脑小血管病相关轻度认知功能障碍患者边缘系统微结构改变研究  

Microstructural Changes of Limbic System in Patients with Mild Cognitive Impairment Induced by Cerebral Small Vessel Disease

作　　者：刘慧琳 刘东涛[1] 卜乔 李坤[2] 潘振宇[2] 范小伟 周立春[1] LIU Hui-Lin;LIU Dong-Tao;BU Qiao;LI Kun;PAN Zhen-Yu;FAN Xiao-Wei;ZHOU Li-Chun(Department of Neurology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China;Department of Radiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China;Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京朝阳医院西院神经内科,北京100043 [2]首都医科大学附属北京朝阳医院西院放射科 [3]首都医科大学附属北京天坛医院神经精神医学与临床心理科

出　　处：《中国卒中杂志》2021年第8期793-798,共6页Chinese Journal of Stroke

基　　金：科技部国家重点研发计划(2020YFC2005304);北京市临床重点专科项目。

摘　　要：目的探讨脑小血管病(cerebral small vessel disease,CSVD)相关轻度认知功能障碍(mild cognitive impairment,MCI)患者边缘系统的微结构改变。方法连续入组CSVD患者,以MoCA<26分为界值分为脑小血管病伴轻度认知障碍组(CSVD-MCI)和对照组。选取扣带回、海马、海马旁回作为感兴趣区,对两组患者进行常规头颅MRI序列检查及扩散峰度成像(diffusion kurtosis imaging,DKI)扫描。对比两组患者的基本信息、基础病患病率、化验指标、焦虑抑郁状态及DKI相关参数,包括平均扩散系数(mean diffusion,MD)、各项异性分数(fractional anisotropy,FA)、轴向扩散峰度(axial kurtosis,AK)、平均扩散峰度(mean kurtosis,MK)和径向扩散峰度(radial kurtosis,RK)。结果共入组80例患者,CSVD-MCI组55例,对照组25例。与对照组相比,CSVD-MCI组受教育程度低(P=0.003),吸烟(P=0.044)和饮酒(P=0.025)比例高,糖尿病(P=0.014)和高血压(P=0.004)患病率高(P=0.004)。DKI结果显示,与对照组相比,CSVD-MCI组右侧前扣带回MD升高(P=0.032),FA、AK、MK、RK降低(P=0.046、P=0.001、P<0.01、P=0.002),左侧前扣带回AK降低(P=0.049),右侧后扣带回MD升高(P=0.030),AK降低(P=0.014),左侧后扣带回FA升高(P=0.036),左侧海马FA、MK、RK降低(P=0.006、P=0.002、P=0.010)。结论脑小血管病致轻度认知功能障碍患者存在扣带回、海马等边缘系统的微结构改变。Objective To investigate the microstructural changes of limbic system in patients with mild cognitive impairment(MCI)induced by cerebral small vessel disease(CSVD).Methods The patients with CSVD who were evaluated by MoCA scale were retrospectively analyzed.The patients with MoCA<26 points were included in the CSVD-MCI group,and the other patients were taken as the control group.Cingulate gyrus,hippocampus and parahippocampal gyrus were selected as regions of interest.Routine MRI sequences and diffusion kurtosis imaging(DKI)were performed in two groups.The baseline information,anxiety and depression status and DKI parameters of the two groups were compared.DKI parameters included mean diffusion(MD),fractional anisotropy(FA),axial kurtosis(AK),mean kurtosis(MK)and radial kurtosis(RK).Results A total of 80 patients were included in this study,with 55 cases in the MCI group and 25 in the control group.Compared to the control group,the CSVD-MCI group had lower education level(P=0.003),higher proportion of smoking(P=0.044)and drinking(P=0.025),and higher prevalence of diabetes(P=0.014)and hypertension(P=0.004).Compared to the control group,DKI image of the limbic system in the CSVD-MCI group showed the following changes:MD increased(P=0.032),FA,AK,MK and RK decreased(P=0.046,P=0.001,P<0.001,P=0.002,respectively)in the right anterior cingulate gyrus,AK decreased(P=0.049)in the left anterior cingulate gyrus;MD increased(P=0.030)and AK decreased(P=0.014)in the right posterior cingulate gyrus,FA increased(P=0.036)in the left posterior cingulate gyrus;and FA,MK and RK decreased in the left hippocampus(P=0.006,P=0.002,P=0.010,respetctively).Conclusions The limbic systems,such as cingulate gyrus and hippocampus,have microstructural changes in the patients with MCI induced by CSVD.

关 键 词：脑小血管病 轻度认知功能障碍 边缘系统 扩散峰度成像 

分 类 号：R749.4[医药卫生—神经病学与精神病学] R743[医药卫生—临床医学]