老年人不同程度脑白质损害脑血流定量研究  

Quantitative analysis of regional cerebral blood flow in elderly with white matter lesions

作　　者：付建辉[1] 袁晶[1] 李胜 郭起浩[1] 洪震[1] 董强[1] 吕传真[1] 赵倩华[1] 

机构地区：[1]复旦大学附属华山医院神经内科,上海200040 [2]江西省东乡县人民医院内科

出　　处：《中华医学杂志》2009年第17期1175-1178,共4页National Medical Journal of China

摘　　要：目的观察老年人不同部位脑白质损害（WML）的严重性是否与脑缺血相关。方法采用改良Fazekas量表，将头颅磁共振FLAIR序列显示的WML分为2个部位：侧脑室周边区域及半卵圆区；4个等级：0级；1级；2级及3级。应用氙气增强CT技术测定不同级别脑白质损害者病损区域内及大脑各部位的局部脑血流（rCBF）。结果侧脑室周边区域、右侧及左侧半卵圆区病损区域内平均rCBF（ml·100g^-1·min^-1）在0级分别为20．8±2．8，22．3±1．9，22．2±2．1；1级分别为20．3±2．5，21．3±1．0，21．0±1．8；2级分别为16．3±2．0，15．6±1．7，15．9±0．9；3级分别为14．1±2．6，14．5±2．2，14．2±1．9。无论是脑白质周边区域，还是半卵圆区，病损越严重，局部脑血流越低（P〈0．05）。进一步分析发现，0级与1级之间各白质部位病损区域内rCBF差异无统计学意义；但2级和3级WML各白质部位病损区域内rCBF与0级和1级WML相比，差异有统计学意义（P〈0．05）。我们还发现双侧颞叶及豆状核局部脑血流下降与白质病损程度有关（P〈0．05）。结论无论是半卵圆区，还是侧脑室周边区域，脑白质损害病损程度均与病损区域内局部脑血流显著相关。Objective To observe whether the severity of white matter lesions （WML） is related to ischemia in elderly. Methods WML were divided into 2 categories （ centrum semiovale and periventricular regions） and four grades （ grade 0, grade 1, grade 2 and grade 3 ） according to the severity of WML showing on the FLAIR sequence of MRI using modified Fazekas scale. The values of regional cerebral blood flow （rCBF） within WML and other brain regions were measured using Xenon contrast CT. Results Mean rCBF （ml·100 g^-1 ·min^-1） within lesions around periventricular areas, in right and left centrum semiovales were 20.8±2.8, 22.3 ± 1.9 and 22.2±2.1 in grade 0; 20.3±2.5, 21.3±1.0 and 21.0±1.8 in gradel ; 16.3 ±2.0, 15.6±1.7 and 15.9±0.9 in grade 2; 14.1 ±2.6, 14.5 ±2.2 and 14.2 ±1.9 in grade3 respectively. The severity of WML is associated significantly with reduction of rCBF within lesions both in centrum semiovale and periventricular regions （ all P 〈 0.05 ）. There was no significant difference in rCBF values between grade 0 and 1, but significant differences existed between grade 0 and grades 2 and 3, between grade 1 and grades 2 and 3 （ all P 〈 0.05 ）. Statistical significance also existed between the severity of white matter lesions and rCBF in bilateral temporal lobes and lentiform nucleuses （P〈0.05 ）. Conclusions The severity of WML both in centrum semiovale and periventricular regions is associated significantly with reduction of rCBF within lesions.

关 键 词：老年 脑白质损害 局部脑血流 

分 类 号：R686[医药卫生—骨科学]