单发皮层下缺血性卒中的VCIND患者认知及微结构改变  

Cognition and microstructural change in single subcortical ischemic stroke patients with VCIND

作　　者：王红 张敬[2] 于春水[2] 程焱[3] 薛蓉[3] WANG Hong;ZHANG Jing;YU Chunshui;CHENG Yan;XUE Rong(Second Department of Encephalopath y ,Affiliated Hospital,Tianjin Academy of Traditional Chinese Medicine,Tianjin 300120,China;Department of Radiology,General Hospital,Tianjin Medical University,Tianjin 300052 ,China;Department of Neurology ,General Hospital,Tianjin Medical University,Tianjin 300052,China)

机构地区：[1]天津市中医药研究院附属医院脑病二科,300120 [2]天津医科大学总医院放射科,300052 [3]天津医科大学总医院神经内科,300052

出　　处：《重庆医学》2018年第19期2529-2533,共5页Chongqing medicine

基　　金：天津市卫生行业重点攻关项目(12KG132)

摘　　要：目的研究单发皮层下缺血性卒中的非痴呆型血管性认知障碍(VCIND)患者认知功能损害特征及在弥散张量成像(DTI)上的改变,探寻单发皮层下缺血性卒中患者发生VCIND的微结构改变特点。方法选择单发皮层下缺血性卒中患者50例,完成认知功能评定,分为VCIND组,单纯缺血性卒中无VCIND组(SCI组),无缺血性卒中及认知功能障碍志愿者组(NC)12例。所有符合入组标准的受试者均行核磁T1、T2成像,DTI检查、Hachinski缺血量表评分,日常生活能力指数(ADL)评分,认知功能评分及Hamilton焦虑抑郁量表评分。采集的原始图像采用统计参数图(SPM8)进行影像数据处理,分析VCIND患者在DTI像上与其他两组的微结构差异。采用基于提分析(VBA)方法对DTI图像的各项异性(FA)及平均弥散率(MD)进行统计分析。结果 VCIND组蒙特利尔认知功能评分平均(22.78±3.68)分,SCI组平均(26.87±0.82)分,NC组平均(26.11±0.33)分,差异有统计学意义(P<0.05);VCIND组的执行功能、计算、即时记忆、注意力、语言流畅性、延迟回忆、定向力评分与SCI组比较差异有统计学意义(P<0.05);VCIND组执行能力、延迟回忆领域得分明显低于SCI组,差异有统计学意义(P<0.05)。与SCI组比较,VCIND组FA值下降最明显区域主要在右侧前额叶眶额回内侧皮层,前扣带区域,MD增高区域在右侧眶额回;与NC组比较,VCIND组FA值下降区域主要位于双侧海马旁回,左侧前额叶皮层,左侧颞中回,右侧额下回、岛叶,左侧枕叶,右侧距状皮层,楔叶及额下回盖部;VCIND组在MD图上较NC组增高部位在左侧岛叶、额中回,脑室旁白质。结论单发皮层下脑梗死VCIND的认知功能损害特点为多领域受损,以执行功能及延迟记忆较明显;DTI有辅助诊断筛查VCIND的影像学意义。Objective To explore the characteristics of cognitive impairment and（diffusion tensor imaging）change in the single subcortical ischemic stroke patients with non-vascular cognitive impairment not dementia（non-VCIND）and to explore the microstructural characteristics of VCIND occurrence.Methods Fifty patients with single subcortical ischemic stroke were selected and divided into the VCIND group and simple ischemic stroke without VCIND group（SCI group）after finishing the recognitive function evaluation.Other 12 volunteers without ischemic stroke and cognitive function impairment served as the normal control group（NC）.The image adopted the voxel-based analysis（VBA）method.All subjects conforming to the grouping standard conducted T1,T2 image and DTI examination,Hachinski ischemic scale score,ADL score,cognitive function score and Hamilton anxiety and depression scale score.The image adopted the voxel-based analysis（VBA）method to analyse Fractional anisotropy（FA）and mean diffusivity（MD）of DTI image,in order to find the differences of microstructure between VCIND and the other groups.Results Three groups of Montreal cognitive function scores were as follows：the score of VCIND group was（22.78±3.68）points,the score of SCI group was（26.87±0.82）points,and the score of NC group was（26.11±0.33）points,the difference was statistically significant（P〈0.05）.The scores of executive ability,calculation ability,instant memory,attention,language fluency,delayed recall and orientation power had statistical difference between the VCIND group and SCI group（P〈0.05）.The scores of execution ability and delayed recall in the VCIND group were significantly lower than those in the SCI group,and the difference was statistically significant（P〈0.05）.Compared with the SCI group,the most obvious areas of FA value decrease in the VCIND group were mainly in medial orbitofrontal cortex the right prefrontal lobe,anterior cingulate area,and MD increased area was in the right orbit frontal

关 键 词：缺血性卒中 非痴呆性血管认知障碍 弥散张量成像 

分 类 号：R743.33[医药卫生—神经病学与精神病学]