皮质下缺血性脑血管病的临床表现及磁共振特征与认知损害的关系

The relationship of MRI features and clinical characteristics of subcortical ischemic vascular disease with cognitive impairment

目的分析皮质下缺血性脑血管病（SIVD）患者的临床特征、认知功能和磁共振成像特征，探讨SIVD患者腔隙性脑梗死（LI）和缺血性脑白质病变与认知损害的关系。方法依据Erkinjuntti提出的磁共振影像学（MRI）诊断标准确定SIVD患者53例，记录患者症状和体征，并进行神经心理学评估并行头部扫描。应用半自动MRI定量方法测定其缺血性脑白质高信号（WMH）体积，记录LI数量，分析LI数量和缺血性脑白质病变与认知损害的关系。结果53例SIVD患者以假球麻痹症状和上运动神经元损伤体征最为常见，分别为18．9％（10／53）和37．7％（20／53）。相关分析显示，年龄与WMH体积呈正相关（r=0．518，P％0．05），简易智能量表（MMSE）得分与WMH体积呈负相关（r=-0．514，P〈0．05），控制其他混杂因素影响后，仅年龄与WMH体积呈正相关（r=0．400，P=0．004）。控制年龄、性别和受教育时间影响因素前后，LI数量和WMH体积均与MMSE得分呈负相关（分别为r=-0．456，-0．514，-0．385，-0．382；均P〈0．05）。受教育时间与MMSE得分相关性具有统计学意义（r=0．518，P〈0．001）。结论年龄可能不是SIVD患者认知损害的主要危险因素。LI数量和缺血性脑白质病变均为SIVD认知功能损害的独立危险因素，LI数量增加、缺血性脑白质病变程度加重预示认知功能损害的恶化。

Objective To investigate the relationship of lacunar infarction （LI） and white matter lesion with cognitive impairment in patients with subcortical ischemic vascular disease （SIVD） Methods Fifty-three patients were diagnosed as SIVD according to the criteria of Erkinjuntti. The symptoms and signs were recorded by an interview and examination, and neuropsychological assessment and magnetic resonance imaging （MRI） were performed. A semi-automated MRI quantitative method was used to measure the volume of white matter hyperintensity （WMH） and the number of LI was counted. Correlation and the partial correlation analysis were performed to examine the relationship of general cognitive function with the volume of WMH and the number of LI. Results The pseudobulbar paralysis symptom and the upper motoneuron injury sign were the most common in these patients （18.9 % and 37.7%）. Correlation analysis showed that there was positive correlation between the volume of WMH and age （r = 0. 518, P 〈 0.05）, and there was negative correlcction between mini-metal state examination （MMSE） scures and the volume of WMH （r= -0. 514, P〈0.05）, After controlling confounding factors, only age was positively correlated with the volume of WMH （r=0. 400, P=0. 004）. There were negative correlation between the number of LI, the volume of WMH and MMSE scores（r=-0. 456, -0. 514,-0. 385, -0. 382;all P〈0.05）, and the years of education was positively correlated with MMSE scores （r=0. 518, P〈 0. 001）. Conclusions Age may not be the main risk factor for cognitive impairment in patients with SIVD. The volume of WMH and the number of LI are independent risk factors for cognitive impairment in patients with SIVD. Patients with severer SIVD or more LI show poorer performance on cognitive function.