脑小血管病患者认知状态与神经影像学特征的相关性分析

Relationship between cognitive condition and neuroimaging features in patients with cerebral small vessel disease

目的:本研究旨在探讨脑小血管病患者认知状态与皮质下腔隙性梗死部位及病灶数、白质病变和内侧颞叶萎缩之间的关系。方法:本研究纳入59例在上海交通大学医学院附属仁济医院神经内科脑血管病二级预防门诊登记的最近一次症状性缺血性卒中病史>3个月的脑小血管病患者。根据详细的神经心理学评估结果,将59例患者分入无认知障碍组(24例)、轻度认知障碍组(22例)和血管性痴呆组(13例),采用头颅磁共振成像多重序列检查及斜冠状面重建,依据所得图像进行皮质下腔隙性梗死病灶计数、白质病变评分和内侧颞叶萎缩评分。结果:脑小血管病患者认知障碍的发生与皮质下腔隙性梗死病灶总数有关(P=0.004),其中皮质下白质部位腔隙性梗死病灶数在3组之间的差异有统计学意义(P=0.001);轻度认知障碍组和血管性痴呆组患者丘脑部位腔隙性梗死病灶数多于无认知障碍组的患者,但差异无统计学意义(P=0.058)。大部分的白质病变病灶位于额叶和顶枕叶,颞叶和基底节的白质病变较少。3组之间双侧额叶(P=0.033)和双侧基底节(P=0.009)的白质病变评分差异有统计学意义。59例患者中,43例完成磁共振成像斜冠状面重建。左右内侧颞叶萎缩一般呈同步发展;3组之间左或右内侧颞叶萎缩评分的差异均有统计学意义(P值均<0.001)。在13例左内侧颞叶萎缩评分≥2分的患者中,11例为无认知障碍组和轻度认知障碍组患者;血管性痴呆组患者均有内侧颞叶萎缩,其中6例患者的左右侧平均内侧颞叶萎缩评分≥2分。多因素分析结果显示,皮质下白质腔隙性梗死病灶数[比值比:2.39(95%可信区间:1.19~5.80),P=0.005]和左内侧颞叶萎缩评分[比值比:10.21(95%可信区间:2.02~51.75),P=0.003]是脑小血管病认知功能的独立危险因素。结论:脑小血管病患者的认知损害程度与皮质下白质腔隙性梗死病灶数和左内侧颞叶萎缩评分相关。

Objective:The purpose of this study is to investigate the relationship between the cognitive state of patients with cerebral small vessel disease(CSVD) and the location and number of lacunar infarcts,the white matter lesion(WML) and medial temporal lobe atrophy(MTA).Methods:This study recruited 59 patients with CSVD who had a recent symptomatic ischemic stroke history > 3 months and were registered in the secondary prevention clinic of cerebrovascular disease in Department of Neurology,Renji Hospital,Shanghai Jiao Tong University School of Medicine.According to the detailed neuropsychological assessment results,59 patients were divided into no cognitive impairment(NCI) group(n=24),mild cognitive impairment(MCI) group(n=22) and vascular dementia(Va D) group(n=13).The magnetic resonance imaging(MRI) of brain with multiple sequences and oblique coronal reconstruction was used for counting the number of lacunar infarcts and grading WML and MTA.Results:Cognitive impairment in patients with CSVD was associated with the number of lacunar infarcts(P=0.004),and the number of lacunar infarcts in the subcortical white matter parts was significantly different among three groups(P=0.001).The patients had more lacunar infarcts in thalamus in MCI and Va D groups than in NCI group,but it did not reach significant difference(P=0.058).The majority of WLMs were located in the frontal and parietal occipital lobes,and there were less lesions in the temporal lobes and basal ganglia.There were significant differences in WML score of bilateral frontal lobes(P=0.003) and basal ganglia(P=0.009) among three groups.Of the 59 patients,MRI oblique coronal reconstruction was performed in 43 patients.It showed that MTA almost developed synchronously in both sides,and there were statistically significant differences in left and right MTA scores among three groups(both P < 0.001).In 13 patients whose left MTA scores were ≥2,11 patients were in NCI and MCI groups.All the patients in Va D group had MTA,and the average left and right MTA scores of 6 patients were ≥2.The result of multivariate analysis showed that the number of subcortical WML [odds ratio:2.39(95% confidence interval:1.19-5.80),P=0.005] and the left MTA score [odds ratio:10.21(95% confidence interval:2.02-51.75),P=0.003] were the independent risk factors of cognitive impairment of patients with CSVD.Conclusion:The degree of cognitive impairment in patients with CSVD is associated with the number of subcortical WML and left MTA score.