三种脑白质损害评分标准在轻度认知损害与阿尔茨海默病中的应用

Comparison and application of three visual rating scales for white matter lesions in Alzheimer＇s disease and mild cognitive impairment

目的比较三种脑白质损害评分标准在轻度认知损害（MCI）和阿尔茨海默病（AD）中的应用价值。方法纳入合格被试共184例，包括107例AD、47例MCI和30例正常对照。所有被试完成标准化认知功能检查和核磁共振（MRI）成像，采用年龄相关白质改变（ARWMC）分级标准、胆碱能通路高信号评分量表（CHIPS）和Fazekas量表三种脑白质评分系统进行脑白质损害评分，比较三种评分方法的一致性及其对三组被试脑白质异常差异的评价，并与认知评分进行相关分析。结果ARWMC分级标准、CHIPS及Fazekas量表的评分呈中度到高度相关，（r=0．61～0．78，均P〈0．01）。三种评分方法对三组病例的脑白质损害的检测：ARWMC分级标准发现AD组与MCI组的脑白质损害在左侧额叶，右侧额叶，与NC组在右侧额叶、左侧颞叶差异有统计学意义（P％0．05），MCI组与NC组的脑白质损害在左侧颞叶有差异F=3．36（P〈0．05）；CHIPS结果显示，AD组与MCI组和NC组的脑白质损害在半卵圆中心层面的前部左侧存在差异，AD组与NC组的脑白质损害还在低外囊层面的后部右侧差异有统计学意义（P〈0.05）；采用Fazekas量表，各组问脑白质损害在脑室旁白质及深部白质均差异无统计学意义。AD组中ARWMC分级标准显示右颞叶评分与集中力及构图力呈正相关，左侧基底节区及右侧基底节区评分与集中力呈负相关；Fazekas量表，脑室旁白质评分与集中力、MMSE、定向力呈负相关，深部白质评分与集中力及抽象判断呈负相关，Fazekas总分与集中力呈负相关。MCI组中CHIPS评分低外囊层面后部左侧与短时记忆呈负相关。结论三种脑白质损害评分标准一致性好；ARWMC分级标准和CHIPS可检测到AD、MCI及健康老年人组间脑白质损害的差异，CHIPS在MCI中与认知评分相关，而ARWMC及Fazekas量表在AD中与多项认知评分相关。CHIPS在MCI、ARWMC分级标准在AD中对脑白质损害的检测及与认知评分的相关性方面更具优势。

Objective To compare the clinical value of three visual rating scales （VRS） for white matter lesions （WML） in Alzheimer＇s disease （AD） and mild cognitive impairment （MCI）. Methods Totally 184 subjects （including 107 AD patients, 47 MCI patients and 30 normal controls） were recruited. All subjects underwent comprehensive neuropsychological tests and were examined with a standard protocol of MR imaging. WML burden was rated with the Age-Related White Matter Changes （ARWMC） rating scale, Cholinergic Pathways Hyperintensities Scale （CHIPS） and Fazekas scale. Consistence of the three rating scales were analyzed, and detection results of WML in AD/ MCI/NC group with the three rating scales were compared. The relationship between WML and cognitive function in AD and MCI groups were explored. Results ARWMC rating scale, CHIPS and Fazekas scales were moderately to highly correlated with WML （r^0. 61-0. 78, all P＊（0.01）. ARWMC showed that WML were in the left and right frontal lobes in AD and MCI groups and in the right frontal lobe and left temporal lobe in NC group, which had significant differences （F~ 4.20, 4.69, 4.69, 3.36, respectively, all P（0.05 ）. WML in the left temporal lobe had a significant difference between MCI group and NC group （F=3.36, P（O. 05）. CHIPS showed that WML in the front left side of centrum semiovale in AD and MCI groups had significant difference as compared with that in NC group （F= 4.88, P^0.05）, and WML in the rear right side of low external capsule had a significant difference between AD and NC groups （F~ 3.04, P^0.05）. Fazekas scale showed that there was no difference in WML among AD, MCI and NC groups. ARWMC showed that scores of WML in right temporal lobe were positively correlated with concentration and visual construction, and bilateral basal ganglia were negatively correlated with the concentration. Fazekas scale showed that scores of WML in periventricular were negatively correlated with concentration, MMSE and orientation, scores of WML in deep white matter were negatively correlated with concentration, abstraction and judgment, and the whole scores were negatively correlated with concentration. CHIPS showed that the scores of WML in the rear left side of low external capsule were negatively correlated with short-term memory in MCI group. Conclusions The three rating scales well consistent with each other. ARWMC rating scale and CHIPS can detect the differences in WML between AD, MCI and NC groups. The scores of CHIPS in WML are related with cognition in MCI group, while scores of ARWMC and Fazekas scale in WML are correlated with many aspects in cognitive function in AD group. In general speaking, CHIPS in MCI patients and ARWMC rating scale in AD patients show more advantages in the detection of WML and have better correlation with cognitive function.