Alzheimer病患者脑内扩大的血管周围间隙的临床意义

Clinical significance of enlarged perivascular spaces in Alzheimer disease patients

目的 :探讨Alzheimer病(Alzheimer disease,AD)患者在不同认知程度下脑内扩大的血管周围间隙(Enlarged perivascular spaces,EPVS)的变化,并进一步分析EPVS与简易精神状态检查(Mini-mental state examination,MMSE)评分之间的关系。方法:30例AD患者(AD组,MMSE<24分)、20例轻度认知障碍患者(Mild cognitive impairment,MCI组;24分≤MMSE<27分)以及30例年龄、性别及受教育程度相匹配的健康老年人(正常对照组,MMSE≥27分)纳入本研究,通过观察MRI T_2WI及T_2FLAIR图像,计数各组基底节区及半卵圆中心区EPVS的数目并进行4级评分。用Kruskal-Wallis及KolmogorovSmirnov Z检验分析组间差异,同时应用Spearman相关分析各组不同脑区EPVS评分与MMSE之间的关系,以及正常对照组基底节区、半卵圆中心区EPVS评分与年龄之间是否相关。结果:三组间基底节及半卵圆中心区EPVS评分均有统计学差异(H值分别为26.45和41.4,P<0.01);与正常对照组相比,AD组的基底节区EPVS评分明显升高(1.06±0.25,1.80±0.71,P<0.01),而与MCI组比较无统计学差异(1.15±0.36,P>0.05);在半卵圆中心区域,AD组的EPVS评分(2.93±0.83)分别高于MCI组(2.40±0.68)及正常对照组(1.40±0.50,P<0.01)。Spearman相关分析显示基底节区、半卵圆中心EPVS评分与MMSE评分均呈负相关(r=-0.708,r=-0.594,P<0.01),同时研究结果显示正常对照组基底节区EPVS评分与年龄存在正相关(r=0.418,P<0.05),但是没有发现半卵圆中心区EPVS评分与年龄存在相关性(P>0.05)。结论:基底节区、半卵圆中心EPVS在AD患者中普遍存在,并一定程度上反映了AD患者认知功能的水平。

Objective： To explore the imaging features of enlarged perivascular spaces（EPVS） in basal ganglia and centrum semiovale in mild cognitive impairment （MCI） and Alzheimer disease （AD） patients, and to analyze the relationship between EPVS and cognitive impairment. Methods： In this study, 30 patients with AD（AD group, mini-mental state examination（MMSE） 〈24）, 20 patients with MCI （MCI group, 24≤MMSE〈27） and 30 normal controls （NC group, MMSE≥27） were reviewed retro- spectively. EPVS in both the basal ganglia and centrum semiovale were counted in axial images according to the following standard： 1 score for EPVS less than 10, 2 scores for EPVS between 11 to 20, 3 scores for EPVS between 21 to 40 and 4 scores for EPVS more than 40. Kruskal-Wallis test and Kolmogorov-Smirnov Z test were used to analyze the inter-group dif- ference. Relationship between the scores of EPVS and MMSE was explored using Spearman＇s correlation analyses. Results： Significantly statistical differences of EVPS score in both the basal ganglia and centrum semiovale were found among the three groups （H values respectively=26.45, 41.4, all P〈0.01）. In the basal ganglia, EPVS score in AD group （1.80±0.71） was higher than that in NC group （1.06±0.25）（P〈0.01）, and there was no difference of EPVS scores between MCI and NC group （P〉0.05）. In the centrum semiovale, EPVS scores in AD group（2.93±0.83） was obviously higher than that in MCI group（2.40±0.68） and NC group （1.40±0.50, P〈0.01）. There were correlations between the scores of EPVS and MMSE in both the basal ganglia and centrum semiovale （r values respectively=-0.708, -0.594, all P〈0.01）. Besides, in the NC group, there was correlation between the score of EPVS and MMSE in the basal ganglia （r=0.418, P〈0.05）. Conclusion： In patients with AD, EPVS is a common phenomenon in both the basal ganglia and centrum semiovale, and it can help to evaluate the changes of cognitive abilities.