摘要
目的评价颈动脉支架植入术(CAS)对颈动脉狭窄患者认知功能的干预作用。方法计算机检索Medline、EMbase、Pubmed、CNKI、万方和维普等数据库,选取建库至2018年12月30日收录的CAS对颈动脉狭窄患者认知功能影响的随机对照试验(RCT)和队列研究文献,CAS组为试验组,药物治疗组为对照组。对比两组简易智能精神状态检查(MMSE)量表、蒙特利尔认知评估(MOCA)量表、数字广度(DS)测试和Barthel指数(BI)量表评分评估结果。2名研究员按照纳入和排除标准独立筛选文献、提取资料、评价文献质量后,采用RevMan 5.3软件作meta分析。结果共纳入2篇RCT、16篇队列研究文献,1756例患者。Meta分析结果显示,CAS组与药物治疗组相比,术后1个月MMSE量表评分差异无统计学意义(MD=1.01,95%CI=-0.24~2.27,P=0.11),MOCA量表评分显著升高(MD=1.88,95%CI=0.83~2.92,P=0.0004);术后3个月MMSE评分、MOCA评分均显著升高(MD=2.06,95%CI=0.62~3.50,P=0.005;MD=2.42,95%CI:0.9~3.95,P=0.002);术后6个月MMSE评分、MOCA评分均显著升高(MD=2.79,95%CI=1.47~4.11,P<0.0001;MD=3.18,95%CI=1.73~4.63,P<0.0001),DS测试评分、BI量表评分差异均无统计学意义(MD=-1.37,95%CI=-0.1~2.83,P=0.07;MD=-2.53,95%CI=-7.62~2.56,P=0.33);术后1年,MOCA评分差异无统计学意义(MD=0.37,95%CI=-4.58~5.33,P=0.88)。结论CAS可改善颈动脉狭窄患者术后3、6个月认知功能,对远期认知功能影响尚需大规模、多中心、高质量RCT研究进一步验证。
Objective To evaluate the intervention effect of carotid artery stenting(CAS)on the cognitive function of patients with carotid artery stenosis.Methods Computer retrieval of Medline,EMbase,Pubmed,CNKI,Wan Fang and VIP databases was conducted to collect the randomized controlled trial(RCT)and cohort research literature concerning the effect of CAS on the cognitive function of patients with carotid artery stenosis.The retrieval time was from the establishment of database to December 30,2018.CAS group was used as study group,and medication group was used as control group.The mini-mental state examination(MMSE)scale,Montreal cognitive assessment(MOCA)scale,digital span(DS)testing,and Barthel index(BI)scale were used to evaluate the cognitive function,and the results were compared between the two groups.According to the inclusion and exclusion criteria,two researchers independently screened literature,extracted data and evaluated the quality of the included literature.RevManr 5.3 software was used to perform meta-analysis.Results A total of 2 RCT articles and 16 cohort research documents,including 1756 patients in total,were enrolled in this study.Meta-analysis showed that no statistically significant difference in one-month post-operative MMSE score existed between the two groups(MD=1.01,95%CI=-0.24-2.27,P=0.11),while MOCA score in CAS group was remarkably higher than that in the control group(MD=1.88,95%CI=0.83-2.92,P=0.0004).Three months after the treatment,both MMSE score and MOCA score in CAS group were more obviously increased than those in the control group(MD=2.06,95%CI=0.62-3.50,P=0.005 and MD=2.42,95%CI=0.9-3.95,P=0.002,respectively).Six months after the treatment,both MMSE score and MOCA score in CAS group were more strikingly increased than those in the control group(MD=2.79,95%CI=1.47-4.11,P<0.0001 and MD=3.18,95%CI=1.73-4.63,P<0.0001,respectively).No statistically significant differences in DS score and BI score existed between the two groups(MD=-1.37,95%CI=-0.1-2.83,P=0.07 and MD=-2.53,95%CI=-7.62-2.56,P=0.33,respectively).One year after the treatment,the difference in MOCA score between the two groups was not statistically significant(MD=0.37,95%CI=-4.58-5.33,P=0.88).Conclusion CAS can improve 3-month and 6-month postoperative cognitive function in patients with carotid artery stenosis.The effect of CAS on long-term cognitive function needs to be clarified by large-scale,multicenter and high-quality RCT studies.
作者
赵宛玉
杜敢琴
段佩养
陈胜江
ZHAO Wanyu;Du Ganqin;DUAN Peiyang;CHEN Shengjiang(The Clinical Medical College of Henan University of Science and Technology,Department of Neurology,First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan Province 471003,China)
出处
《介入放射学杂志》
CSCD
北大核心
2020年第2期129-135,共7页
Journal of Interventional Radiology
基金
河南省洛阳市科技发展计划项目(1503007A-1)。
