脑小血管病影像学表现与血管性认知功能障碍相关性研究  

Association between imaging features of cerebral small vessel disease and vascular cognitive impairment

作　　者：张学艳[1] 樊峰萍[1] 苑聪聪 张丽[1] 赵晓红[1] 周瑾 ZHANG Xueyan;FAN Fengping;YUAN Congcong;ZHANG Li;ZHOU Jin(The First Central Hospital of Baoding,Baoding 071000,Hebei,China)

机构地区：[1]河北省保定市第一中心医院,河北保定071000

出　　处：《现代中西医结合杂志》2018年第13期1393-1398,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的探讨脑小血管病(CVSD)影像学表现与血管性认知功能障碍之间的关系及CSVD相关危险因素。方法将60例经脑MRI证实的CVSD患者按具体病情分为单纯腔隙性脑梗死(LI)组、LI+脑白质疏松(WML)组、LI+脑微出血(CMB)组、LI+WML+CMB组,收集所有研究对象一般资料,进行蒙特尔认知评估量表(MoCA)、简易精神状态量表(MMSE)评分,并与脑MRI阴性的正常者(对照组)进行对照比较。结果各CVSD组MMSE评分和MoCA评分均明显低于对照组(P<0.05);单纯LI组、LI+WML组、LI+CMB组间MMSE评分和MoCA评分比较差异均无统计学意义(P均>0.05),但3组均明显高于LI+WML+CMB组(P均<0.05)。Pearson相关分析显示各组MMSE评分与MoCA评分呈正相关(r=0.877,P=0.000)。CVSD各组均以轻度认知功能损害为著,其中LI组、LI+WML组、LI+CMB组轻度认知功能损害发生率比较差异无统计学意义(P>0.05),但3组均明显低于LI+WML+CMB组(P均<0.05)。CSVD各组时间定向、注意计算、语言理解及图像描述评分均明显低于对照组(P均<0.05),LI+CMB组、LI+WML+CMB组短程记忆评分和LI+WML组、LI+WML+CMB组语言表达评分均明显低于对照组(P均<0.05)。Logistic回归模型多因素分析显示高血压(P=0.009,OR=31.087)、糖尿病(P=0.049,OR=16.849)与CSVD密切相关。结论腔隙性脑梗死、脑白质疏松、脑微出血均可导致认知功能障碍,三者并存时最为明显,且以轻度认知功能障碍为主,其认知功能损害以时间定向、注意计算、短程记忆、语言理解、言语表达及图像描述为主。高血压、糖尿病均与可导致血管性痴呆的CSVD密切相关。Objective It is to explore the relationship between imaging features of cerebral small vessel disease(CVSD)and cognitive impairment and discuss the risk factors of CSVD.Methods 60 patients who were diagnosed CSVD according to MR were divided into four groups:pure lacunar infarction(LI)group,both LI and white matter lesion(WML)group,both LI and cerebral microbleeds(CMB)group,LI,WML and CMB group.General clinical data of all patients were recorded,MMSE and MoCA score were assessed and compared with skull MR negative person which as a control group.Results The scores of MMSE and MoCA in every CVSD group were lower than that in control group(P<0.05).The Pearson related analysis of MMSE and MoCA score in each group were positive correlation(r=0.877,P=0.000).There was no significant difference in pure LI group,LI+WML group and LI+CMB group(P>0.05),but had significant differences with LI+WML+CMB group(P<0.05).Pure LI group,LI+WML group,LI+CMB group,LI+WML+CMB group had significant differences with control group in MMSE and MoCA score(P<0.05);Pure LI group,LI+WML group,LI+CMB group and LI+WML+CMB group had significant difference in the level of cognitive event(P<0.05);MMSE score had shown that time orientation,attention and calculation,short memory,reading comprehension,verbal exposition,picture description of CSVD group were lower than control group(P<0.05);LI+WML+CMB group and control group logistic regression:hypertension(P=0.009,OR=31.087)and diabetes(P=0.049,OR=16.849)were related to CVSD.Conclusion Which LI,WML and CMB can lead to cognitive impairment,the effects were he most obvious when they mixtures and mainly lead to the mild cognitive dysfunction.CSVD especially LI,WML,CMB exist at the same time can lead to cognitive impairment,which mainly show in time orientation,attention and calculation,short memory,reading comprehension,verbal exposition,picture description.hypertension and diabetes were the strongly associated with the CSVD which can lead to the vascular cognitive impairment.

关 键 词：脑小血管病 影像学表现 血管性认知功能障碍 MMSE评分 MoCA评分 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]