腔隙性脑梗死病灶数量和部位与皮质下血管性认知功能损害的相关性研究

Relationship of Number and Location of Lacunar Infarcts to Subcortical Vascular Cognitive Impairment

目的探讨腔隙性脑梗死(LI)病灶数量和部位与皮质下血管性认知功能损害的关系。方法皮质下缺血性脑血管病患者151例,根据神经心理学评估分为认知正常(no cognitive impairment,NCI)组和血管性认知功能损害(vascualr cognitive impairment,VCI)组;记录患者LI的病灶数量和部位,分析两者与认知损害的关系。结果VCI组LI病灶总数和脑白质病变较NCI组明显升高,差异具有统计学意义(P<0.05)。VCI组额区和基底核区LI病灶数量均较NCI组明显升高,差异有统计学意义(P<0.001);而顶枕区、颞区和幕下区LI病灶数量两组比较差异无统计学意义(P>0.05)。控制年龄、性别、受教育年限和脑白质病变的影响后,LI部位能解释阿尔茨海默病评定量表认知部分(ADAS-Cog)得分的37.6%(P<0.001),明显高于LI病灶总数的作用,其中额区和基底核区LI数量与ADAS-Cog得分呈正相关(P<0.05),而顶枕区、颞区和幕下区LI数量与ADAS-Cog得分无相关性(P>0.05)。结论LI的数量和部位均与皮质下缺血性血管性痴呆(SIVD)患者的认知损害有关,LI部位在SIVD认知功能损害中的作用比LI数量更大。额区和基底核区LI数量与总体认知功能损害呈正相关,为皮质下缺血性脑血管病患者认知功能损害的独立预测指标。

Objective To explore the relationship of number and location of lacunar infarct （LI） to cognitive impairment in patients with subcortical isehemie vascular disease. Methods One hundred fifty - one patients with subeortieal ischemie vascular disease were divided into groups NCI （ without cognitive impairment） and VCI （ with vascualr cognitive impairment）. The number and location of LI was recorded, and their relationship to general cognitive function was analyzed. Results The total number of LI lesions and white matter lesions were bigger in VCI group than in NCI group, the difference was significant （P 〈 0. 05）. LI lesion number in frontal area and basal ganglia was significantly bigger in VCI group than in NCI group （P 〈0. 001）.But no significant difference was noted in LI lesion number in temporal, parieto - occipital and infratentorial areas （ P 〉 0. 05 ）. Controlling for age, gender, years of education and effect of white matter lesions, LI location explained 37. 6% of ADAS - Cog scores （P 〈 0. 001 ）, obviously higher than LI lesion total number. LI number in frontal, basal ganglia area was positively correlated to ADAS - Cog scores （ P 〈 0.05 ）, but that in temporal, parieto - occipital and infratentorial areas was not correlated （ P 〉 0. 05 ）. Conclusion The LI number and location are related to cognitive impairment, the effect of LI location is greater than that of LI number. The number of LI at frontal and basal ganglia areas are both independent predictors of cognitive impairment in patients with subcortical ischemic vascular disease.