多发性硬化患者灰质萎缩与认知功能领域损害的相关性研究  

A study of the correlation between gray matter atrophy in multiple sclerosis and impairment of cognitive function domains

作　　者：韩婧 王庆军[3] 王超慧 李志鸿 白润花 张雪[2] 刘建国 Han Jing;Wang Qingjun;Wang Chaohui;Li Zhihong;Bai Runhua;Zhang Xue;Liu Jianguo(Department of Neurology,School of Medicine,South China University of Technology,Guangzhou 510006,China;Department of Neurology,the Sixth Medical Center of PLA General Hospital of Beijing,Beijing 100048,China;Department of Radiology,The PLA General Hospital of Beijing,Beijing 100048,China)

机构地区：[1]华南理工大学医学院,广州510006 [2]解放军总医院第六医学中心神经内科,北京100048 [3]解放军总医院第六医学中心放射诊断科,北京100048

出　　处：《中华内科杂志》2024年第7期666-673,共8页Chinese Journal of Internal Medicine

基　　金：解放军总医院第六医学中心创新培育基金(CXPY202222)。

摘　　要：目的:量化分析多发性硬化(MS)患者脑皮质及深部灰质萎缩情况,探索其与认知功能领域损害的相关性。方法:横断面研究。纳入2022年10月至2023年10月就诊于解放军总医院第六医学中心的MS患者20例及年龄、性别、教育水平相匹配的健康对照组16名,使用FreeSurfer软件,基于3D-MRI技术,对比分析两组皮质厚度及深部灰质体积差异,并对两组受试者进行包括6个认知功能领域在内的神经心理学量表评估,分析MS患者皮质厚度及深部灰质体积与认知功能领域损害的相关性。结果:(1)认知功能领域受损情况:本研究60%的MS患者存在认知障碍,主要表现为言语记忆、言语流畅性、视空间记忆、信息处理速度功能受损(均P<0.05)。其中,以视空间记忆功能损害者居多(占55.0%),信息处理速度损害者最少(占15.0%)。(2)皮质厚度改变情况:与健康对照组相比,MS组皮质萎缩主要集中于额顶部,包括左侧顶叶下回、右侧额上回、右侧顶叶上回皮质厚度均显著变薄(均P<0.05)。其中,左侧顶叶下回萎缩与言语记忆、言语流畅性、信息处理速度损害间均呈显著正相关(均P<0.05),右侧额上回萎缩与言语记忆、言语流畅性、视空间记忆损害间均存在显著正相关(均P<0.05)。(3)深部灰质体积改变情况:与健康对照组相比,MS组深部灰质体积显著减少的区域有双侧丘脑、双侧壳核、双侧苍白球(均P<0.01)、右侧伏隔核(P<0.05)。其中,左侧丘脑萎缩与视空间记忆损害呈显著正相关(r=0.45,P=0.046),左侧壳核萎缩与视空间记忆(r=0.45,P=0.047)及信息处理速度损害(r=0.50,P=0.026)均存在显著正相关。结论:MS患者脑结构改变早期以灰质萎缩为主。其中,深部灰质较皮质萎缩更为突出。MS患者认知障碍方面,以言语记忆、言语流畅性、信息处理速度及视空间记忆功能损害为主,且与相应功能区域脑萎缩显著相关。Objective To quantify cerebral cortical and deep gray matter atrophy in patients with multiple sclerosis(MS)and explore its correlation with impairment in domains of cognitive function.Methods Twenty patients with MS and 16 healthy controls(HC)matched for age,sex,and education level were included.Using FreeSurfer software,based on 3D-MRI technology,the differences in cortical thickness and deep gray matter volume between the two groups were comparatively analyzed.A neuropsychological scale that included six domains of cognitive function was scored on both study groups to analyze the correlation between cortical thickness and volume of deep gray matter in MS patients with impairment in cognitive function domains.Results Impairment in domains of cognitive function:cognitive impairment was present in 60%MS patients in this study,mainly manifesting as impairment of verbal memory,verbal fluency,visuospatial memory,and information processing speed function(all P<0.05).Of these,the majority had impaired visuospatial memory function(55.0%),and the least number of patients had impaired information processing speed(15.0%).Changes in cortical thickness:compared with the HC group,the MS group showed that cortical atrophy was mainly concentrated in the frontoparietal region,including significant thinning of cortical thickness in the left inferior parietal gyrus,right superior frontal gyrus,and the right superior parietal gyrus(all P<0.05).Among them,atrophy of the left inferior parietal gyrus was significantly positively correlated with the impairment of verbal memory,verbal fluency,and information processing speed(all P<0.05).There was a significant positive correlation between the right superior frontal gyrus atrophy and verbal memory,verbal fluency,and visuospatial memory impairment(all P<0.05).Changes in deep gray matter volume:compared with the HC group,deep gray matter volume in the MS group decreased significantly in the bilateral thalamus,bilateral putamen,bilateral pallidum(all P<0.01),and right nucleus accumbens(P<0

关 键 词：多发性硬化 大脑皮质 萎缩 认知 磁共振成像 

分 类 号：R744.51[医药卫生—神经病学与精神病学]