轻度认知障碍患者痴呆转化预测的结构MRI纵向研究  

Longitudinal structural MRI study in process of mild cognitive impairment converting to AD dementia

作　　者：李瑜霞 王晓妮[1] 孙宇[1] 夏明睿[4] 李永秋 李一凡[5] 李坤成[2] 韩璎[1] 

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]首都医科大学宣武医院放射科,北京100053 [3]唐山市工人医院神内一科,063000 [4]北京师范大学认知神经科学与学习国家重点实验室&IDG/麦戈文脑科学研究院,北京100875 [5]中南大学湘雅医学院八年制研究生学院,长沙410013

出　　处：《中华神经医学杂志》2016年第4期384-390,共7页Chinese Journal of Neuromedicine

基　　金：（1）国家自然科学基金（31371007、81430037）（2）北京市科委首都市民健康培育项目（Z131100006813022）（3）凯力康医学研究项目（201206006）

摘　　要：目的探讨轻度认知障碍（MCI）患者痴呆转化过程中结构MRI纵向变化特征以及基线期结构磁共振（sMRI）特征。方法收集自2009年9月至2011年3月就诊于首都医科大学宣武医院神经内科门诊及记忆专科门诊的MCI患者27例（MCI组），以及同期存各社区招募健康老年志愿者31例f正常对照组1，存基线期和随访期分别对其进行神经心理测评及sMRI影像数据采集，应用基于体素的形态学分析方法进行全脑灰质体积计算，根据随访期是否转化为AD将MCI组分为转化组（MCI—C组1（16例）和未转化组（MCI—nc组）（11例），比较3组受试者灰质体积的变化轨迹，并与神经心理测评结果进行相关性分析。结果（1）与MCI—nc组相比，MCI—c组存基线期双侧腹内侧前额叶、双侧额中回、双侧颞上回存在明显的脑萎缩；（2）正常对照组的萎缩程度明显低于其他2组，MCI—c组的萎缩范围及程度与MCI—nc组比较差异无统计学意义（p〉0．05）；（3）MCI—c组受试者内侧颖叶、海码、海马旁叫、楔前叶、顶下小叶等脑区的灰质体积下降与MMSE、MoCA评分呈止相父。结论MCI—C与MCI—nc患者的脑萎缩模式没有本质的区别，内侧颞叶、海马、海马旁回、楔前叶、顶下小叶等脑区灰质体积下降可能成为预测MCI向AD转化的结构影像学标记物。Objective To explore the longitudinally changed patterns in the structure of mild cognitive impairment （MCI） due to Alzheimer＇s disease （AD） during the process of converting to AD dementia and further investigate the structural features at the baseline of MCI converters with the purpose of finding the potential structure l biomarkers which may predict the conversion in a short term. Methods Twenty-seven patients with MCI, collected from September 2009 to March 2011, and 31normal controls （NC） were enrolled in this study; neuropsychological assessment and structural magnetic resonance imaging （sMRI） data were acquired respectively at baseline and follow-up. Voxel-based morphometry （VBM） was used to calculate the whole brain gray matter volume. According to the follow up results, patients were divided into MCI converters group （MCI-a, n=16） and MCI non-converters group （MCI-nc, n=11）; the trajectory of longitudinal sMRI among the three groups was compared and the correlation between sMRI and neuropsychological assessment was analyzed. Results As compared with MCI-nc group, there was obvious brain atrophy in the bilateral ventromedial prefrontal cortices, bilateral middle frontal gyri and bilateral superior temporal gyri in the MCI-c group. In the comparison of trajectory of sMRI longitudinal changes in the three groups, the degree of brain atrophy in NC group was much lower than the other two groups, and there was no significant difference between MCI-c and MCI-nc group. There were positive correlations between scores of mini-mental state examination and Montreal cognitive assessment and decreased volume of gray matter in the medial temporal lobe, hippocampus, parahippocampal gyms, precuneus, inferior parietal lobule, lateral temporal lobe and dorsolateral frontal lobe. Conclusions No essential difference in the pattern of encephalatrophy is noted between MCI-c and MCI-nc groups. The decline of brain gray matter volume in medial temporal lobe, hippocampus, parahippocampal gyms, precune

关 键 词：阿尔茨海默病 轻度认知障碍 纵向研究 磁共振成像 

分 类 号：R749.16[医药卫生—神经病学与精神病学]