脑白质病变评价量表在认知功能障碍中的作用  

The role of white matter lesions visual scale in cognitive impariment

作　　者：冯丽[1,2] 叶娜[1] 贾伟丽[1] 王金芳 刘鑫鑫 王诗男 张玉梅 FENG Li1,2, YE Na1, JIA Wei-li1, WANG Jin-fangl, LIU Xin-xin1, WANG Shi-nan1, ZHANG Yu-mei1(1. Neurological Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China;2. Department of Neurology, Chengde Central Hospital, Heibei Chengde 067000, Chin)

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]河北省承德市中心医院神经内科,河北承德067000

出　　处：《中国医刊》2018年第7期730-734,共5页Chinese Journal of Medicine

基　　金：国家自然科学基金(81371201);国家重点基础研究发展计划(973计划)青年科学家项目(2013CB837300);首都医科大学基础与临床合作重点项目(16JL03)

摘　　要：目的评估脑白质病变MRI视觉量表之间信度评价,探讨视觉评价量表与认知障碍的关系。方法选取2014年8月至2016年10月于北京天坛医院神经内科住院或门诊的脑白质病变患者100例,由两名医师采用改良Scheltens、Manolio、Fazekas、Ylikoski 4个视觉分级量表分别对脑白质病变严重程度进行评分。不同评估者之间采用Kappa检验进行重测信度检验,不同视觉量间用内部一致性检验采用Cronbachα检测;脑白质病变与认知障碍的关系采用Pearman等级相关分析。采用蒙特利尔认知评估量表(Montreal cognitive assessment,Mo CA)评价认知障碍严重程度。通过线性回归分析评价不同量表的相关性。结果 4个视觉量表的内部一致性检验中,Ylikoski量表和改良Scheltens量表Cronbachα信度系数较高,分别为0.824和0.802。不同评分者对视觉量表的一致性评价,Fazekas量表最高(K=0.782),Manolio量表(K=0.449)最低。4个视觉评价量表与Mo CA视空间及执行力评分(3.67±1.45)、注意力评分(5.01±1.45)、记忆力评分(2.44±1.62)进行相关性分析,改良Scheltens量表与Mo CA的视空间及执行力评分、注意力评分、记忆力评分显著相关(r=-0.564,P<0.01;r=-0.375,P<0.05;r=-0.484,P<0.01)。线性回归分析显示4个不同视觉量表间的相关系数最大值为0.843,最小值为0.706。结论脑白质病变4个视觉分级量表间不仅具有很好的相关性和信度,而且与认知障碍均有相关性。其中,Fazekas量表评估项目简单,临床应用便捷;改良Scheltens量表能够较准确地评估脑白质病变的严重程度,适合观察脑白质病变的进展及其与临床特征之间的关系。Objective To evaluate the reliability of the visual scale of white matter lesions, and also to explore the correlation between different visual scales and cognition. Method 100 patients with different degrees of white matter lesions were randomly recruited by the two physicians.The modified Scheltens, Manolio, Fazekas and Ylikoski were used to assess the severity of white matter lesions（WMLs）. Montreal Cognitive Assessment（Mo CA） was used to evaluate the cognitive function. The re-test reliability between different raters was performed by Kappa values. Cronbachα was detected by internal consistency test. The relationship between WMLs and cognition was analyzed by pearman rank correlation analysis. The linear regression analysis was used to predict the mutual transformation and model of different grades. Result In the internal consistency test of the four visual scales, the Ylikoski scale（α=0.824） and the modified Scheltens（α=0.802） were the best. The consistency of the visual scale was the highest, and the consistency of the visual grading scale was highest Fazekas（K=0.782） and the Manolio rating scale（K=0.449） were poor.（3.67±1.45）, attention score（5.01±1.45）, and memory score（2.44±1.62） in the correlation analysis of the visual grading scale and Mo CA visual space.（r=-0.564, P 〈0.01;r=-0.375, P〈 0.05; r=-0.484, P〈 0.01）, and the Scheltens and Mo CA were significantly correlated with visual spatial and executive scores, attention score and memory score The The linear regression analysis showed that the correlation coefficient between the four visual scales was 0.843 and the minimum was 0.706. Conclusion The four visual grading scales of WMLS not only have good correlation and reliability, but also correlated with cognitive impairment. As for Fazekas scale, although simple, but the clinical application is convenient. The improved Scheltens not only accurately assesses the severity of WMLs, but also has a good correlation with cognitive impairment. It is suitable

关 键 词：脑白质病变 认知障碍 视觉分级量表 

分 类 号：R743.9[医药卫生—神经病学与精神病学]