非痴呆型血管性认知功能障碍合并脑微出血患者磁敏感加权成像检查与神经量表的相关性

Correlation Analysis between SWAN and Neural Scale in Patients with Vascular Cognitive Impairment with No Dementia and Cerebral Microbleeds

目的探讨基于磁敏感加权成像(SWAN)检查中老年非痴呆型血管性认知功能障碍(VCIND)合并脑微出血(CMBs)与神经量表的相关性。方法选择2017年2月~2019年8月中国人民解放军北部战区总医院收治的CMBs患者350例,根据是否发生VCIND将患者分为VCIND组(46例)和对照组(304例);根据CMBs数量评估病情严重程度分为轻度组105例、中度组167例、重度组78例;根据CMBs部位分为皮质-皮质下组(126例)、基底节-丘脑组(101例)、脑干组(74例)、小脑组(49例)。所有患者均行SWAN扫描明确CMBs部位和个数,并行蒙特利尔认知评估(MoCA)、简易智能精神状态检查(MMSE)、临床痴呆评定(CDR)、美国国立卫生院神经功能缺损评分(NIHSS)量表评估认知功能和神经功能缺损程度。观察不同CMBs部位、CMBs病情程度,患者MoCA、MMSE、CDR、NIHSS评分差异,采用logistic回归分析CMBs与认知功能障碍的相关性。结果VCIND组MoCA、MMSE评分低于对照组(P<0.05),CDR、NIHSS评分高于对照组(P<0.05),皮质-皮质下组MoCA、MMSE评分低于基底节-丘脑组、脑干组、小脑组(P<0.05),CDR评分高于基底节-丘脑组、脑干组、小脑组(P<0.05)。MoCA、MMSE评分随着CMBs病情加重而降低(P<0.05),CDR、NIHSS评分随着CMBs病情加重而升高(P<0.05)。logistic回归分析结果显示白质疏松、皮质-皮质下CMBs、重度CMBs是CMBs患者发生VCIND的独立危险因素(P<0.01)。结论缺血性脑卒中后继发CMBs患者易发生VCIND,CMBs部位以及多发CMBs病灶患者认知功能受损更明显。

Objective To investigate the correlation between vascular cognitive impairment with no dementia(VCIND) complicated with cerebral microbleeds(CMBs) and neural scale based on susceptibility weighted angiography(SWAN).Methods A total of 350 CMBs patients admitted to General Hospital of Northern Thearer Command of PLA from February 2017 to August 2019 were selected.According to the occurrence of VCIND,the patients were divided into the VCIND group(46 cases) and the control group(304 cases).According to the number of CMBs, the patients were divided into mild group(105 cases),moderate group(167 cases),and severe group(78 cases).According to CMBs site, the patients were divided into the cortex-subcortex group(126 cases),basal ganglia-thalamus group(101 cases),brainstem group(74 cases) and cerebellum group(49 cases).All patients underwent SWAN to determine the location and number of CMBs.Montreal cognitive assessment(MoCA),mini-mental state examination(MMSE),clinical dementia assessment(CDR),national institute of health stroke(NIHSS) scale were performed to evaluate the cognitive function and degree of neurological deficit.The scores of MoCA,MMSE,CDR and NIHSS in patients with CMBs at different sites and severity were assessed, and the correlation between CMBs and cognitive dysfunction was analyzed by logistic regression.Results In VCIND group, the scores of MoCA and MMSE were lower(P<0.05),and the scores of CDR and NIHSS were higher than those in the control group(P<0.05).In the cortex-subcortex group, the scores of MoCA and MMSE were lower(P<0.05),and the score of CDR was higher than those in the basal ganglia-thalamus group, brainstem group and cerebellum group(P<0.05).The scores of MoCA and MMSE decreased with the severity of CMBs(P<0.05),while the scores of CDR and NIHSS increased with the severity of CMBs(P<0.05).Logistic regression analysis showed that loose white matter, cortex-subcortex CMBs and severe CMBs were independent risk factors for VCIND in CMBs patients(P<0.01).Conclusion The patients with CMBs secondary to ischemic stroke are prone to VCIND,and the cognitive function is apparently impaired in patients with cortex-subcortex CMBs and multiple CMBs lesions.