皮质下缺血性脑血管病患者额叶白质病变对认知领域的损害研究

Study of cognitive impairments caused by the white matter lesions in the frontal lobe in patients with subcortical ischemic vascular disease

目的探讨皮质下缺血性血管病(SIVD)患者的额叶的白质病变(WML)累及的认知功能域。方法将50例SIVD患者,根据额叶WML评分的严重程度,分为严重WML组(视觉评分>3分)27例和轻度WML组(视觉评分≤3分)23例。另以7例无SIVD的人群作为对照。对所有受试者进行全套的认知心理学测查并对结果进行对比分析。结果 3组间一般资料的差异无统计学意义。与轻度WML组和对照组相比,严重WML组的非额叶白质评分、额叶腔隙灶数目明显增多(均P=0.000);与轻度WML组相比,严重WML组的蒙特利尔认知评估量表评分明显降低(P=0.047);且执行功能相关的认知评分明显降低(P=0.006),在调整了额叶的腔隙灶数量后,该差异仍有统计学意义(P=0.038)。多元回归分析发现,对注意执行Z分显著影响的因素为额叶WML评分(P=0.000)。结论在SIVD患者中,额叶的WML主要累及执行功能。

Objective To explore the pattern of cognitive impairments mainly caused by the white matter lesions（WML） in the frontal lobe in patients with subcortical ischemic vascular disease （SIVD）.Methods Fifty SIVD patients were divided into severe WML group （visual score ＆gt;3, n=27） and mild WML group（visual score ≤3, n=23） according to their severities of the WML in frontal lobe .Seven patients without SIVD were collected as controls .All patients underwent a set of neuropsychological battery ,and the results were analyzed .Results There was no statistical significance among three groups on basic data .Compared with mild WML group and control group , non frontal white matter scores and numbers of lacunes in frontal lobe of severe WML group were significantly higher （ all P=0.000）.Compared with mild WML group,the Montreal cognitive assessment scale in severe WML group were significantly lower （ P=0.047 ） , and scores related to the executive function were significantly lower （ P=0.006 ） , even after adjusting the numbers of lacunes in frontal lobe ,there was statistically significant difference （P=0.038）. Multiple regression confirmed that the Z scores of executive functions were mainly affected by white matter lesions located in the frontal lobe （ P=0.000 ） .Conclusion WML located in the frontal lobe mainly affect the executive function in patients with SIVD .