轻度认知障碍及阿尔茨海默病患者脑血流灌注与认知功能的回归分析  

Regression analysis of cerebral blood perfusion and cognitive function in patients with mild cognitive impairment and Alzheimer′s disease

作　　者：徐耀[1] 陈兰兰[1] 苏悦[1] 孙胜楠 张洪英[2] Xu Yao;Chen Lanlan;Su Yue;Sun Shengnan;Zhang Hongying(Department of Neurology,Northern Jiangsu People's Hospital,Yangzhou 225001,China;Medical Imaging Department,Northern Jiangsu People's Hospital,Yangzhou 225001,China)

机构地区：[1]江苏省苏北人民医院神经内科,扬州225001 [2]江苏省苏北人民医院医学影像科,扬州225001

出　　处：《中华医学杂志》2019年第3期193-197,共5页National Medical Journal of China

基　　金：国家自然科学基金面上项目(81471642);扬州市科技局面上项目(YZ2016077).

摘　　要：目的研究阿尔茨海默病(AD)患者与轻度认知障碍(MCI)患者脑灌注与认知功能之间的关系。方法选取2016年11月至2017年11月江苏省苏北人民医院神经内科AD患者21例,MCI患者18例及21名年龄、性别和受教育程度相匹配的健康老年人作为健康对照组。行头部MRI及动脉自旋标记(ASL)检查,采用简易精神状态量表(MMSE)及Addenbrooke改良认知评估量表(ACE-R)评价患者的认知功能,分析三组各脑区灌注信号差异与认知障碍的关系。结果两组ACE-R分值比较,注意及定向、记忆、语言流利性、语言及视空间评分各项评分AD组均显著小于MCI组(均P<0.001);使用REST1.8软件单因素方差分析,设经校正P<0.05时,AD组全脑普遍灌注低于健康对照组;而AD组与MCI组比较,灌注减低的区域主要集中于额顶颞叶;MCI组与健康对照组比较也显示出额顶颞叶皮质灌注的减低;AD组及MCI组患者多个脑区的脑血流量与ACE-R各项评分进行Pearson相关分析发现,多个脑区CBF值降低程度与ACE-R总分呈正相关,与ACE-R各项评分包括注意及定向、记忆、语言流利性、语言及视空间评分也呈现出正相关表现。结论ASL技术可以无创性的检测AD及MCI患者脑血流代谢的变化,揭示AD及MCI患者脑功能损害与脑血流代谢之间的关系。Objective To analyze the relationships between cerebral blood perfusion and impairments of cognitive function in patients with Alzheimer′s disease (AD) and mild cognitive impairment (MCI). Methods A total of 21 patients with AD, 18 patients with MCI and 21 healthy adults as control group (NC group) matched in age, gender and education were recruited between November 2016 and November 2017 from Northern Jiangsu People′s Hospital. All cases were performed routine head MRI, arterial spin labeling (ASL). Cognitive function evaluation including simple mental state scale (MMSE) and improved Addenbrooke′s cognitive examination revised (ACE-R) of patients were also assessed. The difference between cerebral blood perfusion signals and cognitive impairment of the three groups were analyzed. Results The subtest scores of attention and orientation, memory, language fluency, language and visual space of ACE-R scores were significantly reduced (P<0.001,uncorrected) for AD when compared with MCI. Using REST1.8 software to perform single factor ANOVA, and adjusted for P<0.05. The AD group showed a decrease in total cerebral perfusion compared to the NC group, a decrease and in the frontotemporal lobe compared to MCI group;compared with the normal group, MCI group also showed decreased perfusion in frontotemporal cortex. Pearson correlation analysis was performed on the cerebral blood flow and ACE-R scores in the AD group and the MCI group,the decrease degree of CBF in multiple brain regions was positively correlated with the total score of ACE-R′s total scores, and the subtest score of ACE-R including attention and orientation, memory, language fluency, language and visual space also showed positive correlation. Conclusion ASL technology can detect the changes of cerebral blood flow metabolism in AD and MCI patients, and reveal association relationships between brain function damage and cerebral blood flow metabolism in AD and MCI patients.

关 键 词：阿尔茨海默病 认知障碍 磁共振成像 动脉自旋标记 

分 类 号：R749.1[医药卫生—神经病学与精神病学]