皮质下缺血性脑血管病患者不同脑区脑白质病变与血管性认知功能损伤的相关性研究  

Correlation between White Matter Lesions in Different Brain Regions and Vascular Cognitive Impairment in Patients with Subcortical Ischemic Cerebrovascular Disease

作　　者：廖健颖 朱蔚文[2] 李又福[2] 王娟 LIAO Jianying;ZHU Weiwen;LI Youfu;WANG Juan(School of Public Health,Guangzhou Medical University,Guangzhou 511436,China;Department of Neurology,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广州医科大学公共卫生学院,广东省广州市511436 [2]广州医科大学附属第二医院神经内科,广东省广州市510260

出　　处：《实用心脑肺血管病杂志》2020年第11期48-53,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：国家自然科学基金资助项目(81703299)。

摘　　要：背景脑白质病变(WMLs)是皮质下缺血性脑血管病(SIVD)的主要病变类型,SIVD是最常见的血管性认知功能损伤亚型之一,但WMLs对血管性认知功能损伤的影响尚未完全明确。目的探讨SIVD患者不同脑区WMLs与血管性认知功能损伤的相关性。方法选取2018年6月—2020年1月广州医科大学附属第二医院神经内科收治的332例SIVD患者,根据简易智能状态检查量表(MMSE)评分和受教育程度分为无认知障碍组(NCI组,n=108)、轻度认知障碍组(MCI组,n=75)及血管性痴呆组(VaD组,n=149)。比较三组患者临床资料及不同脑区(额叶、顶枕叶、颞叶、幕下区及基底核区)年龄相关白质改变评分量表(ARWMC)评分,并比较不同WMLs严重程度患者及不同脑区WMLs严重程度患者MMSE评分。结果VaD组患者年龄大于NCI组和MCI组,受教育年限短于MCI组,脑梗死发生率高于NCI组(P<0.05)。MCI组患者ARWMC总分及额叶ARWMC评分高于NCI组(P<0.05)。VaD组患者ARWMC总分及顶枕叶、颞叶、基底核区ARWMC评分高于NCI组和MCI组,额叶和幕下区ARWMC评分高于NCI组(P<0.05)。重度WMLs患者定向力、注意力和计算力、回忆能力及语言能力评分低于轻中度WMLs患者(P<0.05)。重度额叶、幕下区、基底核区WMLs患者定向力、注意力和计算力、回忆能力及语言能力评分分别低于轻中度患者(P<0.05)。重度顶枕叶WMLs患者定向力、注意力和计算力、语言能力评分低于轻中度患者(P<0.05)。重度颞叶WMLs患者回忆能力评分低于轻中度患者(P<0.05)。结论SIVD患者WMLs严重程度与血管性认知功能损伤有关,其中重度额叶、幕下区、基底核区WMLs患者定向力、注意力和计算力、回忆能力、语言能力损伤明显,重度顶枕叶WMLs患者定向力、注意力和计算力、语言能力损伤明显,重度颞叶WMLs患者回忆能力损伤明显。Background White matter lesions(WMLs)is the main lesion type of subcortical ischemic cerebrovascular disease(SIVD),and SIVD is one of most common subtypes of vascular cognitive impairment.However,the effect of WMLs on vascular cognitive impairment has not been fully defined.Objective To investigate the correlation between WMLs in different brain regions and vascular cognitive impairment in patients with SIVD.Methods A total of 332 patients with SIVD admitted to the Department of Neurology,the Second Affiliated Hospital of Guangzhou Medical University from June 2018 to January 2020 were selected,and the patients were divided into three groups:non-cognitive impairment group(NCI group,n=108),mild cognitive impairment group(MCI group,n=75)and vascular dementia group(VaD group,n=149)according to Mini-Mental State Examination Scale(MMSE)score and education level.The clinical data and the agerelated white matter change(ARWMC)score in different brain regions(frontal lobe,parietooccipital lobe,temporal lobe,infratentorial region and basal ganglia region)were compared among the three groups.The MMSE score were compared in patients with different WMLs severity,and with different WMLs severity in different brain regions.Results The age of VaD group was higher than that of NCI group and MCI group,the education years was less than that of MCI group,and the incidence of cerebral infarction was higher than that of NCI group(P<0.05).The total ARWMC score and ARWMC score of frontal in MCI group were higher than those in NCI group(P<0.05).The total ARWMC score and ARWMC scores of parietooccipital lobe,temporal lobe and basal ganglia region in VaD group were higher than those in NCI group and MCI group,and ARWMC scores of frontal lobe and infratentorial region in VaD group were higher than those in NCI group(P<0.05).The scores of orientation,attention and calculation,memory ability,and language ability in patients with severe WMLs were lower than those in patients with mild to moderate WMLs(P<0.05).The scores of orientation,attentio

关 键 词：颅内血管疾病 皮质下缺血性脑血管病 脑白质病 认知障碍 

分 类 号：R743[医药卫生—神经病学与精神病学]