扣带回胆碱能通路损伤对脑血流量及其认知功能的影响
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摘要
目的探讨胆碱能通路扣带回损伤(impairment cingulate gyrus,ICG)后与相应脑血流量(CBF)改变及认知功能的关系。方法选择"记忆下降"患者182例,根据左、右侧ICG情况,分别分为左侧ICG组64例与左侧无ICG组118例;右侧ICG组64例与右侧无ICG组118例。采用蒙特利尔认知评估量表(MoCA)评定认知功能,观察各脑区CBF、ICG及双侧大脑前动脉(ACA)狭窄情况。结果多因素分析显示,受教育年限、适量饮酒为左、右侧ICG保护性因素(P<0.05,P<0.01),吸烟为左、右侧ICG独立危险因素(P<0.05),且高血压为左侧ICG独立危险因素(OR=3.661,P=0.001)。右侧ICG组右侧半卵圆中心层、右侧侧脑室顶部层及右侧基底节层局部CBF、MoCA评分[(18.80±7.44)分vs (21.30±6.27)分]、命名、注意力及抽象评分均明显低于右侧无ICG组(P<0.05,P<0.01)。左侧ICG组左侧半卵圆中心层、左侧侧脑室顶部层及左右侧基底节层局部CBF、MoCA评分[(19.06±6.77)分vs(21.15±6.72)分]、注意力[(4.25±1.73)分vs(4.88±1.55)分]及抽象评分[(0.58±0.69)分vs(0.85±0.82)分]均明显低于左侧无ICG组(P<0.05,P<0.01)。结论扣带回胆碱能通路损伤后ACA支配的皮质CBF降低,且存在执行力、注意力及抽象力的认知功能损害特点。
Objective To study the relationship between CBF and cognitive function after cingulate gyrus cholinergic pathway injury.Methods One hundred and eighty-two patients were divided into left ICG group(n=64)and non left ICG group(n=118)or into right ICG group(n=64)and non right ICG group(n=118).Their cognitive function was assessed according to the MoCA,their blood perfusion and CBF in different cerebral regions were measured,and their bilateral ACA stenosis was assayed.Results The education level and appropriate alcohol consumption were the protective factors for both left and right cingulate gyrus cholinergic pathway injury(P<0.05,P<0.01)while smoking was the independent risk factor for both left and rignt cingulate gyrus cholinergic pathway injury(P<0.05),hypertension was the independent risk factor for left cingulate gyrus cholinergic pathway injury(P<0.05,P<0.01).The rCBF was significantly slower in both right and left ICG groups than in both non right and left ICG groups(P<0.05,P<0.01).The MoCA,naming,attention and abstraction scores were significantly lower in both right and left ICG groups than in both non right and left ICG groups(P<0.05,P<0.01).ConclusionACA plays an important role in downregulating the cortex CBF,which is characterized by the damage of execution,attention and abstraction after cingulate gyrus cholinergic pathway injury.
Objective To study the relationship between CBF and cognitive function after cingulate gyrus cholinergic pathway injury.Methods One hundred and eighty-two patients were divided into left ICG group(n=64)and non left ICG group(n=118)or into right ICG group(n=64)and non right ICG group(n=118).Their cognitive function was assessed according to the MoCA,their blood perfusion and CBF in different cerebral regions were measured,and their bilateral ACA stenosis was assayed.Results The education level and appropriate alcohol consumption were the protective factors for both left and right cingulate gyrus cholinergic pathway injury(P<0.05,P<0.01)while smoking was the independent risk factor for both left and rignt cingulate gyrus cholinergic pathway injury(P<0.05),hypertension was the independent risk factor for left cingulate gyrus cholinergic pathway injury(P<0.05,P<0.01).The rCBF was significantly slower in both right and left ICG groups than in both non right and left ICG groups(P<0.05,P<0.01).The MoCA,naming,attention and abstraction scores were significantly lower in both right and left ICG groups than in both non right and left ICG groups(P<0.05,P<0.01).ConclusionACA plays an important role in downregulating the cortex CBF,which is characterized by the damage of execution,attention and abstraction after cingulate gyrus cholinergic pathway injury.
引文
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[3] Iizuka T,Kameyama M.Cholinergic enhancement increases regional cerebral blood flow to the posterior cingulate cortex in mild Alzheimer's disease[J].Geriatr Gerontol Int,2017,17(6):951-958. DOI:10.1111/ggi.12818.
[4] Bohnen NI,Grothe MJ,Ray NJ,et al.Recent advances in cholinergic imaging and cognitive decline-revisiting the cholinergic hypothesis of dementia[J].Curr Geriatr Rep,2018,7(1):1-11. DOI:10.1007/s13670-018-0234-4.
[5]中国医师协会神经内科分会脑与脊髓损害专业委员会.慢性酒精中毒性脑病诊治中国专家共识[J].中华神经医学杂志,2018,17(1):2-9. DOI:10.3760/cma.j.issn.1671-8925.2018.01.001.
[6] Zedde M,Pascarella R.Pressure and pipes:from neuroimaging to virtual measurement[J].Eur J Neurol,2018,25(4):607-608. DOI:10.1111/ene.13576.
[7]刘念军,刘茂森,辛文龙,等.2型糖尿病双侧海马及后扣带回损伤MRI新技术研究进展[J].磁共振成像,2018,9(6):476-480. DOI:10.12015/issn.1674-8034.2018.06.014.
[8] Chaves-Coira I,Barros-Zulaica N,Rodrigo-Angulo M,et al.Modulation of specific sensory cortical areas by segregated basal forebrain cholinergic neurons demonstrated by neuronal tracing and optogenetic stimulation in Mice[J].Front Neural Circuits,2016,10:28. DOI:10.3389/fncir.2016.00028.
[9]谭诚,彭文宏,邓彦.皮质下小血管病性认知障碍非痴呆型患者认知恶化的危险因素和预测因子[J].中华医学杂志,2014,94(5):352-355.DOI:10.3760/cma.j.issn.0376-2491.2014.05.011.
[10] Mu1oz Maniega S,Chappell FM,Valdés Hernández MC,et al.Integrity of normal-appearing white matter:influence of age,visible lesion burden and hypertension in patients with small-vessel disease[J].J Cereb Blood Flow Metab,2017,37(2):644-656. DOI:10.1177/0271678X16635657.
[11] Ostojic J,Kozic D,Pavlovic A,et al.Hippocampal diffusion tensor imaging microstructural changes in vascular dementia[J].Acta Neurol Belg,2015,115(4):557-562. DOI:10.1007/s13760-014-0419-3.
[12] Roland JL,Snyder AZ,Hacker CD,et al.On the role of the corpus callosum in interhemispheric functional connectivity in humans[J].Proc Natl Acad Sci U S A,2017,114(50):13278-13283. DOI:10.1073/pnas.1707050114.
[13] Wu YF,Wu WB,Liu QP,et al.Presence of lacunar infarctions is associated with the spatial navigation impairment in patients with mild cognitive impairment:a DTI study[J].Oncotarget,2016,7(48):78310-78319. DOI:10.18632/oncotarget.13409.