轻度认知障碍患者空间导航障碍与脑白质高信号的相关性

Correlation between spatial navigation disorder and white matter hyperintensity in patients with mild cognitive impairment

目的探索轻度认知障碍(MCI)患者脑白质病变与空间导航能力之间的关系。方法选取2015年1月至2018年2月在南京大学医学院附属鼓楼医院就诊的32例MCI患者[年龄(66±11)岁,男16例,女16例]以及年龄、性别、受教育程度匹配的28位健康对照组(NC)[年龄(70±11)岁,男19名,女9名]进行空间导航能力测试和神经行为心理学量表评价;采用横断面研究,所有被试同时均进行3.0T磁共振三维液体反转恢复序列及高分辨T1加权成像扫描,采用白质高信号分割工具包(W2MHS)自动标记并提取白质高信号的体积。结果MCI患者自我参照导航(P=0.002)、环境参照导航(P=0.039)的平均误差距离均大于对照组,混合(环境参照和自我参照)导航的平均误差距离与正常对照组无差异(P=0.070),而全脑白质高信号体积、侧脑室旁白质高信号体积、深部白质高信号体积组间差异无统计学意义(均P>0.05)。偏相关分析显示控制年龄、性别、教育程度及全脑容积后,MCI患者混合(环境参照和自我参照)导航的平均误差距离与全脑白质高信号体积、深部白质高信号体积及侧脑室旁白质高信号体积呈正相关(r=0.469、0.434、0.512,均P<0.05),环境参照导航的平均误差距离与侧脑室旁白质高信号体积(r=0.403,P=0.033)正相关,自我参照导航平均误差距离与脑白质高信号体积无关联性。结论MCI患者空间导航能力与脑白质病变有关,对进一步研究影响人类空间导航能力的潜在生物学机制具有重要意义。

Objective To investigate the relationship between white matter lesions and spatial navigation ability in patients with mild cognitive impairment(MCI).Methods A total of 32 MCI patients[age(66±11)years,16 males and 16 females]who were treated in the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2015 to February 2018 were selected,and matched with age,gender and education level of 28 healthy controls(NC)[age(70±11)years,19 males and 9 females]underwent spatial navigation ability test and neuropsychology scale evaluation.In the cross-sectional study,all subjects simultaneously underwent 3.0T magnetic resonance three-dimensional liquid inversion recovery sequence and high-resolution T1 weighted imaging scan.The Wisconsin White Matter Hyperintensities Segmentation Toolbox(W2MHS)was used to automatically mark and extract the volume of the white matter hyperintensity.Results The average error distances of egocentric virtual(P=0.002)and allocentric virtual(P=0.039)of MCI patients are greater than that of the control group,but the average error distance of mixed(allocentric-egocentric virtual)navigation had no statistic difference between two groups(P=0.070).The volume of the whole white matter hyperintensity,periventricular white matter hyperintensity,and deep white matter hyperintensity showed no significant differences between two groups(all P>0.05).Partial correlation analysis showed that after controlling for age,gender,education level and whole brain volume,the average error distance of mixed(allocentric-egocentric virtual)navigation in MCI patients was positively correlated to the volume of the whole white matter hyperintensity,deep white matter intensity,and periventricular white matter hyperintensity(r=0.469,0.434,0.512,all P<0.05).The average error distance of allocentric virtual navigation is positively correlated with the volume of periventricular white matter hyperintensity(r=0.403,P=0.033).There is no correlation between the average error distance of egocentric virtual navigation and the hyperintensity of white matter.Conclusions The spatial navigation ability of patients with MCI is related to white matter lesions,which is of great significance for further research on the potential biological mechanisms affecting human spatial navigation ability.