胆碱能通路损伤在血管性认知功能障碍中的作用

The role of cholinergic pathway lesions in vascular cognitive impairment

目的通过比较胆碱能通路高信号评分（CHIPS）与缺血性脑卒中患者认知功能之间的关系，探索胆碱能通路损伤在血管性认知功能障碍中的作用。方法采用MRI对住院缺血性脑卒中患者进行CHIPS评分、总体白质高信号Schelten评分，同时使用北京版蒙特利尔认知量表（MoCA）进行认知功能评估，分析影像学评分与认知评估间的相关性。结果共纳入34例研究对象[45—82岁，平均（62．2±8．8）岁]，该群体CHIPS评分与MoCA得分间标准化回归系数β=-0．382，P=0．026，而Schehen评分与MoCA得分间B=-0．357，P=0．042；在视空间与执行功能、命名、注意与抽象分项评分中，CHIPS与分项评分存在相关性；Schelten评分与命名、注意和抽象评分亦存在相关性。结论胆碱能通路损伤在白质病变所致血管性认知功能障碍中起作用，其主要作用可能是影响视空间与执行功能。

Objective To investigate the relationship between white matter lesions （WML） within the cholinergic pathway and vascular cognitive impairment. Method Middle-aged and elderly stroke patients underwent brain MRI examination and Montreal Cognitive Assessment （MoCA）. Cholinergic Pathways Hyperintensities Scale （CHIPS） scores and the overall WML burden by Schelten on fluid- attenuated inversion recovery MRI images were determined and compared with MoCA scores. Spearman partial rank correlation coefficients and standardized regression coefficients were calculated. Results Thirty four patients were included （mean age （62.2 ± 8.8 ） years, 45-82 years ）. MoCA scores negatively correlated with WML burdens by Schelten scores （ β = - 0. 357, P = 0. 042 ） and CHIPS scores （ β = -0. 382 ,P = 0. 026 ）. CHIPS scores were negatively associated with visuospatial and executive function （r = -0. 290, P =0. 048）, naming function （r = - 0.486, P = 0.002）, attention （r = - 0. 311, P = 0. 037 ） and abstraction （ r = - 0. 344, P = 0. 023 ）. Sehelten scores were negatively associated with naming function （ r = - 0. 492, P = 0. 002） , attention （ r = - 0. 364, P = 0. 017 ） and abstraction （ r = - 0. 390, P =0. 011 ）. Conclusion WML lesions within the cholinergie pathyway play a possible role in vascular cognitive impairment especially in visuospatial and executive function.