilateral frontal cerebral blood flow to the temporal lobe,hippocampus,thalamus,such as dysfunction,it is possible that low perfusion cause damage to the brain cognitive network,related research needs further.5.In the different type of constitutions of patients with MCA severe stenosis or occlusion,Tanshi constitution were the most common.6.Tanshi constitution are both risk constitutions for cognitive impairment and cerebral infarction in patients with MCA severe stenosis or occlusion.7.Qixu constitution and Yinxu constitution are the risk constitutions of cognitive impairment in patients with MCA severe stenosis or occlusion.