微出血对脑小血管病早期认知障碍的作用机制研究  

Mechanism research about the role of microbleeds for early cognitive impairment in small vascular disease

作　　者：糜建华[1] 卢东[2] 赵薇[2] 支楠[2] 曹雯炜[2] 俞羚[2] 耿介立[2] 徐群[2] 

机构地区：[1]上海交通大学医学院附属仁济医院南院神经内科,上海201112 [2]上海交通大学医学院附属仁济医院神经内科,上海200127

出　　处：《上海交通大学学报（医学版）》2017年第12期1644-1649,共6页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家重点研发计划(2016YFC1300604);上海市科学技术委员会西医引导项目(14411964400)~~

摘　　要：目的·明确脑微出血(CMBs)对于SVD早期认知障碍的影响及其作用机制。方法·连续招募严格定义的SVD非痴呆患者57名,对其进行详细神经心理测查,并对患者进行磁敏感成像(SWI)和弥散张量成像(DTI)磁共振检查。根据CMBs计数将患者分为CMBs组、非CMBs组,以及多发性CMBs组(全脑CMBs≥3个)、非多发性CMBs组(全脑CMBs<3个)。用感兴趣区分析法测定脑室旁、半卵圆中心和皮质下总的白质平均弥散度(MD)和各向异性分数(FA)。结果·多发性CMBs组在注意执行和记忆功能的评分显著低于非多发性CMBs组。全脑CMBs计数与脑室旁白质MD、皮质下白质MD、脑室旁白质FA和皮质下白质FA均显著相关。全脑CMBs计数经矫正后与注意执行功能显著相关,进一步经皮质下/脑室旁白质FA和MD及CMBs部位矫正后仍显著相关。结论·CMBs能反映SVD患者缺血性病变导致的白质完整性破坏程度,并独立作用于脑实质损伤而造成早期认知障碍;CMBs对认知损害的作用可能存在阈值效应。Objective·To make clear the role of cerebral microbleeds （CMBs） for early cognitive impairment in small vessel disease （SVD）. Methods·Fifty-seven consecutive SVD patients without dementia were strictly recruited. All participants were examined with a comprehensive battery of neuropsychological tests, SWI and DTI. According to the amount of CMBs, the patients were divided into CMBs group and non-CMBs group, or divided into multiple CMBs group （CMBs ≥ 3） and non-multiple CMBs group （CMBs〈3）. The mean diffusivity （MD） and fractional anisotropy （FA） in periventricular, central semiovale and subcortical white matter was analyzed with a region-of-interest method. Results·The score of multiple CMBs group in attention and memory function was significantly lower than that of the non-multiple CMBs group. Correlation analysis showed that the count of CMBs in the whole brain was significantly correlated with periventricular white matter MD, subcortical white matter MD, periventricular white matter FA and subcortical white matter FA. The count of CMBs in the whole brain adjusted by age, gender, education was significantly correlated with attention/executive function. After adjustment of subcortical/ periventricular white matter FA and MD and locations of CMBs they still had significant correlation. Conclusion·CMBs can reflect the degree of destruction of white matter integrity, and have independent effects on injury of brain parenchyma, resulting in early cognitive impairment. The research also suggests the role of CMBs in cognitive impairment may exist threshold value effect.

关 键 词：脑小血管病 认知障碍 微出血 多模式磁共振 

分 类 号：R743.3[医药卫生—神经病学与精神病学]