脑小血管病患者类淋巴系统功能与认知障碍关系的研究  

Study on the relationship between glymphatic system function and cognitive impairment in patients with cerebral small vessel disease

作　　者：钟琴 李惠[1] 李友 张树桐[1] 王翔[1] 谢元亮[1] 李翔[1] 黄增发 ZHONG Qin;LI Hui;LI You(Department of Radiology,Wuhan Central Hospital Affiliated to Huazhong University of Science and Technology,Wuhan 430010,China)

机构地区：[1]武汉市中心医院放射科,武汉430014

出　　处：《放射学实践》2024年第7期874-880,共7页Radiologic Practice

基　　金：武汉市科技局项目(2022020801020545)。

摘　　要：目的:探讨脑小血管病(CSVD)患者类淋巴系统功能与认知功能的关系。方法:前瞻性收集70例CSVD患者和37例健康对照(HCs),采用基于扩散张量成像(DTI)的髓静脉周围间隙扩散系数(ALPS指数)来评估类淋巴功能。比较HCs组、CSVD认知正常(CSVD-CN)组、CSVD认知障碍(CSVD-CI)组间的ALPS指数差异。采用Spearman相关分析和Logistic回归分析来评估CSVD患者ALPS指数与认知功能评分间的关系。结果:CSVD-CI组的左侧ALPS指数、右侧ALPS指数和双侧平均ALPS指数均显著低于CSVD-CN组和HCs组(P<0.017,Bonferroni校正)。CSVD患者双侧平均ALPS指数与MoCA评分(ρ=0.583,P<0.001)、视空间与执行功能(ρ=0.285,P=0.017)、注意力(ρ=0.301,P=0.011)、延迟回忆(ρ=0.697,P<0.001)和定向力(ρ=0.329,P=0.006)呈正相关。较低的双侧平均ALPS指数可显著增加CSVD患者认知障碍的风险,且是CSVD患者整体认知功能障碍的独立危险因素,校正混杂因素后的风险比值比(OR)为3.674[(95%CI:1.017~13.273),P=0.047]。结论:CSVD患者存在类淋巴系统功能障碍,整体类淋巴功能下降是CSVD患者整体认知功能障碍的独立危险因素。Objective:To explore the relationship between glymphatic system function and cognitive function in patients with cerebral small vessel disease(CSVD).Methods:Seventy patients with CSVD and 37 healthy controls(HCs)were prospectively collected.Diffusion tensor imaging(DTI)analysis along the perivascular space(ALPS index)was applied to characterize glymphatic function.ALPS index among the HCs group,CSVD-normal cognition group(CSVD-CN),and CSVD-impaired cognition group(CSVD-CI)were compared.Spearman correlation analysis and logistic regression analysis were used to evaluate the relationship between ALPS index and cognitive function in patients with CSVD.Results:The left ALPS index,right ALPS index,and bilateral average ALPS index of the CSVD-CI group were significantly lower than those of the CSVD-CN group and HCs group(P<0.017,bonferroni correction).The bilateral average ALPS index of CSVD patients was positively correlated with MoCA score(ρ=0.583,P<0.001),visual space and executive function(ρ=0.285,P=0.017),attention(ρ=0.301,P=0.011),delayed memory(ρ=0.697,P<0.001),and directional ability(ρ=0.329,P=0.006).The lower bilateral average ALPS index could significantly increase the risk of cognitive impairment,and it was an independent risk factor for overall cognitive impairment in CSVD patients[after adjusting for confounding factors,OR=3.674,95%CI(1.017~13.273),P=0.047].Conclusion:Patients with CSVD had glymphatic dysfunction.The overall declined glymphatic function is an independent risk factor for cognitive impairment in patients with CSVD.

关 键 词：脑小血管病 类淋巴系统 扩散张量成像 认知障碍 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743[医药卫生—诊断学]