血管性痴呆的动态CT观察及机制研究

A follow-up CT scan observation of stroke patients complicated with vascular dementia

目的 研究血管性痴呆的发病机制。方法 选择首次发病的卒中患者 167例 ,分别在首次发病、每次复发及 5年时进行动态头颅CT扫描及智能测定。按 5年时是否痴呆分为血管性痴呆组 (VD组 ,95例 )及无痴呆血管病组 (对照组 ,72例 )。将二组资料进行对比 ,并行统计学分析。结果 1年时VD发生率为3 1.73 % ,2年 5 0 .17% ,5年 5 6.89% ,VD组发作次数多、病灶体积增大、病灶数目增多、病变部位由单侧→双侧、左侧病变增大、皮层下病变增大多见 ,脑萎缩相关指标提示皮质下萎缩明显 ,但白质疏松面积改变二组差别无显著性。结论 血管性痴呆多发于卒中首次发病后 1～ 2年内 ,VD发生率与发作次数、病灶体积、病灶数目增加及病变部位改变 (如单侧→双侧 ,左侧病变扩大 ,丘脑或角回病变等 )最相关 ,其次为皮层下脑萎缩的快速发展 ,而白质疏松改变与VD关系较小。首次卒中后

Objective To study the pathogenesis of vascular dementia. Methods Follow up CT scans and IQ tests were performed sequentially in 167 stroke patients for five years. These patients were divided into two groups: the vascular dementia(VD) group( n =95) and the control group( n =72) who suffered from vascular disease but without dementia. The data obtained from the study were compared between the two groups. Results It was found that 56.89% of the patients developed dementia within 5 years, and 50.17% of them occurred in two years after their first onset of stroke. More lesions and larger volumes, especially the subcortical lesions, were observed in VD group. Most of the original unilateral lesions finally developed as bilateral lesions in the VD patients. Subcortical cerebral atrophy was more serious in the VD group. There was no significant difference in respect to the leuco araiosis area changes between the two groups. Conclusion Vascular dementia after stroke occurs largely in two years after the first onset. The occurrence of VD was related to the relapse of stroke,the volume, and the location of the lesion. Rapid subcortical cerebral atrophy is the second contributing factor to VD development. Leuco araiosis seems not to be related to it. Effective treatment of stroke carried out within two years after the first onset is conducive to reduce the occurrence of VD.