阿尔茨海默病和遗忘型轻度认知障碍患者海马血管周围间隙扩大的对比观察

Hippocampal enlarged perivascular spaces in AD and amnesia mild cognitive impairment patients

目的比较阿尔茨海默病(AD)与遗忘型轻度认知障碍(aMCI)患者海马血管周围间隙扩大(EPVS)发生率和数量,并探讨海马EPVS与海马萎缩的相关性。方法选择2016年10月~2018年12月在北京大学人民医院神经内科记忆门诊诊断的AD患者105例为AD组,aMCI患者55例为aMCI组,同期在门诊进行体检的认知正常的健康老年人(HC)50例为HC组。在MRI 3D BRAVO成像斜冠状位上观察海马EPVS数量,用内侧颞叶萎缩评定量表(MTA)评分判断海马萎缩程度,比较3组海马EPVS数量差异,Spearman相关性分析海马EPVS与MTA评分的相关性。结果AD组、aMCI组和HC组海马EPVS发生率分别是87.62%、83.64%和76.00%,且严重的海马EPVS(>4个)的比例分别为40.00%、23.64%和12.00%;AD组、aMCI组和HC组海马EPVS总数比较,差异有统计学意义[4.00(2.00,6.00)个vs 3.00(2.00,4.00)个vs 2.50(0.75,3.25)个,P=0.001];与aMCI组和HC组比较,AD组海马EPVS总数明显增多,差异有统计学意义(P=0.025,P=0.003);aMCI组与HC组海马EPVS总数比较,差异无统计学意义(P=0.131)。海马EPVS与海马萎缩的MTA评分呈正相关(r=0.328,P=0.000)。结论AD患者海马EPVS数量高于aMCI患者和HC,其可能与海马萎缩程度相关。

Objective To study the relationship between hippocampal enlarged perivascular spaces(H-EPVS)and hippocampal atrophy by comparing the incidence and number of H-EPVS in AD and amnesia mild cognitive impairment(aMCI)patients.Methods One hundred and five AD patients and 55 aMCI patients admitted to our hospital from October 2016 to December 2018 served as AD group and aMCI group respectively with 50 healthy elderly persons with normal cognitive function served as control group.The number of H-EPVS on MRI 3D BRAVO image was recorded.The severity of hippocampal atrophy was assessed according to its MTA score.The relationship between H-EPVS and MTA score was analyzed by Spearman correlation analysis.Results The incidence of H-EPVS was 87.62%,83.64%and 76.00%respectively in AD group,aMCI group and control group.The incidence of severe H-EPVS(>4)was 40.00%,23.64%and 12.00%respectively in AD group,aMCI group and control group.The totoal number of H-EPVS was significantly different in 3 groups(4.00 vs 3.00 vs 2.50,P=0.001)and was significantly greater in AD group than in aMCI group and control group(P=0.025,P=0.003).No significant difference was detected in the total number of H-EPVS between aMCI group and control group(P=0.131).The number of H-EPVS was positively related with the MTA score(r=0.328,P=0.000).Conclusion The number of H-EPVS is greater in AD patients than in aMCI patients and controls,which is related with the severity of hippocampal atrophy.