脑膜瘤切除术患者术后脑白质微结构变化与术后早期认知功能的相关性分析  

Correlation between postoperative microstructural changes in cerebral white matter and early postoperative cognitive function in patients undergoing meningioma resection

作　　者：冯慧茹 魏宇魁[2] 林庆堂 刘扬[1] 卢洁[3] 王天龙[1] Feng Huiru;Wei Yukui;Lin Qingtang;Liu Yang;Lu Jie;Wang Tianlong(Department of Anesthesiology and Operating Theater,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Radiology and Nuclear Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院麻醉手术科,北京100053 [2]首都医科大学宣武医院神经外科,北京100053 [3]首都医科大学宣武医院放射与核医学科,北京100053

出　　处：《中华医学杂志》2024年第5期357-364,共8页National Medical Journal of China

基　　金：首都医科大学临床专科学院(系)培养基金开放课题(CCMU2023ZKYXY006)

摘　　要：目的分析脑膜瘤切除术患者手术前后脑白质微结构变化与术后早期认知功能的相关性。方法前瞻性纳入2022年4月至2023年4月在首都医科大学宣武医院行首次脑膜瘤切除术的17例患者为观察组,男5例,女12例,年龄(56.4±7.3)岁。另纳入同期15例年龄和教育相匹配的脑肿瘤患者为对照组,男5例,女10例,年龄(55.2±8.0)岁。观察组患者分别在术前1 d、术后1 d、术后3~4 d内进行神经心理学测试(neuropsychological tests,NST),主要包括听觉词语学习测验-华山版(AVLT-H)、蒙特利尔认知评估基本量表(MoCA-B)、画钟测验(CDT-30)、形状连线测验B(STT-B)及动物语言流畅性测试(AFT);并在术前1 d及术后3~4 d进行MRI扫描,采集弥散张量成像(DTI)图像。对照组患者在入院后1、3、6 d进行相同的NST评估,以校正重复NST的学习效应。采用基于纤维束的空间统计分析(TBSS)技术评估手术后全脑脑白质微结构的组水平变化,包括各向异性指数(FA)、平均弥散系数(MD)、轴向弥散系数(AD)和径向弥散系数(RD)的变化,然后将差异有统计学意义的DTI指标与认知功能进行相关性分析。结果校正学习效应后,观察组患者手术后AVLT-H(R)、MoCA-B及CDT-30评分下降,STT-B评估时间延长,围手术期差值分别为-0.78(95%CI:-3.28~-0.28)分、-2.22(95%CI:-4.22~-0.72)分、-2.74(95%CI:-5.29~-0.19)分、61.49(95%CI:5.71~117.27)s,差异均有统计学意义(均P<0.05)。基于DTI数据的TBSS组水平分析提示脑膜瘤患者麻醉手术后右侧小脑上脚、左侧内囊后肢及胼胝体膝部FA降低,左侧前放射冠RD升高,差异均有统计学意义(均P_(FWE)<0.05)。线性相关分析发现胼胝体膝部和右侧小脑上脚的围手术期FA降低值与校正学习效应后的AVLT-H(L)的围手术期下降值呈正相关(r=0.72,0.52,均P_(FWE)<0.05)。结论脑膜瘤切除术患者存在术后认知功能下降的风险,基于DTI数据的胼胝体膝部和右侧小脑上脚的围手术期FA�Objective To analyze the correlation between microstructure changes in cerebral white matter before and after surgery and early postoperative cognitive function in patients undergoing meningioma resection.Methods A total of 17 patients who underwent their first meningioma resection at Xuanwu Hospital of Capital Medical University from April 2022 to April 2023 were prospectively included as observation group,with 5 males and 12 females,aged(56.4±7.3)years.Another 15 age-and education-matched patients with cerebral benign tumor were recruited as control group during the same period,with 5 males and 10 females,aged(55.2±8.0)years.Neuropsychological tests(NST),mainly including auditory verbal learning test of Huashan version(AVLT-H),the Montreal cognitive assessment-basic(MoCA-B),clock drawing task-30(CDT-30),shape trails test-B(STT-B)and animal fluence test(AFT),were conducted at 1 day before surgery,1 day and within 3-4 days after surgery in the observation group.Simultaneously,magnetic resonance imaging(MRI)scans were performed to collect diffusion tensor imaging(DTI)images at 1 day before surgery and within 3-4 days after surgery.The same NST were conducted at 1 day,3 days and 6 days after admission in the control group to adjust for learning effects from repeated tests.The microstructure changes of the whole brain white matter were evaluated at the group level by using tract-based spatial statistics(TBSS)technology,including changes of fractional anisotropy(FA),mean diffusion(MD),axial diffusion(AD),and radial diffusion(RD).Then,correlation was performed between DTI indicators with statistically significant and cognitive function.Results After adjusting for the learning effects,the AVLT-H(R),MoCA-B,and CDT-30 scores decreased,and the evaluation time of STT-B prolonged after surgery in patients with meningioma.And their perioperative decreased values were-0.78(95%CI:-3.28--0.28)points,-2.22(95%CI:-4.22--0.72)points,-2.74(95%CI:-5.29--0.19)points,and 61.49(95%CI:5.71-117.27)seconds,respectively,with statisticall

关 键 词：脑膜瘤 麻醉 脑膜瘤切除术 弥散张量成像 脑白质 术后认知功能 随访研究 

分 类 号：R739.45[医药卫生—肿瘤] R614[医药卫生—临床医学]