动脉瘤壁强化与全身炎症共同导致未治疗的未破裂颅内动脉瘤患者出现认知功能障碍。

Aneurysm Wall Enhancement and Systemic Inflammation Jointly Contribute to Cognitive Dysfunction in Untreated Unruptured Intracranial Aneurysm Patients.

作者信息

Wu Xiao-Bing, Luo Bin, Guo Xin, Liu Chi-Chen, Liu Yi-Ao, Ye Jie-Shun, Fan Shao-Yi, Li Qing-Jian, Wang Sheng-Wen

机构信息

Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.

Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, People's Republic of China.

出版信息

J Inflamm Res. 2025 Jul 10;18:9045-9053. doi: 10.2147/JIR.S515856. eCollection 2025.

DOI:10.2147/JIR.S515856

PMID:40661189

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12258539/

Abstract

BACKGROUND AND PURPOSE

Peripheral inflammatory markers and aneurysm wall enhancement (AWE) on high-resolution vessel wall MRI (HR-VWI) may reflect inflammation in unruptured intracranial aneurysms (UIAs). We assessed cognitive function and its association with inflammatory markers in UIA patients.

METHODS

The study included 120 consecutive patients with UIAs diagnosed between September 2018 and December 2023 and a control group of 27 healthy adults at our institution. Neuropsychological function in these patients was evaluated using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Scale (HAMA), and Self-Rating Depression Scale (SDS). A MoCA score of <23 was classified as cognitive decline, while scores of ≥23 indicated normal cognitive function. The peripheral blood inflammatory markers and radiological characteristics were compared between the patients with cognitive decline and those with normal cognitive function. The presence of AWE and white matter hyperintensities (WMH) in UIA was identified through HR-VWI.

RESULTS

UIA patients demonstrated significantly poorer cognitive performance than controls, with lower MMSE (27.0 vs 29.0, P < 0.001) and MoCA scores (23.0 vs 25.0, P = 0.020). Patients with cognitive decline were older and exhibited elevated inflammatory markers (NLR, SII, hsCRP; all P < 0.05), along with higher rates of AWE and white matter hyperintensities (WMH) (both P < 0.001). Multivariate analysis identified AWE (OR = 5.33, 95% CI:1.82-15.59), WMH (OR = 4.26, 95% CI:1.58-11.49), and age (OR = 1.07, 95% CI:1.02-1.12) as independent predictors of cognitive decline (all P ≤ 0.01). Moreover, the cognitive decline group also showed higher SDS and HAMA scores (P < 0.05), suggesting a correlation between emotional distress and cognitive impairment.

CONCLUSION

Untreated UIA patients exhibit cognitive decline associated with systemic inflammation (NLR, SII, hs-CRP). AWE, WMH and age are independent risk factors, suggesting vascular inflammation contributes to cognitive dysfunction.

摘要

背景与目的

高分辨率血管壁磁共振成像（HR-VWI）上的外周炎症标志物和动脉瘤壁强化（AWE）可能反映未破裂颅内动脉瘤（UIA）中的炎症。我们评估了UIA患者的认知功能及其与炎症标志物的关联。

方法

该研究纳入了2018年9月至2023年12月期间连续诊断的120例UIA患者以及我院27名健康成年人组成的对照组。使用简易精神状态检查表（MMSE）、蒙特利尔认知评估量表（MoCA）、汉密尔顿焦虑量表（HAMA）和自评抑郁量表（SDS）对这些患者的神经心理功能进行评估。MoCA评分<23分被归类为认知功能减退，而≥23分表明认知功能正常。比较认知功能减退患者和认知功能正常患者的外周血炎症标志物及影像学特征。通过HR-VWI确定UIA中AWE和白质高信号（WMH）的存在。

结果

UIA患者的认知表现明显比对照组差，MMSE评分较低（27.0对29.0，P<0.001），MoCA评分也较低（23.0对25.0，P = 0.020）。认知功能减退的患者年龄较大，炎症标志物升高（中性粒细胞与淋巴细胞比值、全身炎症反应指数、高敏C反应蛋白；均P<0.05），AWE和白质高信号（WMH）的发生率也较高（均P<0.001）。多因素分析确定AWE（比值比=5.33，95%置信区间：1.82 - 15.59）、WMH（比值比=4.26，95%置信区间：1.58 - 11.49）和年龄（比值比=1.07，95%置信区间：1.02 - 1.12）是认知功能减退的独立预测因素（均P≤0.01）。此外，认知功能减退组的SDS和HAMA评分也较高（P<0.05），表明情绪困扰与认知障碍之间存在关联。