单纯脑白质疏松症与Binswanger病及脑梗死合并脑白质疏松症患者认知功能、影像学特征及危险因素的比较(英文)

Comparison of congitive function,image characteristics and risk factors in patients with leukoaraiosis,Bingswanger disease and cerebral infarction combining leukoaraiosis

背景:脑白质疏松症(Leukoaraiosis,LA)是由多种不同病因引起的一组影像学所描述的临床综合征,对其确切发病机制及临床表现和早期评估普遍重视不足。目的:探讨单纯脑白质疏松症患者的危险因素、认知功能、步态变化与CT及MRI特征以及与Binswanger病(Binswangerdisease,BD)、脑梗死的关系。设计:以诊断为依据的回顾性病例对照研究。地点和对象:1995-08/2000-03到山东大学齐鲁医院门诊或住院的脑血管病患者,包括114例LA患者,41例BD患者,113例脑梗死合并LA患者。干预:对参加者详细询问病史、神经科查体,行头颅CT或MRI检查,采用简易精神状态量表进行神经心理学测试。主要观察指标:①既往发生高血压、冠心病、糖尿病、高脂血症、吸烟及脑卒中等危险因素情况。②各组患者主要临床特征及头颅CT或MRI表现。结果:单纯LA组危险因素多样化,以轻度记忆力减退、步态欠平稳为主要临床特点;CT显示脑白质异常以1型为主(70.2%),MRI显示脑白质异常以1型为主(71.6%),单纯LA组均无脑室扩大。BD组危险因素以高血压为主(95.1%)、均有神经局灶体征、均有较明显的认知功能障碍、脑卒中样发作为主要临床特征;CT显示脑白质异常以3型为主(73.2%),MRI显示脑白质异常以3型(54.3%)、4型(45.7%)为主,BD组均有双侧脑室对称性扩大。

BACKGROUND:Leukoaraiosis(LA) is a clinical syndrome manifested by a group of images,which is caused by various factors. However,it has not been attached much importance to its mechanism,clinical manifestations as well as early assessment. OBJECTIVE:To explore the risk factors,cognition,gait,CT and MRI characteristics of simply leukoaraiosis(LA) as well as its relationship with Binswanger's disease(BD) and cerebral infarction (CI). DESIGN:Retrospective case control study on the basis of diagnosis. SETTING and PARTICIPANTS:The patients were diagnosed with cerebrovascular diseases in Qilu Hospital of Shandong University during August 1995 to March 2000.There were 114 patients with LA,41 patients with BD and 113 patients with CI combining LA. INTERVENTIONS:The participants were asked detailed medical histories,taken neural examinations,head CT or MRI and MMES scale to measure neuropsychological states. MAIN OUTCOME MEASURES:①Previous history of hypertension, coronary heart disease,diabetes,hyperlipemia,smoking and cerebral infarction;②Clinical features of patients in each group,head CT or MRI images. RESULTS: There were diversified risk factors of simply LA which were characterized by mild hypomnesia,instable gait.Both CT and MRI showed that type 1 anomaly of white matter was commonly seen(70.2%,71.6%)respectively.There was no dilated ventricle found in simply LA group. Hypertension was the primary risk factor of BD group(95.1%). Patients in this group all had local neurological signs,obvious cognitive dysfunction and symptoms like cerebral apoplexy.CT showed that the type 3 anomaly of white matter accounts for 73.2%.MRI showed that type 3,type 4 anomaly were common seen which was 54.3%and 45.7%respectively. There were bilateral ventricle dilations in this group.In CI combining LA group,coronary heart disease(50%),hypertension(43.4%) and hyperlipemia(31.0%) were major risk factors.Patients in this group had obvious cognitive dysfunction than patient in simply LA group besides suffering different level of neural focal sign such as hemiplegia and so on.Type 2 anomaly of white matter was commonly seen from both CT(66.4%) and MRI(68.1%) with dilated ventricle(39.8%). CONCLUSION:Simply LA has various risk factors. It has no obvious neural focal sign and the diagnosis of it is mainly based on the imaging showing of type 1 white matter anomaly.The diagnostic standard of BD includes hypertension,obvious cognitive dysfunction and episode of CI.The imaging diagnosis is based on the type 3 anomaly of white matter in CT and type 3 or 4 in MRI.The risk factors of CI combining LA are coronary heart dishease,ypertension and hyperlipemia.It has more obvious cognitive dysfunction that simply LA.