脑小血管病MRI表现与认知障碍的相关性研究-东南大学学报医学版

脑小血管病MRI表现与认知障碍的相关性研究

单位：南京医科大学第一附属医院老年神经病学科, 江苏南京 210029

分类号：R743

出版年·卷·期（页码）：2013·32·第六期（738-742）

摘要：

目的：探讨脑小血管病（CSVD）MRI表现与认知障碍（CI）的关系。方法：分析93例符合CSVD患者MRI表现的白质病变（WML）及腔隙性脑梗死（LI）的病灶和数量，根据蒙特利尔认知评估（MoCA）量表将患者分为认知障碍（CI）组和非认知障碍（no CI，NCI）组，分析两组患者MRI表现与CI的关系。结果：两组患者动脉硬化危险因素相比，在饮酒、高血压和血脂方面，CI组的发生率显著高于NCI组（分别是71.4% vs 27.5%，57.1% vs 27.5%，54.8% vs 17.6%；分别P=0.00、0.004和0.00），而在吸烟和糖尿病方面，两组差异无统计学意义（分别50.0% vs 25.5%，21.4% vs 11.6%；分别P=0.15和0.207）；CI组LI病灶总数和脑WML分值明显高于NCI组，差异具有统计学意义（P<0.01）。在校正年龄、性别和WML的影响后，LI病灶总数能解释MoCA得分的55.1%。同时MoCA分值仍与WML有关（P<0.001），说明LI病灶总数和WML均为MoCA分值的预测因素，而LI部位能解释MoCA得分的42.9%（P<0.001）。其中额区、颞区和基底核区LI数量与MoCA分值呈正相关（P<0.01），顶枕区和幕下区LI数量与MoCA分值无相关性（P>0.05）。结论：WML以及LI病灶的数量和部位均与CSVD患者的CI有关，额区、颞区和基底核区LI病灶数量与CI的严重度呈正相关。

Objective: To investigate the relationship between cerebral small vessel disease (CSVD) assessed by magnetic resonance imaging and cognitive impairment. Methods: A total of 93 patients with CSVD, characterized by white matter lesions (WML) and lacunar infarction (LI) were divided into cognitive impairment (CI) and no cognitive impairment (NCI) groups according to Montreal Cognitive Assessment (MoCA). The severity of WML was assessed, and the total number of LI and the numbers of LI in different regions of the brain were recorded. Their correlation with CI was analyzed. Results: As compared with the NCI group,the proportion of alcohol, hypertension and blood TC and LDL-C concentration in CI group were significantly increased (P<0.05); there were no significant differences in the proportion of smokers and diabetes mellitus between two groups (P>0.05). The total number of LI and the scores of WML were significantly increased in CI group than those in NCI group (P<0.01). After controlling the impact of age, sex and the scores of WML, the total number of LI could account for 55.1% of the scores of MoCA. LI numbers in frontal, temporal and basal ganglia area were positively correlated to MoCA scores (P<0.01), while those in parieto-occipital and infratentorial area were not correlated significantly (P>0.05). Conclusion: The WML and the numbers and locations of LI are related to CI symptoms. The numbers of LI at frontal, temperal and basal ganglia areas were independent prediction of CI in patients with CSVD.

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