脑小血管病患者磁共振总负担与认知障碍的相关性研究
摘要
目的探讨老年脑小血管病(CSVD)患者的磁共振总负担与认知障碍发展和大脑网络损伤的相关性,为评估CSVD患者认知衰退提供一种临床方法。方法选择2014年10月至2017年8月在昆明医科大学第二附属医院神经内科就诊的年龄大于60岁的CSVD患者200例,选择年龄、性别相匹配的30名正常人作为对照组,进行多模式磁共振(MRI)测定、蒙特利尔认知评估(Mo CA)和血管危险因素评估。评价CSVD的MRI总负担与认知障碍及大脑网络损伤的相关性。采用SPSS 22.0进行方差分析和χ~2检验。结果认知障碍随CSVD总负担评分增加而加重,与对照组相比,总负担评分2分时,患者的视空间和执行、注意力、抽象能力和延迟记忆有明显下降,均有统计学意义(P<0.05)。总负担评分4分患者表现为视空间和执行、命名、注意力、语言、抽象能力、定向力和延迟记忆的全面下降,均有统计学意义(P<0.01)。大脑网络损伤随CSVD总负担增加而加重,弥散张量成像显示,随总负担增加,总负担达到3分患者即出现看似正常的脑白质区(NAWM)的各向异性系数(FA)显著降低,平均扩散度(MD)显著升高,均有统计学意义(P<0.05,P<0.01)。双侧海马体积随总负担增加有下降趋势,与对照组相比,CSVD总负担评分4分的患者,左右侧海马体积明显减少,差异均有统计学意义(P<0.01)。与对照组相比,高血压、2型糖尿病、心脏疾病和高胆固醇血症随CSVD总负担评分增加比例明显升高,差异均有统计学意义(趋势χ~2值分别为13.09、19.28、18.46和22.85,P<0.01)。结论 CSVD的MRI总负担评分整合了CSVD 4个MRI特征,能够更全面地评估CSVD对认知的影响,有助于识别具有认知衰退风险的CSVD患者,可对CSVD患者进行更有针对性地预防和治疗。
引文
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[3]熊静,李馨蕊,田红,等.青年缺血性脑小血管病血管影像特点和危险因素分析[J].中国慢性病预防与控制,2014,22(3):257-259.
[4]Hainsworth AH,Brittain JF,Khatun H.Pre-clinical models of human cerebral small vessel disease:utility for clinical application[J].J Neurol Sci,2012,322(1-2):237-240.
[5]Gorelick PB,Scuteri A,Black SE,et al.Vascular contributions to cognitive impairment and dementia:a statement for healthcare professionals from the american heart association/american stroke association[J].Stroke,2011,42(9):2672-2713.
[6]Klarenbeek P,van Oostenbrugge RJ,Rouhl RP,et al.Ambulatory blood pressure in patients with lacunar stroke:association with total MRI burden of cerebral small vessel disease[J].Stroke,2013,44(11):2995-2999.
[7]Song TJ,Kim J,Song D,et al.Total cerebral small-vessel disease score is associated with mortality during follow-up after acute ischemic stroke[J].J Clin Neurol,2017,13(2):187-195.
[8]Staals J,Booth T,Morris Z,et al.Total MRI load of cerebral small vessel disease and cognitive ability in older people[J].Neurobiol Aging,2015,36(10):2806-2811.
[9]Uiterwijk R,van Oostenbrugge RJ,Huijts M,et al.Total cerebral small vessel disease MRI score is associated with cognitive decline in executive function in patients with hypertension[J].Front Aging Neurosci,2016,8(301):1-8.
[10]Fazekas F,Kleinert R,Offenbacher H,et al.Pathologic correlates of incidental MRI white matter signal hyperintensities[J].Neurology,1993,43(9):1683-1689.
[11]Jellinger KA,Attems J.Prevalence and pathogenic role of cerebrovascular lesions in Alzheimer disease[J].J Neurol Sci,2005,229(230):37-41.
[12]Jellinger KA.Alzheimer disease and cerebrovascular pathology:an update[J].J Neural Transm,2002,109(5):813-836.
[13]Launer LJ,Hughes TM,White LR.Microinfarcts,brain atrophy,and cognitive function:the Honolulu Asia Aging Study Autopsy Study[J].Ann Neurol,2011,70(5):774-780.
[14]吴小燕,王少会,薛忠元,等.脑梗死患者脑内微出血的发生及危险因素分析[J].中国慢性病预防与控制,2013,21(4):473-476.
[15]Akoudad S,Wolters FJ,Viswanathan A,et al.Association of cerebral microbleeds with cognitive decline and dementia[J].JAMA Neurol,2016,73(8):934-943.
[16]Daulatzai MA.Cerebral hypoperfusion and glucose hypometabolism:key pathophysiological modulators promote neurodegeneration,cognitive impairment,and Alzheimer’s disease[J].J Neurosci Res,2017,95(4):943-972.
[17]Murray AD.Imaging approaches for dementia[J].AJNR Am J Neuroradiol,2012,33(10):1836-1844.
[18]Prins ND,Scheltens P.White matter hyperintensities,cognitive impairment and dementia:an update[J].Nat Rev Neurol,2015,11(3):157-165.
[19]薛忠元,葛纪,宋洋.阿尔茨海默病和血管性痴呆患者的认知功能损害及精神行为特点分析[J].中国慢性病预防与控制,2013,21(2):157-160.
[20]Qiu C,Fratiglioni L.A major role for cardiovascular burden in agerelated cognitive decline[J].Nat Rev Cardiol,2015,12(5):267-277.
[21]Cooper LL,Woodard T,Sigurdsson S,et al.Cerebrovascular damage mediates relations between aortic stiffness and memory[J].Hypertension,2016,67(1):176-182.
[22]Alosco ML,Gunstad J,Xu X,et al.The impact of hypertension on cerebral perfusion and cortical thickness in older adults[J].J Am Soc Hypertens,2014,8(8):561-570.
[23]Zambon D,Quintana M,Mata P,et al.Higher incidence of mild cognitive impairment in familial hypercholesterolemia[J].Am J Med,2010,123(3):267-274.