磁共振成像对老年性痴呆患者海马解剖结构的评估价值研究

Value of magnetic resonance imaging in evaluating anatomical structure of hippocampus in patients with senile dementia

目的 探讨MRI对老年性痴呆患者海马解剖结构的评估价值。材料与方法 前瞻性纳入2019年7月至2021年7月山西省汾阳医院收治的93例老年性痴呆患者纳入病例组,另外选取同期于山西省汾阳医院体检的健康人群40例纳入对照组。所有对象均予以海马区MRI扫描,比较两组海马区MRI相关测量数据差异,采用蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)评分和日常生活活动能力(Activity of Daily Living, ADL)评分对两组受试者进行认知评估,分析老年性痴呆患者海马区MRI相关测量数据与认知功能的相关性。结果 病例组左右双侧海马面积(hippocampal area, HFA)(t=-5.533、-6.615,P<0.05)、标准化海马面积(standardized hippocampal area, SHFA)(t=-3.824、-5.198,P<0.001)、海马横径(transverse hippocampal transverse diameter, HTD)(t=-4.602、-6.212,P<0.001)、标准化海马横径(standardized hippocampal transverse diameter, SHTD)(t=-4.358、-9.464,P<0.001)明显低于对照组,而颞角宽度(temporal horn width, THW)(t=2.564、3.956,P<0.05)、标准化颞角宽度(standardized temporal horn width,STHW)(t=4.076、3.714,P<0.001)及内侧颞叶萎缩(medial temporal atrophy, MTA)(t=22.477、19.236,P<0.001)评分明显高于对照组;病例组MoCA评分较对照组低,而ADL评分较对照组高,差异有统计学意义(t=15.541、9.307,P<0.001);Pearson相关性分析显示,老年性痴呆患者左右双侧SHFA(r=0.303、0.462,P<0.05)、SHTD(r=0.233、0.557,P<0.05)值分别与MoCA评分呈正相关,左右双侧SHFA(r=0.211、0.213,P<0.05)、SHTD(r=0.330、0.288,P<0.05)值分别与ADL评分呈正相关,左侧STHW值与MoCA、ADL评分呈负相关(r=-0.452、-0.287,P<0.05)。结论 老年性痴呆患者海马萎缩较健康人群明显,经海马区MRI检查可准确了解老年性痴呆患者海马体萎缩程度,为临床治疗方案的制订提供参考。

Objective: To investigate the value of magnetic resonance imaging(MRI) in evaluating anatomical structure of hippocampus in patients with senile dementia. Materials and Methods: Ninety three patients with senile dementia admitted to Fenyang Hospital of Shanxi Province from July 2019 to July 2021 were selected as the case group. Meanwhile, 40 healthy individuals who underwent physical examination in the same hospital during the same period were selected as the control group. All subjects received MRI scanning of hippocampus. Related MRI data of hippocampus were compared between the two groups. The Montreal Cognitive Assessment(MoCA) score and the Activity of Daily Living(ADL) score were used for cognitive assessment. The correlation between related MRI data of hippocampus and cognitive function in patients with senile dementia was analyzed. Results: The bilateral(left and right)hippocampal areas(HFA)(t=-5.533,-6.615;P<0.05), standardized hippocampal area(SHFA)(t=-3.824,-5.198;P<0.001),hippocampal transverse diameter(HTD)(t=-4.602,-6.212;P<0.001), and standardized hippocampal transverse diameter(SHTD)(t=-4.358,-9.464;P<0.001) of the case group were smaller than those of the control group, while the temporal horn width(THW)(t=2.564, 3.956;P<0.05), standardized temporal horn width(STHW)(t=4.076, 3.714;P<0.001) and medial temporal atrophy(MTA)(t=22.477, 19.236;P<0.001) scores were significantly higher than those of the control group. The case group had lower MoCA scores and higher ADL scores than the control group(t=15.541, 9.307, P<0.05). Pearson correlation analysis showed that patients with senile dementia left and right bilateral SHFA(r=0.303, 0.462;P<0.05), SHTD(r=0.233, 0.557;P<0.05) were positively correlated with MoCA scores;SHFA(r=0.211, 0.213;P<0.05), SHTD(r=0.330, 0.288;P<0.05) were positively correlated with ADL score, while STHW were negatively correlated with MoCA and ADL scores(r=-0.452,-0.287, P<0.05). Conclusions: Hippocampal atrophy is more obvious in patients with senile dementia than in healthy people. MRI examination of hippocampus is conducive to accurate understanding of the degree of hippocampal atrophy in patients with mild senile dementia, thereby providing reference for developing clinical treatment plan.