急性缺血性卒中患者胆碱能通路损伤与血管性认知障碍的相关性研究  

Study of the correlation between vascular cognitive impairment and cholinergic pathway lesions in patients with acute ischemic stroke

作　　者：赵瑞杰[1] 张楠[1] 程焱[1] 

机构地区：[1]天津医科大学总医院神经内科,天津300052

出　　处：《中风与神经疾病杂志》2012年第4期297-300,共4页Journal of Apoplexy and Nervous Diseases

基　　金：天津医科大学科学基金资助项目(2010ky25)

摘　　要：目的探索急性缺血性卒中患者胆碱能通路损伤与血管性认知障碍(VCI)的相关性。方法连续收集在天津医科大学总医院神经内科住院的急性缺血性卒中患者87例。采用简易智能精神状态检查量表(MMSE)及蒙特利尔认知评估量表(MoCA)进行认知评估,同时使用脑胆碱能通路白质量表(CHIPS)和Fazekas量表进行脑白质病变测评,评价其对VCI的应用价值,并分析影像学评分与认知评估间的相关性。结果以MMSE、MoCA作为界定认知障碍的标准时,缺血性卒中患者急性期认知障碍发生率分别为26.4%、79.3%,差异有统计学意义(P=0.000)。CHIPS与MMSE、MoCA量表评分总分均呈负相关(r=-0.378,P=0.043;r=-0.504,P=0.005);Fazekas与MMSE及MoCA量表评分总分均无明显相关性(r=-0.094,P=0.627;r=-0.410,P=0.056);CHIPS评分与MoCA分项中视空间与执行功能、注意与抽象能力下降呈负相关,其中与视空间与执行功能下降关系最为密切(r=-0.514,P=0.004),而Fazekas评分仅与注意能力下降存在相关性(r=-0.404,P=0.030)。结论急性缺血性卒中患者胆碱能通路损伤与白质病变所致VCI相关;MoCA与CHIPS评分联合应用可以作为简便、快速筛查和评定白质病变所致VCI的良好工具。Objective To investigate the correlation between vascular cognitive impairment（VCI）and cholinergic pathway lesions in patients with acute ischemic stroke.Methods Eighty-seven patients with acute ischemic stroke（onset within 7 days）hospitalized in Neurologic Department of Tianjin Medical University General Hospital were recruited.The cognitive function was assessed with Mini-Mental State Examination（MMSE） and Montreal Cognitive Assessment（MoCA）.Two trained raters evaluated magnetic resonance imaging（MRI）scans using MRI rating scales Cholinergic Pathways HyperIntensities Scale（CHIPS）and Fazekas）for white matter changes.Their value of application to VCI and correlations between the cognitive impairment and MRI rating scales were evaluated.Results Cognitive impairments were present in 79.3% of patients with acute ischemic stroke by the MoCA,but in only 26.4% of patients by the MMSE,the difference of frequency of cognitive impairment was statistically significant（P=0.000）.CHIPS scores were negatively correlated with MMSE scores（r=-0.378,P=0.043）and MoCA scores（r=-0.504,P=0.005）.There was no significant correlations between Fazekas scores and MMSE scores（r=-0.094,P=0.627）,and MoCA scores（r=-0.410,P=0.056）.CHIPS scores were negatively associated with visuospatial and executive function（r=-0.514,P=0.004）,attention（r=-0.440,P=0.017） and Abstraction（r=-0.368,P=0.049）.Fazekas scores were only negatively associated with attention（r=-0.404,P=0.030）.Conclusion The present findings support the view that a significant correlation exists between VCI and white matter lesions within the cholinergic pathway in patients with acute ischemic stroke.The combined application of MoCA and CHIPS can be used as a good tool which can rapidly screen and evaluate VCI caused by white matter lesions.

关 键 词：缺血性卒中 胆碱能纤维 神经通路 脑白质病变 血管性认知障碍 

分 类 号：R743.3[医药卫生—神经病学与精神病学]