不同亚型认知功能障碍患者脑影像学特征

Study on the Cerebral Neuroimaging in Different Subtypes of Cognitive Impairment

目的研究不同亚型认知功能障碍(CI)患者脑影像学特征。方法 381例认知功能障碍患者被分为4个临床亚型,其中:(1)非痴呆型血管性认知功能障碍(VCIND)55例;(2)血管性痴呆(VD)152例;(3)伴有血管因素的阿尔茨海默病(ADVR)133例;(4)不伴有血管因素的阿尔茨海默病(ADNVR)41例。对照组102例非认知功能障碍患者与381例CI患者均进行CT和(或)MRI检测。结果 VCIND、VD、ADVR、ADNVR与对照组脑白质病变发生率分别为23(41.8%)、90(59.2%)、68(51.1%)、12(29.3%)、15(14.7%),经检验CI四亚型均高于对照组,ADNVR明显低于ADVR和VD亚型(P<0.05);脑梗死发生率分别为19(34.5%)、114(75.0%)、26(19.5%)、3(7.3%)、19(18.6%),经检验ADNVR组明显低于其它组,而VD组明显高于其它组(P<0.05);脑萎缩发生率分别为29(52.7%)、73(48.0%)、98(73.7%)、35(85.4%)、35(34.3%),经检验ADNVR与ADVR明显高于其它组(P<0.05),但该2组间比较差异无显著性(P>0.05)。结论不同亚型认知功能障碍患者脑白质病变、脑梗死与脑萎缩的发生率均较高,脑白质病变与ADVR和VD的发生可能有关,而与ADNVR相关性较小;脑梗死与VD的发生明显有关,而与ADNVR相关性较小;脑萎缩与ADNVR与ADVR的发生明显有关。

Objective To investigate the characteristic of the the cerebral neuroimaging in different subtypes of cognitive impairment.Methods 381 cases who have cognitive impairment were divided into four subtypes：（1）vascular cognitive impairment with no dementia（VCIND）（55 cases）;（2）vascular dementia（VD）（152 cases）;（3）Alzheimer＇s disease with vascular factors（ADVR）（133 cases）;（4）Alzheimer＇s disease with no vascular factors（ADNVR）（41 cases.All cases were scaned by CT or MRI.Results As for incidence of the white matter lesions,it was significantly higher in the four different subtypes[VCIND（41.8%）、VD（59.2%）、ADVR（51.1%）、ADNVR（29.3%）]of CI than that in control group（14.7%）,it was significantly lower in ADNVR than that in VD and ADVR;As for incidence of the cerebral infarction,it was lower in ADNVR（7.3%）than that in other groups[VCIND（34.5%）、VD（75.0%）、ADVR（19.5%）、control group（18.6%）],it was significantly higher in VD than that in other groups;As for incidence of the encephalatrophy,it was significantly higher in ADNVR（85.4%） and ADVR（73.7%） than that in other groups[VCIND（52.7%）、VD（48.0%）、control group（34.3%）],but there was no difference between ADNVR and ADVR.Conclusion Our results indicated that there existed higher incidence in different subtypes of cognitive impairment on cerebral white matter lesions、cerebral infarction and encephalatrophy,cerebral white matter lesions may be relate to the ADVR and VD,less correlation with ADNVR.There were distinct relationship between the cerebral infarction and VD,less relevance between the cerebral infarction and ADNVR.Encephalatrophy play an important role in the occurrence of ADNVR and ADVR.