脑白质病变与皮质下缺血所致血管性认知障碍的相关分析

Correlative analysis of white matter lesions with subcortical ischemic induced vascular cognitive impairment

目的:探讨脑白质病变(WMLs)体积与部位对皮质下缺血性血管性认知障碍(SIVCI)的预测意义。方法:入组SIVCI患者65例,正常对照组(NC)50例。采用神经心理测试评估记忆力、执行功能、视空间、语言、注意力及总体认知功能;应用3D Slicer软件测量额叶、顶枕区、颞叶、幕下等脑区的WMLs体积;采用相关性分析及分层多元线性回归分析探讨WMLs部位与体积对SIVCI的预测意义。结果:SIVCI组的WMLs总体积以及额叶、顶枕区的WMLs体积均显著性高于NC组(P<0.05);与NC组相比,SIVCI组总体认知及各认知域均受损(P<0.05);SIVCI患者的WMLs总体积与MMSE、MoCA、AVLT、CDT、VFT、DST评分呈显著负相关(P<0.05),与SCWT、TMT耗时呈显著正相关(P<0.05)。SIVCI患者的额叶WMLs体积与SCWT、TMT-b耗时呈正相关(P<0.05);校正高血压及高脂血症病史后,WMLs总体积能解释各量表评分变化的17.1%~40.9%(P<0.05);额叶WMLs体积解释执行功能相关量表评分的28.0%~32.0%(P<0.05)。结论:WMLs体积及部位与SIVCI密切相关,WMLs总体积对认知功能,额叶WMLs对执行功能的变化均具有一定预测价值,对临床上早期诊断、早期干预SIVCI具有一定指导意义。

Objective:To access the predictive value of volume and location of white matter lesions(WMLs)on subcortical ischemic vascular cognitive impairment(SIVCI).Methods:Sisty-five patients with SIVCI and 50 normal controls(NC)were enrolled.A serial of neuropsychological tests covering memory,executive function,visuospatial function,language and attention were performed on the subjects.The volumes of WMLs in frontal lobe,parieto-occipital lobe,temporal lobe and infratentorial region were measured with 3 D Slicer software respectively.Correlation analysis and multiple regression analysis were used to explore the predictive effect of volume and location of white matter lesions on SIVCI.Results:The total volume of WMLs and the volume in frontal lobe and parieto-occipital lobe in SIVCI group were higher than those in NC group(P<0.05);There was a comprehensive cognitive impairment in the SIVCI group compared to the NC group(P<0.05);The total volume of WMLs was negatively correlated with MMSE,MoCA,AVLT,CDT,VFT,and DST scores(P<0.05),but positively correlated with SCWT and TMT scores(P<0.05).The volume of WMLs in frontal lobe was negatively correlated with SCWT and TMT-b score(P<0.05);After adjusting for history of hypertension and hyperlipidemia,total volume of WMLs could explain 17.1%~40.9%of the scale scores(P<0.05).Frontal WMLs volume accounted for 28.0%~32.0%of executive function related scale scores(P<0.05).Conclusion:The volume and location of WMLs are closely related to the development of SIVCI.The total volume of WMLs has certain predictive value for overall cognitive function and frontal WMLs for executive function,which has definite guiding effect on early diagnosis and intervention of SIVCI.