314例脑白质病变患者MRI影像学与临床特点的回顾性分析

Retrospective Analysis on MRI Imaging and Clinical Features in 314 Patients of Leukodystrophy

目的：研究脑白质病变的影像学改变及临床特点。方法回顾性纳入60～85岁行MRI检查示脑白质高信号改变的患者，回顾其影像学资料、临床资料，总结归纳脑白质病变的类型、严重程度，病史、认知与情绪评价结果，诊断等。结果脑白质病变类型以1型、2型为主，分别占总例数的47．45％、31．21％。病变程度均以轻度为主：脑室周围白质轻度改变占57．64％，脑深部白质轻度改变占68．79％。病史提示56．69％患高血压病，28．34％患脑卒中，29．30％患糖尿病。57．96％患者存在认知功能障碍；12．42％患者存在抑郁。66例脑梗死，42例阿尔兹海默病，88例血管性痴呆。中医诊断为“痴呆”患者以肾精亏虚（脑髓空虚）为主，占58．27％。结论脑白质病变影像学以轻中度改变为主，其发病可能与高血压、卒中、糖尿病等有关，其病变程度可能与认知功能下降有关，痴呆患者中医证型以肾精亏虚（脑髓空虚）型为主。

Objective To study the imaging changes and clinical features of leukodystrophy.Meth-ods The patients,aged from 60 to 85 years,with high signal changes of alba in MRI examination were in-cluded and their imaging data and clinical data were analyzed retrospectively.The type of leukodystrophy and severity,evaluation results of medical history,cognition and emotion,diagnosis and others were summed up. Results The type 1 and type 2 lukodystrophy are predominated,accounting for 47.45% and 31 .21% re-spectively.Most cases were mild in severity,in which,the mild change in peripheral ventricular white matter accounted for 57.64%,and the white matter of deep brain for 68.79%.The medical history showed that 56.69% of them suffered from hypertension,23.34% of them from stroke and 29.30% from diabetes. 57.96% of patients had cognitive disturbance and 1 2.42% had depression.There were 66 cases of cerebral infarction,42 cases of Alzheimer′s disease and 88 cases of vascular dementia.“Dementia”diagnosed by TCM is predominated as kidney essence deficiency（emptiness of brain marrow）in differentiation,accounting for 58.27%.Conclusion Leukodystrophy is predominated as the mild case in imaging,likely related to hyper-tension,stroke,diabetes,etc.The severity of disease is possibly associated with declining of cognitive func-tion.Dementia in TCM is mainly differentiated as kidney essence deficiency（emptiness of brain marrow）.