脑白质疏松患者病变部位与认知功能的相关性  

The relationship of white matter lesions location and cognitive function in leukoaraisosis patients

作　　者：冯丽[1,2] 叶娜[1] 王金芳[1] 王诗男 张玉梅 

机构地区：[1]首都医科大学附属天坛医院神经病学中心,北京100050 [2]承德市中心医院神经内科,承德067400

出　　处：《中华行为医学与脑科学杂志》2018年第1期26-30,共5页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：国家自然科学基金项目（81371201）;首都医科大学基础与临床合作重点项目（16JL03）

摘　　要：目的通过比较脑白质疏松（leukoaraisosis，LA）患者病变解剖位置与认知功能的关系，探讨脑白质病变部位对认知功能的影响。方法选取75例LA患者，由两名医师分别采用改良Scheltens量表、Manolio量表、Fazekas量表评估不同部位脑白质病变严重程度。采用蒙特利尔认知评估量表（Montreal cognitive assessment，MoCA）评价认知障碍严重程度。采用Spearman等级相关分析评价脑白质病变部位与认知障碍的关系。应用t检验对脑室旁白质病变（Periventricular white matter lesions PWMLs）认知功能障碍组（PWMLs-CI）和认知功能正常组（PWMLs-CN）各个变量进行差异性检验。结果Fazekas PWMLs与MoCA总分（r＝－0.388，P＝0.007）及视空间与执行（r＝－0.466，P＝0.000）、延迟回忆（r＝－0.461，P＝0.001）、抽象（r＝－0.355，P＝0.011）及定向力（r＝－0.337，P＝0.016）评分显著相关（P〈0.05）；Scheltens PWMLs与MoCA总分（r＝－0.390，P＝0.003）及视空间与执行（r＝－0.464，P＝0.000）、注意（r＝－0.375，P＝0.008）、延迟回忆（r＝－0.484，P＝0.000）及定向力（r＝－0.342，P＝0.013）评分呈负相关（P〈0.05），而皮层下白质病变（deep white matter lesions DWMLs）与MoCA总分无显著相关性（P〉0.05）。与PWMLs-CN比较，PWMLs-CI在执行能力（42.13±0.89）、注意力（16.36±1.24）和视空间（2.25±0.31）评分降低，差异有统计学意义（P〈0.05）。结论脑白质病变部位对认知功能有影响，PWMLs更为密切，其认知功能障碍特点表现为执行功能、注意力和视空间方面。ObjectiveTo study the effect of white matter lesions location on cognitive function by comparing the correlation between the anatomical location of white matter lesions and cognitive function in leukoaraisosis（LA） patients.MethodsA total of 75 LA patients with different degrees of white matter lesion were randomly recruited.The modified Scheltens scale, Manolio scale and Fazekas scale were utilized to assess the severity of white matter lesions （WMLs） by two physicians.Montreal cognitive assessment （MoCA） was used to evaluate the cognitive function.The correlation between WMLs location and cognitive function was analyzed by spearman rank correlation analysis.The t-test was used to test the differences of periventricular white matter lesions with cognitive impairment （PWMLs-CI） and periventricular white matter lesions with cognitive normal（PWMLs-CN） in each goup.ResultsFor Fazekas scale, PWMLs were significantly correlated with the decrease scores of MoCA score （r=-0.388, P=0.007）, visuospatial and executive（r=-0.466, P=0.000）, delayed recall （r=-0.461, P=0.001）, abstraction （r=-0.355, P=0.011） and orientation （r=-0.337, P=0.016）（P 〈0.05）. For Scheltens scale, PWMLs was negatively correlated with MoCA score （r=-0.390, P=0.003）, visuospatial and executive （r=-0.464, P=0.000）, delayed recall （ r=0.484, P=0.000）, attention（r=-0.375, P=0.008） and orientation （r=-0.342, P=0.013） （P〈0.05）, but not in deep white matter lesions （DWMLs）（P〉0.05）. Compared with PWMLs-CN, executive function （42.13±0.89）, attention （16.36±1.24） and visuospatial （2.25±0.31） in PWMLs-CI had statistical significance （P 〈0.05）.ConclusionWhite matter lesions location affect cognitive function, PWMLs are more closely related to cognitive impairement, characterized by executive function, attention and visuospatial aspects.

关 键 词：脑白质病变部位 视觉分级量表 认知障碍 

分 类 号：R742[医药卫生—神经病学与精神病学]