伴有脑白质高信号的无症状腔隙性脑梗死患者认知功能特点分析  

Characteristics of cognitive function in silent lacunar cerebral infarction patients with white matter hyperintensities

作　　者：曾惟伊 陈姚静 孙璇 张占军[2] 贾建军 Zeng Weiyi;Chen Yaojing;Sun Xuan;Zhang Zhanjun;Jia Jianjun(Department of Neurology,Chinese PLA General Hospital No.2 Medical Center,Beijing 100853,China)

机构地区：[1]解放军医学院解放军总医院第二医学中心神经内科,北京100853 [2]北京师范大学认知神经科学与学习国家重点实验室

出　　处：《中华老年心脑血管病杂志》2019年第5期502-505,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：全军医药卫生"十二五"面上项目(CWS11J099)

摘　　要：目的探究脑白质高信号(WMH)与无症状腔隙性脑梗死患者认知功能的相关性及其影响因素。方法选择2010年1月～2018年3月北京市老年脑健康计划社区临床队列的无症状腔隙性脑梗死患者174例,根据MRI对脑白质病变部位及程度分级,脑室周围WMH 0级21例,1级102例,2级39例,3级12例;深部WMH 0级19例,1级53例,2级86例,3级16例。对不同部位、不同程度脑白质病变患者认知功能进行比较。结果无症状腔隙性脑梗死患者随脑室周围WMH分级升高,年龄明显增高(P=0.001)。脑室周围WMH不同分级患者情景记忆、工作记忆和简易智能状态检查量表(MMSE)评分比较,差异有统计学意义(P<0.05,P<0.01)。深部WMH不同分级患者工作记忆评分比较,差异有统计学意义(P<0.05)。多元线性回归分析显示,脑室周围WMH 1级和2级是工作记忆下降的危险因素(β=-0.264,P=0.038;β=-0.325,P=0.011),WMH 3级是MMSE评分下降的危险因素(β=-0.273,P=0.014)。结论伴有WMH的老年无症状腔隙性脑梗死患者记忆能力易受损伤,认知障碍的主要危险因素是脑室周围脑白质病变。Objective To study the association between white matter hyperintensities(WMH)and cognitive function in silent lacunar cerebral infarction patients and its risk factors.Methods One hundred and seventy-four silent lacunar cerebral infarction patients were included in this study. They underwent MRI to show the site and severity of their WMH,including degrees 0-3 of periventricular WMH in 21,102,39,12 patients respectively,and deep WMH in 19,53,86,16 patients respectively.Then,their cognitive function scores were compared.Results The degree of WMH was significantly higher and the age was significantly older in silent lacunar cerebral infarction patients(P<0.05).The situation memory,working memory and Simplified Intelligent State Scale score were significantly different in patients with different degrees of WMH in peripheral brain(P<0.05,P<0.01).The working memory was significantly different in patients with different degrees of WMH in deep brain(P<0.05).Degrees 1 and 2 of periventricular WMH were the independent risk factors for the impaired working memory(β=-0.264,P=0.038;β=-0.325,P=0.011)while degree 3 of periventricular WMH was the independent risk factor for the impaired cognitive function(β=-0.273,P=0.014).Conclusion The memory is easy to be impaired in silent lacunar cerebral infarction patients with WMH of aging brain.Periventricular WMH is the major risk factor for cognitive impairment.

关 键 词：脑梗死 痴呆 血管性 神经心理学 认知障碍 

分 类 号：R743.3[医药卫生—神经病学与精神病学]