路易体痴呆脑磁共振成像特征的视觉评分分析  

Analysis of visual scores of brain magnetic resonance imaging features of dementia with Lewy bodies

作　　者：卢昊[1] 朱涵 刘帅[3] 甘景环 曹宸 吴昊 左美美 所信君 纪勇[3] Lu Hao;Zhu Han;Liu Shuai;Gan Jinghuan;Cao Chen;Wu Hao;Zuo Meimei;Suo Xinjun;Ji Yong(Department of Medical Imaging,Tianjin Huanhu Hospital,Tianjin 300350,China;Graduate School of Tianjin Medical University,Tianjin 300070,China;Department of Neurology,Tianjin Huanhu Hospital,Tianjin 300350,China;Center for Cognitive Neurology,Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurology,Cangzhou People's Hospital,Cangzhou 061000,China)

机构地区：[1]天津市环湖医院医学影像科,天津300350 [2]天津医科大学研究生院,天津300070 [3]天津市环湖医院神经内科,天津300350 [4]首都医科大学附属北京天坛医院认知障碍科,北京100070 [5]沧州市人民医院神经内科,沧州061000

出　　处：《中华老年医学杂志》2022年第12期1441-1446,共6页Chinese Journal of Geriatrics

基　　金：天津市卫生健康科技项目(ZC20121)。

摘　　要：目的探讨磁共振成像(MRI)特征视觉评分在路易体痴呆(DLB)诊断、DLB分级诊断中的应用价值。方法本研究前瞻性收集了102例DLB患者和102例认知正常中老年人作为正常对照组(NC)。全部研究对象均进行了MRI检查和神经心理学评估。根据临床痴呆评定量表(CDR)评分将入组的DLB患者分为轻度(CDR=1.0)、中度(CDR=2.0)和重度(CDR=3.0)3组。对MRI检查结果进行视觉评分,评定量表包括:内侧颞叶萎缩(MTA)、全脑皮质萎缩-额叶(GCA-F)、后部皮质萎缩(PCA)、脑白质损害(Fazekas)、脑微出血(CMBs)和埃文斯指数(EI)。分别比较上述指标在DLB组和NC组之间、不同严重程度的DLB组之间的统计学差异。结果神经心理学方面DLB组[16.0(11.0,21.0)]分的简易精神状态检查(MMSE)评分明显低于NC组[29.0(28.0,30.0)]分(Z=-12.31,P<0.001),DLB组[9.5(6.0,15.0)]分的蒙特利尔认知评估测试(MoCA)评分明显低于NC组[28.0(27.0,29.0)]分(Z=-12.40,P<0.001),DLB组[32.0(23.8,40.0)]分的日常生活能力(ADL)评分明显高于NC组[20.0(20.0,20.0)]分(Z=-11.98,P<0.001)。DLB患者的所有MRI视觉评定量表的评分均高于NC组(P<0.001)。不同严重程度的DLB患者之间比较,MTA评分差异有统计学意义(P0<0.001),轻度组[1.0(1.0,2.0)]分的MTA低于中度组[2.0(1.0,2.0)]分(P_(1)<0.001,P_(2)<0.001);中度组[2.0(1.0,2.0)]分的MTA低于重度组[2.0(2.0,3.0)]分、(P_(1)=0.003,P_(2)=0.010)。结论评价了多种视觉评分在DLB诊断中的意义,并明确了MTA可用于协助诊断DLB及区分DLB严重程度,为临床诊断提供了新的辅助工具。Objective To assess the practical value of visual scores of magnetic resonance imaging(MRI)features in the diagnosis and classification of dementia with Lewy bodies(DLB).Methods In this study,102 DLB patients were prospectively recruited,with 102 cognitively normal elderly people as the normal control group(NC).All included subjects underwent MRI examinations and neuropsychological assessments.Based on the clinical dementia rating(CDR)scale,DLB patients were divided into a mild(CDR=1.0),a moderate(CDR=2.0)and a severe(CDR=3.0)group.The results of MRI were scored visually and the rating scales included medial temporal lobe atrophy(MTA),global cortical atrophy-frontal subscale(GCA-F),posterior cortical atrophy(PCA),white matter lesions(the Fazekas scale),cerebral microbleeds(CMBs),and the Evans Index(EI).Statistical differences were compared between the DLB and NC groups and between DLB patients with different degrees of cognitive impairment.Results In terms of neuropsychology,the Mini-Mental State Examination(MMSE)score of the DLB group[16.0(11.0,21.0)]was statistically significantly lower than that of the NC group[29.0(28.0,30.0)](Z=-12.31,P<0.001),the Montreal Cognitive Assessment(MoCA)score of the DLB group[9.5(6.0,15.0)]was statistically significantly lower than that of the NC group[28.0(27.0,29.0)](Z=-12.40,P<0.001),and the Activities of Daily Living(ADL)score of the DLB group[32.0(23.8,40.0)]was statistically significantly higher than that of the NC group[20.0(20.0,20.0)](Z=-11.98,P<0.001).The scores of all MRI visual assessment scales in DLB patients were statistically significantly higher than those in the NC group(P<0.001).There were significant differences in MTA scores between DLB patients with different degrees of cognitive impairment(P0<0.001).The MTA score of the mild group[1.0(1.0,1.0)]was statistically significantly lower than that of the moderate group[2.0(1.0,2.0)](P_(1)<0.001,P_(2)<0.001);The MTA score of the moderate group[2.0(1.0,2.0)]was statistically significantly lower than that of the seve

关 键 词：LEWY体病 痴呆 精神状态检查表 神经心理学测验 

分 类 号：R445.2[医药卫生—影像医学与核医学] R749.13[医药卫生—诊断学]