短暂性全面性遗忘症伴海马损伤的血管危险因素及神经心理因素特征分析  

Analysis of Vascular Risk Factors and Neuropsychological Factors in Transient Global Amnesia with Hippocampal Lesions

作　　者：王为森 杜冰滢 李丙翰 张馨元 彭雯佳 毕晓莹 WANG Weisen;DU Bingying;LI Binghan;ZHANG Xinyuan;PENG Wenjia;BI Xiaoying(Department of Neurology,The First Affiliated Hospital of Naval Medical University,Shanghai 200433,China;Department of Radiology,The First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院神经内科,上海200433 [2]海军军医大学第一附属医院放射诊断科

出　　处：《中国卒中杂志》2025年第3期341-348,共8页Chinese Journal of Stroke

基　　金：国家自然科学基金面上项目(82371495);上海市卫健委科研项目基金(202340066)。

摘　　要：目的探究短暂性全面性遗忘症(transient global amnesia,TGA)伴海马损伤患者的临床、血管危险因素及神经心理因素特征。方法回顾性纳入2015年1月—2024年1月海军军医大学第一附属医院收治的TGA患者,统计TGA伴海马损伤的部位及发病至完成头颅MRI的时间。根据是否伴有海马损伤将TGA患者分为TGA伴海马损伤组和TGA不伴海马损伤组,比较两组患者之间血管危险因素、小血管标志物、大血管狭窄程度、神经心理量表评估结果的差异。结果共纳入72例患者,平均年龄(63.7±11.7)岁,男性27例(37.5%),伴有海马损伤者21例(29.2%)。TGA伴海马损伤主要累及海马体部(57.1%),患者发病后3~<5 d完成头颅MRI的海马损伤检出率较高(42.9%)。与TGA不伴海马损伤组相比,TGA伴海马损伤组高血压(76.2%vs.49.0%,P=0.034)、发病1周内完成头颅MRI(95.2%vs.66.7%,P=0.025)、中重度白质高信号(38.1%vs.11.8%,P=0.025)以及脑室旁白质高信号3分(33.3%vs.9.8%,P=0.037)的比例均显著较高,而HAMA评分(3.0分vs.7.0分,P=0.008)和焦虑状态比例(4.8%vs.29.4%,P=0.048)显著更低。结论海马损伤是部分TGA患者的特征性影像学标志物,可能与高血压和小血管损伤有关。不伴海马损伤的TGA则可能与神经心理因素有关。Objective To investigate the clinical characteristics,vascular risk factors,and neuropsychological factors in patients with transient global amnesia(TGA)associated with hippocampal lesions.Methods A retrospective study was conducted on patients with TGA admitted to the First Affiliated Hospital of Naval Medical University from January 2015 to January 2024.The locations of TGA with hippocampal lesions and the time from onset to completion of brain MRI were recorded.TGA patients were divided into two groups based on whether they were accompanied by hippocampal lesions:the TGA with hippocampal lesions group and the TGA without hippocampal lesions group.The differences in vascular risk factors,small vessel markers,degree of large vessel stenosis,and neuropsychological assessment results were compared between the two groups.Results A total of 72 patients were included,with an average age of(63.7±11.7)years,and 27 males(37.5%).Twenty-one patients(29.2%)had hippocampal lesions.TGA with hippocampal lesions mainly involved the body of the hippocampus(57.1%),and the detection rate of hippocampal lesions in brain MRI completed 3-<5 days after onset was relatively high(42.9%).Compared with the TGA without hippocampal lesions group,the proportion of hypertension(76.2%vs.49.0%,P=0.034),completion of brain MRI within one week from onset(95.2%vs.66.7%,P=0.025),moderate to severe cerebral white matter hyperintensity(38.1%vs.11.8%,P=0.025),and periventricular white matter hyperintensity score of 3 points(33.3%vs.9.8%,P=0.037)were significantly higher in the TGA with hippocampal lesions group,while the HAMA score(3.0 points vs.7.0 points,P=0.008)and the proportion of anxiety state(4.8%vs.29.4%,P=0.048)were significantly lower.Conclusions Hippocampal lesions are the characteristic imaging marker of part of TGA patients and may be associated with hypertension and small vessel lesions.TGA without hippocampal lesions may be related to neuropsychological factors.

关 键 词：短暂性全面性遗忘症 海马损伤 血管危险因素 白质高信号 神经心理评估 

分 类 号：R74[医药卫生—神经病学与精神病学]