血管周围间隙扩大与轻度认知障碍患者的关系

Analysis of the relationship between enlarged perivascular space and patients with mild cognitive impairment

目的探讨血管周围间隙扩大(EPVS)与轻度认知障碍(MCI)的关系及对MCI患者认知功能的影响。方法回顾性连续纳入2019年2月至12月南京医科大学附属常州市第二人民医院神经内科及心理科门诊收治的MCI患者38例,并以年龄、性别相匹配的健康志愿者40例作为对照。对两组均进行全套的认知功能测定,将各项认知测试得分均进行标准化Z分转换。通过MRI评估两组EPVS的分布情况,进一步分析EPVS对MCI患者认知功能的影响。结果MCI组中EPVS发生率为86.8%(33/38),明显高于对照组52.5%(21/40,P=0.001);MCI组患者的蒙特利尔认知评估量表(MoCA)评分[22(19~24)分]及教育年限[(8.6±1.3)年]均低于对照组[MoCA评分:27(26~28)分;教育年限:(9.9±3.0)年,均P<0.05]。在MCI患者中的中重度基底节区EPVS(BG-EPVS)的比例明显高于对照组[65.8%(25/38)比35.0%(14/40),χ^2=7.389,P=0.007]。多因素Logistics回归分析结果表明,中重度BG-EPVS(OR=1.910,95%CI:1.203~3.034,P=0.006)是MCI的独立危险因素。在MCI患者中,中重度BG-EPVS组执行功能Z分、信息处理速度Z分均明显高于轻度组[0.17(-0.06,0.37)分比-0.36(-0.63,-0.08)分,0.12(-0.06,0.56)分比-0.51(-0.69,-0.36)分;Z=-3.831,-4.354,均P<0.01]。进一步行Spearman相关分析表明,MCI患者BG-EPVS等级与执行功能Z分(r=0.713)、信息处理速度Z分(r=0.732)呈正相关(均P<0.01)。结论EPVS在MCI患者中有较高的发生率,中重度BG-EPVS是MCI的独立危险因素,主要影响MCI患者的执行功能和信息处理速度。

Objective To explore the relationship between enlarged perivascular space(EPVS)and mild cognitive impairment(MCI)and its effect on cognitive function in patients with MCI.Methods From February to December 2019,a total of 38 patients with MCI treated in both the Department of Neurology and the Department of Psychology in Changzhou Second People′s Hospital affiliated to Nanjing Medical Unuversity were collected.Forty healthy volunteers matched with age and gender were included as controls.A full set of cognitive function scales were measured in both groups,and the scores of each cognitive test were converted into standardized Z scores.The distribution of EPVS in the two groups was evaluated by MRI,and the effects of EPVS on the cognitive domain of MCI patients were further analyzed.Results The incidence of EPVS in MCI group was 86.8%(33/38),which was higher than 52.5%(21/40)of control group(P=0.001).The score of Montreal cognitive assessment(MoCA)and years of education in MCI group were lower than those in control group(22[19-24]vs.27[26-28];[8.6±1.3]vs.[9.9±3.0];both P<0.05).In patients with MCI,the proportion of moderate-severe EPVS in basal ganglia(BG-EPVS)was significantly higher than that of control group(65.8%[25/38]vs.35.0%[14/40],χ^2=7.389,P=0.007).Multivariate logistics regression analysis showed that the moderate-severe BG-EPVS(OR,1.910,95%CI 1.203-3.034,P=0.006)was an independent risk factor for patients with MCI.In patients with MCI,it was found that the Z scores of executive function and information processing speed in moderate and severe BG-EPVS group were significantly higher than those of mild group(0.17[-0.06,0.37]vs.-0.36[-0.63,-0.08],Z=-3.831;0.12[-0.06,0.56]vs.-0.51[-0.69,-0.36],Z=-4.354;both P<0.01);Further Spearman correlation analysis showed that the BG-EPVS grade of MCI patients was positively correlated with Z score of executive function(r=0.713)and Z score of information processing speed(r=0.732,both P<0.01).Conclusions There is a high incidence of EPVS in patients with MCI.The moderate-severe BG-EPVS is an independent risk factor for patients with MCI,mainly affecting the executive function and information processing speed of patients with MCI.