抗N-甲基-D-天冬氨酸受体脑炎患者认知损害与脑血流灌注改变的相关性

Cognitive function and cerebral blood perfusion changes in patients with anti-N-methyl-D-aspartate receptor encephalitis

目的探究抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎患者的认知障碍、脑血流灌注改变及其相互关系。方法纳入2015年6月至2019年2月在安徽医科大学第一附属医院及中国科学技术大学附属第一医院就诊的恢复期抗NMDAR脑炎患者15例和健康对照(HC)15名,接受神经心理学评估其临床症状及认知功能,磁共振动脉自旋标记(ASL)灌注成像扫描评估其脑血流灌注情况,并进一步分析两者相关性。结果(1)抗NMDAR脑炎患者蒙特利尔认知评估量表(MoCA)得分低于健康对照组[(26.5±2.5)分比(28.6±1.9)分,P=0.015],在记忆、注意、语言、执行功能得分方面也均低于健康对照组(P<0.05),在临床症状、生活能力及精神情绪方面两组间差异无统计学意义(P>0.05)。(2)抗NMDAR脑炎患者全脑总脑血流量(CBF)明显低于HC组(0.949±0.028比0.953±0.025,P=0.001),双侧额下回三角部/岛盖部及左侧中央前回CBF明显低于HC组,左侧颞下回及左侧梭状回CBF明显高于HC组(P<0.05)。(3)抗NMDAR脑炎患者左侧中央前回CBF与Stroop色词测验-字呈负相关(r=-0.68,P=0.005);左侧梭状回CBF与Stroop色词测验-字(r=0.62,P=0.015)及彩色数字连线实验-A(r=0.81,P<0.001)呈正相关,与中文听觉词语学习测试-即刻(r=-0.59,P=0.020)及言语流畅性测验-动物(r=-0.58,P=0.024)呈负相关。结论抗NMDAR脑炎患者存在记忆、语言、注意和执行功能等认知功能障碍并与脑血流灌注改变相关,脑血流灌注可以作为抗NMDAR脑炎早期诊断,病情监测及预后评估的指标,改善恢复期患者脑血流有可能对认知恢复有促进作用。

Objective To investigated cognitive and cerebral blood flow changes in a cohort of patients with anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis.Methods Fifteen patients with confirmed anti-NMDAR encephalitis from the First Affiliated Hospital of Anhui Medical University and the First Affiliated Hospital of University of Science and Technology of China between June 2015 and February 2019 were included in the study.Meanwhile,another 15 healthy subjects were selected as controls.All participants underwent neuropsychological tests for assessment of the clinical symptoms and arterial spin labeling(ASL)of magnetic resonance perfusion imaging scan were employed to evaluate cerebral perfusion.Then the relationship between changed cerebral blood perfusion and cognitive function was evaluated.Results Patients with anti-NMDAR encephalitis showed significantly reduced overall cognitive function(Montreal cognitive assessment(MoCA))than healthy controls(26.5±2.5 vs 28.6±1.9,P=0.015),they also exhibited poorer performance in immediate memory,recognition,attention,language and executive function than healthy controls(P<0.05).However,no significant differences in clinical symptoms,viability,mental state and mood were observed between the two groups(P>0.05).Patients with anti-NMDAR encephalitis showed significantly reduced total brain cerebral blood flow(CBF)compared with the healthy controls(0.949±0.028 vs 0.953±0.025,P=0.001).Compared with the healthy controls,the patients had decreased CBF in triangular and opercular parts of bilateral inferior frontal gyrus and left central frontal gyrus,however,they showed increased CBF in the left inferior temporal gyrus and left fusiform gyrus(all P<0.05).In NMDAR group,the CBF in left central anterior gyrus was negatively correlated with Stroop′s Color Word-word(r=-0.68,P=0.005).The CBF in left spindle gyrus was positively correlated with Stroop′s Color Word-word(r=0.62,P=0.015)and completion time of color trail test-A(r=0.81,P<0.001),respectively,however,it was negatively correlated with Chinese Auditory Verbal Learning Test-immediate(r=-0.59,P=0.020)and Verbal Fluency Test-animals(r=-0.58,P=0.024),respectively.Conclusions Patients with anti-NMDAR encephalitis have prevalent cognitive deficits such as memory,language,attention and executive dysfunction as well as changes in blood perfusion,which may be related to cognitive deficits.Changes in cerebral blood perfusion can be used as indicators for early diagnosis,disease monitoring and prognosis evaluation of anti-NMDAR encephalitis.Improving the cerebral blood flow of patients may promote the recovery of cognition.