小脑损伤与认知功能的相关性研究  

Correlation between cerebellar injury and cognitive function

作　　者：李政[1] 徐蓉[1] 刘任远[2] 罗云[3] LI Zheng;XU Rong;LIU Renyuan;LUO Yun(Department of Rehabilitation Medicine,Drum Tower Hospital Affiliated to Medical College of Nanjing University,Nanjing,Jiangsu 210008,China;Department of Medical Imaging,Drum Tower Hospital Affiliated to Medical College of Nanjing University,Nanjing,Jiangsu 210008,China;Department of Neurology,Drum Tower Hospital Affiliated to Medical College of Nanjing University,Nanjing,Jiangsu 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院康复医学科,江苏南京210008 [2]南京大学医学院附属鼓楼医院医学影像科,江苏南京210008 [3]南京大学医学院附属鼓楼医院神经内科,江苏南京210008

出　　处：《安徽医药》2019年第12期2392-2395,共4页Anhui Medical and Pharmaceutical Journal

基　　金：国家自然科学基金项目(81671140)

摘　　要：目的探讨小脑损伤与认知功能的相关关系,磁共振波谱分析(MRS)对于早期预测认知功能损伤的意义。方法选取2012年2月至2017年10月南京大学医学院附属鼓楼医院37例存在小脑损伤(包括脊髓小脑性共济失调、小脑脑炎)的住院病人作为研究对象。采用简易认知状态量表,蒙特利尔认知评估量表评估研究对象认知水平;对所有研究对象进行多体素氢质子磁共振波谱(1H-MRS)检查,定位小脑为感兴趣区(VOI)计算VOI内各代谢比值:N-乙酰天门冬氨酸(NAA)/肌酸(Cr)、乙酰胆碱(Cho)/Cr、Cho/NAA。根据认知功能评估量表分数将病,人分为认知正常、损害两组,利用独立样本t检验研究两组病人MRS指标的区别,进一步以Pearson线性相关分析代谢比值与认知损害的相关性。结果部分小脑损伤病人存在认知功能损害,右侧小脑半球NAA/Cr在认知功能正常(1.10±0.27)和损伤组(0.82±0.25)间差异有统计学意义(P=0.003)且右侧小脑半球NAA/Cr值与认知功能评估量表MMSE及MOCA分数均呈正相关(r=0.450,P=0.005;r=0.507,P=0.001)。结论,小脑参与高级认知功能活动;MRS检查能够在小脑体积改变之前发现病人颅内代谢产物改变,对早期预测认知功能损伤有重要意义。Objective We did this study to investigate the correlation between cerebellar injury and cognitive function,and the significance of Magnetic Resonance Spectroscopy(MRS)in early prediction of cognitive impairment.Methods 37 inpatients with cerebellar injury(including spinocerebellar ataxia,cerebellar encephalitis and multiple system atrophy)were selected from February 2012 to October 2017 in the Affiliated Drum Tower Hospital of Nanjing University School of Medicine as research objects.TheSimple Cognitive State Scale and the Montreal Cognitive Assessment Scale were used to assess the cognitive of the subjects.All subjects underwent Multivoxel 1H-MRS examination and the cerebellum was set as a region of interest(ROI).The metabolic ratios[N-acetyl aspartate(NAA)/creatine(Cr),acetylcholine(Cho)/Cr,Cho/NAA]of the VOI were calculated.Based on the cognitive function scale scores,the patients were divided into two groups:normal cognitive and cognitive decline.We used the independentsample t test to study the difference of data of MRS between the two groups,and cognitive impairment was further analyzed by the Pearson linear correlation.Results Some patients with cerebellar injury had cognitive impairment.The difference of NAA/Cr ofright cerebellum had statistical significant between normal cognitive(1.10±0.27)and cognitive decline(0.82±0.25)group(P=0.003),and the right cerebellar hemisphere NAA/Cr was positively correlated with Cognitive function assessment scales MMSE and MOCA(r=0.450,P=0.005;r=0.507,P=0.001).Conclusion The cerebellum take participates in advanced cognitive function.MRS can detect the changes of intracranial metabolites before the volume changes,which is important for early prediction of cognitive impairment.

关 键 词：小脑疾病 认知障碍 磁共振波谱学 天冬氨酸蛋白酶类 肌酸 乙酰胆碱 因果律 

分 类 号：R74[医药卫生—神经病学与精神病学]