颅内病灶特征与初诊脑转移癌患者认知功能水平的相关性研究

Correlation between characteristics of intracranial lesions and level of cognitive function in patients with an initial diagnosis of brain metastases

目的 探讨初诊脑转移癌患者颅内病灶特征与认知功能水平的相关性.方法 以2015-2016年间收治的51例初诊脑转移癌患者为研究对象,利用CT和（或） MRI确定患者颅内病灶特征,用蒙特利尔认知评估量表评估患者认知功能水平.组间比较采用Mann-Whitney U检验,等级资料相关性采用Spearman法分析.结果 51例初诊脑转移癌患者中47例（92%）存在认知功能障碍,其中轻度认知功能障碍31例（61%）,痴呆16例（31%）.单独左、右半球受累的患者认知功能水平无统计学差异（P=0.425）,双侧半球受累较单独左侧半球受累的患者认知功能水平下降（P=0.042）.病灶累及≥3个脑叶较单个或2个脑叶受累的患者认知功能水平下降（P=0.015、0.024）.颅内病灶体积及水肿带体积对患者总体认知功能无影响（P=0.077、0.178）.颅内病灶个数＆gt;3个的患者较病灶个数为1~3个的患者认知功能水平下降（P=0.010）.结论 90%以上的初诊脑转移癌患者存在认知功能障碍,认知功能障碍主要与病灶部位、累及脑叶、病灶个数相关,而与病灶及水肿带体积无相关性.

Objective To investigate the correlation between the characteristics of intracranial lesions and the level of cognitive function in patients with an initial diagnosis of brain metastases.Methods A retrospective analysis was performed in 51 patients with an initial diagnosis of brain metastases who were admitted to The Second Hospital Affiliated to Suzhou University from January 2015 to April 2016.CT and （or） MRI were used to determine the characteristics of intracranial lesions and the Montreal Cognitive Assessment was used to evaluate the cognitive function of patients.Comparison between groups was made by Mann-Whitney U test.The correlation between ranked data was analyzed by Spearman rank correlation test.Results Of the 51 patients with an initial diagnosis of brain metastases,47（92%） had cognitive impairment,including mild cognitive impairment in 31（61%） and dementia in 16（31%）.There was no significant difference in level of cognitive function between the patients with involvement of the left hemisphere alone and those with involvement of the right hemisphere alone （P=0.425）.The patients with involvement of both hemispheres had a significantly lower level of cognitive function than those with involvement of the left hemisphere alone （P=0.042）.The patients with involvement of three or more brain lobes had a significantly lower level of cognitive function than those with involvement of one or two brain lobes （P=0.015,0.024）.The intracranial lesion volume and edema volume had no significant effect on the overall cognitive function of patients （P=0.077,0.178）.The patients with〉3 intracranial lesions had a significantly lower level of cognitive function than those with 1-3 intracranial lesions （P=0.010）.Conclusions More than 90% of patients with an initial diagnosis of brain metastases have cognitive impairment.Cognitive impairment is mainly associated with lesion site,involvement of brain lobes,and number of lesions,but not with lesion volume and edema volume.