阻塞性睡眠呼吸暂停低通气综合征患者海马及脑白质病变与认知功能的相关性  

Correlation between cognitive function and hippocampal atrophy and cerebral white matter lesions in patients with obstructive sleep apnea hypopnea syndrome

作　　者：彭万达 陈锐[1] 蒋震[2] 徐孝秋[2] 王婧[1] 李洁[3] 刘春风[3] 

机构地区：[1]苏州大学附属第二医院呼吸科睡眠中心,215004 [2]苏州大学附属第二医院影像诊断科,215004 [3]苏州大学附属第二医院神经内科,215004

出　　处：《中华医学杂志》2014年第10期724-728,共5页National Medical Journal of China

基　　金：国家自然科学基金（81270147）;卫生部科研基金（2012W4）

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者颅脑MRI显像中海马体积及脑白质的变化与认知功能之间的关系。方法顺序纳入2012年3月至2013年8月因打鼾在苏州大学附属第二医院睡眠中心行多导睡眠图（PSG）监测的患者81例，依据睡眠呼吸暂停低通气指数（AHI）分为轻度OSAHS组（23例）、中度OSAHS组（18例）、重度OSAHS组（23例）及单纯鼾症组（17例）。采用颅脑MRI常规序列及垂直于双侧海马的液体衰减反转恢复（FIAIR）序列进行成像，根据Schehens标准及Fukudas法分别对大脑海马体积萎缩、脑白质病变相关的侧脑室周围高信号灶（PVH）的严重程度进行评分；应用蒙特利尔认知评估量表（MoCA）、简易智能状态量表（MMSE）评估认知功能变化，分析以上参数在四组患者之间的变化，以及认知功能评分与海马、脑白质结构改变及PSG参数之间的相关性。结果随着OSAHS严重程度的加重，患者认知评分尤其是MoCA评分在组间呈下降趋势，海马体积萎缩程度及PVH评分均呈升高趋势。与单纯鼾症组比较，重度OSAHS组海马体积萎缩评分升高[（2．4±1．2）比（1．5±1．2）分，P=0．007]，PVH评分升高[（3．6±1．0）比（1．6±1．5）分，P=0．000]，MoCA和MMSE评分降低[（24．5±2．7）比（28．0±1．9）分，P=0．000和（27．5±1．4）比（28．7±1．3）分，P=0．013]，认知功能受损主要表现在视空间与执行力、延迟记忆力等方面。海马体积萎缩、PVH评分与MoCA评分负相关（r=-0．30、-0．30，P=0．010、0．006）。多元线性回归分析提示，决定MoCA评分的主要危险因素为AHI、海马体积萎缩程度（标化回归系数为：-0．386、-0．247，P=0．000、0．020）。OSAHS患者海马体积萎缩、PVH评分与AHI、氧减指数（ODI）、呼吸相关微觉醒指数（RI）正相关，与最低脉氧饱和度（LSaO2）、平均脉氧饱和度（MObjective To explore the relationship between cognitive impairment and the changes of hippocampal structure and cerebral white matter on brain magnetic resonance imaging （MRI） in subjects with obstructive sleep apnea hypopnea （OSAHS）. Methods A total of 81 snoring patients were monitored by overnight polysomnography （PSG） at Sleep Center, Second Affiliated Hospital, Soochow University from March 2012 to August 2013. Based on the results of apnea-hypopnea index （AHI）, they were divided into mild （n = 23 ）, moderate （ n = 18 ）, severe OSAHS （ n = 23 ） and primary snoring （ n = 17 ） groups. Periventricular hyperintensity （PVH） related to the severity of cerebral white matter lesions and hippocampal atrophy on brain MRI were evaluated according to the Fukudas method and Scheltens standard. The sequences of regular and perpendicular to bilateral hippocampal fluid attenuated inversion recovery （FIAIR） were used. Montreal cognitive assessment （MoCA） and mini-mental state examination （MMSE） were performed to evaluate the changes of cognitive function in all subjects. Results The cognitive function scores, especially MoCA, progressively decreased and the scores of hippocampal atrophy and PVH increased as the severity of OSAHS aggravated among these groups. Compared to primary snoring group, MoCA and MMSE scores decreased （24. 5 ± 2. 7 vs 28.0 ±1.9, P = 0. 000 ; 27. 5 ±1.4 vs 28. 7 ± 1.3, P = 0. 013 ） and hippocampal atrophy and PVH scores increased （2.4 ± 1.2 vs 1.5 ± 1.2, P = 0. 007 ; 3.6 ± 1.0 vs 1.6 ± 1.5, P = 0. 000） in the severe OSAHS group. The evaluations of MoCA subdomains further revealed selective reduction in visual space, execution function and delayed memory. PVH scores and hippocampal atrophy scores were negatively correlated with MoCA scores （r = - O. 30, P =0. 010; r = - 0. 30, P = 0. 006）. Multiple linear regression analysis indicated that the degrees of AHI and hippocampal atrophy were the major risk factors for MoCA scores （ standar

关 键 词：睡眠呼吸暂停 阻塞性 海马 脑白质 认知 蒙特利尔认知评估量表 

分 类 号：R766[医药卫生—耳鼻咽喉科]