缺血性深部脑白质损害患者认知障碍和静息态功能磁共振成像研究  

Characteristics of cognitive impairment and resting-state functional MRI in patients with ischemic deep white matter lesions

作　　者：王玥 段春梅 徐瑞 段炜 WANG Yue;DUAN Chunmei;XU Rui;DUAN Wei(Department of Neurology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院神经内科,重庆400037

出　　处：《第三军医大学学报》2020年第20期2039-2045,共7页Journal of Third Military Medical University

基　　金：重庆市社会民生科技创新专项一般项目(CSTC2015shmszx120106)。

摘　　要：目的探索缺血性深部脑白质损害(deep white matter lesions,DWMLs)患者的认知障碍特征及与不同脑区皮层功能之间的关系。方法纳入2016-2018年我科门诊及住院的轻度缺血性深部脑白质损害患者38名,依据患者有无认知障碍分为认知障碍组及认知正常组,同时匹配对照组18名(颅脑核磁共振证实未见白质病变且认知功能正常的老年体检人群)。采用神经心理量表及静息态功能磁共振的比率低频振幅值分析深部脑白质损害患者认知障碍的特点以及功能异常的皮层脑区。结果深部脑白质损害患者的执行功能、注意功能、记忆功能和视空间功能均显著降低(P<0.05),其中执行、注意功能损害在认知障碍的早期阶段出现。通过静息态功能核磁共振检查发现:与对照组比较,深部脑白质损害伴认知障碍患者的双侧额中回、双侧楔叶、左侧楔前叶、左侧前扣带回、双侧颞中回、左侧枕颞内侧回的比率低频振幅值降低(P<0.05),同时,左侧海马杏仁核、左侧顶上回、左侧小脑蚓部的比率低频振幅值升高(P<0.05)。与对照组比较,深部脑白质损害认知正常患者的双侧额中回、左侧前扣带回、双侧颞中回的比率低频振幅值降低(P<0.05),无比率低频振幅值明显升高的脑区。Pearson相关性分析发现:上述功能异常脑区均与深部脑白质损害患者的认知障碍具有显著相关性。结论深部脑白质损害可导致执行功能、注意功能、记忆功能和视空间功能下降,其中执行、注意功能下降是深部脑白质损害导致认知障碍的首发症状。缺血性DWMLs患者的多个脑区皮层功能下降,而且与认知障碍相关。皮层功能损害可能是缺血性DWMLs所致认知障碍的原因之一。Objective To investigate characteristics of cognitive impairment in patients with ischemic deep white matter lesions(DWMLs)and the correlation of cognitive impairment with changes in cortical functionality in different brain regions.Methods We analyzed the data of 38 hospitalized patients or outpatients with mild ischemic DWMLs in our department,including 18 with cognitive impairment and 20 with normal cognitive function.Eighteen patients without DWMLs matched for age,gender and education level served as the control group.The cognitive function of the participants was assessed with neuropsychological tests,and resting-state functional magnetic resonance imaging(fMRI)was performed to detect the cortical regions with functional abnormalities based on the fractional amplitude of low frequency fluctuation(fALFF).Results We found that the patients with DWMLs had significant impairment of executive,attention,memory and visuospatial functions(P<0.05),and deterioration of executive function and attention function could occur in early stage of cognitive impairment.The fALFFs of the bilateral middle frontal gyrus,bilateral cuneiform lobe,left anterior cuneiform lobe,left anterior cingulate gyrus,bilateral middle temporal gyrus,and left medial occipitotemporal gyrus were markedly reduced,while those of the left hippocampus-amygdaloid nucleus,left superior parietal gyrus,and left cerebellum vermis were obviously increased in patients with both DWMLs and cognitive impairment as compared with the control group(P<0.05).In patients with DWMLs but normal cognitive function,the fALFFs of the bilateral middle frontal gyrus,left anterior cingulate gyrus,and bilateral middle temporal gyrus were also significantly decreased in comparison with the control group(P<0.05),but no brain regions with increased fALFF were detected in these patients.Pearson correlation analysis suggested a significant correlation between these abnormalities in the brain regions and cognitive impairment in the patients with DWMLs.Conclusion DWMLs can induce imp

关 键 词：深部脑白质损害 认知障碍 神经心理量表 静息态功能核磁共振 皮层 

分 类 号：R741.044[医药卫生—神经病学与精神病学] R742[医药卫生—临床医学]