老年认知功能障碍与高尿酸血症及脑灰质结构改变的关系研究  

Study on the Relationship between Cognitive Dysfunction and Hyperuricemia and Structural Changes of Gray Matter in the Elderly

作　　者：王晓[1] 杨牧 余雯晴 苏雪娟 WANG Xiao;YANG Mu;YU Wen-qing;SU Xue-juan(Department of Radiology,The Affiliated Nanyang Second General Hospital,Xinxiang Medical University,Nanyang 473012,Henan Province,China;Department of Neurology,The Affiliated Nanyang Second General Hospital,Xinxiang Medical University,Nanyang 473012,Henan Province,China)

机构地区：[1]新乡医学院附属南阳市第二人民医院影像科,河南南阳473012 [2]新乡医学院附属南阳市第二人民医院神经内科,河南南阳473012

出　　处：《中国CT和MRI杂志》2024年第1期18-20,共3页Chinese Journal of CT and MRI

基　　金：国家重点研发计划项目(2017YFC0111900);河南省医学科技攻关计划联合共建项目(LHGJ20191469)。

摘　　要：目的分析老年认知功能障碍与高尿酸血症的关系,观测患者脑灰质结构改变情况,探讨相关脑机制。方法前瞻性选取在本院住院或门诊就医的老年认知功能障碍患者392例,根据认知功能障碍分类诊断标准及认知评定量表分为轻度认知障碍组224例,痴呆组168例;另取同期在本院健康体检的老年人182例为对照组。比较各组血尿酸水平,收集并分析可能的影响因素。采用基于体素的形态测量学方法对患者全脑容积进行分割,在Matlab 6.5环境下运行spm5,分析简易精神状态检查表(MMSE)分级与全脑灰质容积的相关性。结果痴呆组患者血尿酸水平[(419.47±32.51)μmol/L]明显高于轻度认知障碍组[(354.80±27.63)μmol/L]和对照组[(226.48±32.15)μmol/L];轻度认知障碍组血尿酸水平明显高于对照组(均P<0.01)。多因素Logistic回归分析显示,年龄(B=1.821,OR=2.134,95%CI=1.296~4.830,P=0.000)、受教育程度(B=1.559,OR=1.607,95%CI=0.971~3.519,P=0.001)、高尿酸血症(B=2.671,OR=3.641,95%CI=1.695~7.831,P=0.000)是老年认知功能障碍的独立影响因素。其中高尿酸血症发生认知功能障碍的风险高出尿酸正常者的3.641倍。老年认知功能障碍患者MMSE分级与灰质容积成负相关的脑区包括:左侧前扣带回、左内侧额上回、两侧海马旁回、两侧岛叶、两侧舌回、两侧小脑皮层、左侧尾状核、右侧颞中回、左侧后扣带回、左侧枕中回(均P<0.005);成正相关的脑区包括:左侧颞中回、左侧颞下回、两侧丘脑和豆状苍白球、右侧背外侧额上回、左侧缘上回、右侧枕上回和中回、左侧楔前叶(均P<0.005)。结论高尿酸血症是老年认知功能障碍的危险因素;情绪、记忆及默认网络脑灰质结构异常与老年认知功能障碍的发生、发展相关。Objective To analyze the relationship between cognitive dysfunction and hyperuricemia in the elderly,observe the changes in the brain gray matter structure of patients,and explore related brain mechanisms.Methods Prospectively selected 392 elderly patients with cognitive dysfunction who were hospitalized or outpatients in our hospital.According to the classification and diagnostic criteria of cognitive dysfunction and cognitive assessment scale,they were divided into 224 cases of mild cognitive impairment group and 168 cases of dementia group.In addition,182 elderly patients who had a physical examination in this hospital during the same period were selected as the control group.Compare the blood uric acid levels of each group,collect and analyze possible influencing factors.Using voxel-based morphometry to segment the patient’s total brain volume,run spm5 in Matlab 6.5 to analyze the correlation between the grading of the Mini Mental State Checklist(MMSE)and the total brain gray matter volume.Results The blood uric acid level of the dementia group[(419.47±32.51)μmol/L]was significantly higher than that of the mild cognitive impairment group[(354.80±27.63)μmol/L]and the control group[(226.48±32.15)μmol/L];the blood uric acid level of the mild cognitive impairment group was significantly higher than that of the control group(all P<0.01).Multivariate logistic regression analysis showed that age(B=1.821,OR=2.134,95%CI=1.296~4.830,P=0.000),education level(B=1.559,OR=1.607,95%CI=0.971~3.519,P=0.001),and hyperuricemia(B=1.559,OR=1.607,95%CI=0.971~3.519,P=0.001)are independent influencing factors of cognitive dysfunction in the elderly.The risk of cognitive dysfunction in hyperuricemia is 3.641 times higher than that of those with normal uric acid.The brain regions in which the MMSE classification of elderly patients with cognitive impairment is negatively correlated with gray matter volume include:left anterior cingulate gyrus,left medial superior frontal gyrus,bilateral parahippocampal gyrus,bilateral insula,b

关 键 词：认知功能障碍 老年人 高尿酸血症 脑灰质 结构变化 

分 类 号：R445.2[医药卫生—影像医学与核医学] R741[医药卫生—诊断学]