脑小血管病的病变分布特征与临床表现关系的研究  

Cerebral Small Vessel Disease:Distributions,Clinical Manifestations and Their Relations

作　　者：高天理[1] 刘春洁[1] 李颖[1] 

机构地区：[1]首都医科大学附属北京安贞医院神经内科,北京市100029

出　　处：《中国全科医学》2014年第1期39-42,共4页Chinese General Practice

摘　　要：目的探讨脑小血管病(CSVD)患者MRI上病变分布特征与临床表现的关系。方法选择2012年6月—2013年3月在北京安贞医院神经内科以腔隙性脑梗死(LI)、头晕、步态不稳住院且经颅脑MRI证实为CSVD的患者共145例。采集患者性别、年龄等一般资料及高血压、糖尿病、既往卒中和短暂性脑缺血发作(TIA)、认知功能减退、步态障碍、头晕和眩晕及尿失禁等病史。分析患者危险因素、临床表现及病变严重程度与MRI上病变分布特征的关系。结果将145例CSVD患者根据年龄相关脑白质改变(ARWMC)评分分为3组:轻度组79例,中度组47例,重度组19例。3组的性别及卒中和TIA史、糖尿病、高血压患病率比较,差异均无统计学意义(P>0.05);年龄比较,差异有统计学意义(P<0.05)。皮层下、基底节区、脑干和小脑不同病变部位患者的轻度认知损害、卒中和TIA史、头晕和眩晕、步态障碍的发生率比较,差异均有统计学意义(P<0.05);尿失禁发生率比较,差异无统计学意义(P>0.05)。结论 CSVD患者患高血压较普遍,重度组的患者年龄较大;皮层下病变会导致更多患者出现认知功能下降、步态障碍、卒中和TIA相关症状、眩晕和尿失禁;基底节区病变与卒中和TIA相关症状、步态障碍有关。充分认识CSVD的分布特征和临床表现,将有助于辨别出更多的患者,能更有效防治老年人的认知能力下降和机体功能丧失。Objective To investigate the lesion distributions and clinical manifestations of cerebral small vessel disease （ CSVD） as well as the distribution - manifestation relationship through a retrospective analysis. Methods Medical records of 145 patients with MRI - confirmed CSVD were reviewed. The relationships of the MRI - revealed distributions of CSVD lesion with various clinical variables were analyzed. Results According to ratings in age - related white matter changes （ARWMC）, the patients fell into three lesion severity - different groups： mild （n = 79）, moderate （n = 47）, and severe （n = 19） . There were no differences in gender, history of stroke and TIA, diabetes, hypertension prevalence between the three groups （P 〉 0. 05） . The average age was significantly different between groups （P 〈 0. 05） . The incidence rates of mild cognitive impairment, stroke and TIA history, dizziness, vertigo, and gait disorder were significantly different in patients with lesions in the subcortex, basal ganglia, brainstem and cerebellum between groups （P 〈 0. 05） . The incidence rate of urinary incontinence was not significantly different （P 〉 0. 05） . Conclusion In CSVD, the lesion distributions are associated major clinical manifestations. A better understanding may help identify cognitive impairment and basal dysfunctions in the elderly, thereby resulting timely management.

关 键 词：脑小血管病 病变分布 临床表现 危险因素 

分 类 号：R743.9[医药卫生—神经病学与精神病学]