DTI成像参数与脑微出血者认知功能障碍的关系
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摘要
目的探究脑微出血(CMBs)患者弥散张量成像(DTI)检测参数与认知功能障碍间的相关性。方法收集笔者医院神经内科98例脑微出血患者作为观察组,另选择在笔者医院检测未发现脑部微出血80例作为对照组,采用日常生活能力评定表(ADL)对日常生活进行评定,蒙特利尔认知评分表(Mo CA)对受试者认知功能进行评估,所有受试者均能进行DTI成像检测,观察CMBs病灶数目以及分布情况,对比两组Mo CA、ADL评分,DTI参数FA、MD值与Mo CA评分进行Pearson相关性分析。结果共检测出325例CMBs病灶,基底核区占44.31%,大脑皮质以及皮质占26.46%,丘脑占8.31%、脑白质占8.00%、小脑占6.77%、脑干占6.15%。观察组脑白质、丘脑、小脑FA值低于对照组,MD值高于对照组,差异有统计学意义(P<0.05)。观察组空间执行能力、命名能力、记忆力、注意力、抽象能力、语言、定向能力、总分均低于对照组,差异有统计学意义(P<0.05)。观察组ADL步行、转移、上下楼梯等各项评分以及总分均低于对照组,差异有统计学意义(P<0.05)。Pearson相关性分析显示,MoCA评分中空间执行能力、命名能力、记忆力、注意力、抽象能力、语言、定向能力、总分与基底核、脑皮质、脑白质、丘脑、小脑、脑干FA值呈正相关,与MD值呈负相关。结论 DTI检测FA值、MD值与CMBs患者Mo CA评分存在一定的相关性,对患者认知功能障碍恢复具有一定的指导作用。
Objective To investigate the correlation between diffusion tensor imaging( DTI) parameters and cognitive impairment in patients with cerebral hemorrhage( CMBs). Methods Totally 98 patients with cerebral hemorrhage in the Department of neurology were collected as observation group. In addition,80 cases of brain micro bleeding were detected in our hospital as the control group. Daily life ability scale( ADL) was used to assess daily life. The Montreal cognitive rating scale( Mo CA) was used to assess the cognitive function of the subjects. All subjects were performed by DTI imaging test. The number and distribution of CMBs lesions were observed. The correlation of two groups of Mo CA and ADL score,DTI parameter,FA,MD value and Mo CA score were analyzed by Pearson. Results A total of325 CMBs lesions were detected. The basal ganglia area was 44. 31%,cerebral cortex and cortex was accounted for 26. 46%,thalamus was8. 31%,white matter was 8%,cerebellum was 6. 77%,and brainstem was 6. 15%. The FA value of the white matter,thalamus and cerebellum in the observation group was lower than that in the control group,and the MD value was higher than that of the control group,and the difference was statistically significant( P < 0. 05). The spatial execution ability,naming ability,memory,attention,abstraction ability,language,orientation ability and total score of the observation group were lower than those of the control group,the difference was statistically significant( P < 0. 05). In observation group,ADL walking,transfer,up and down stairs and other scores and total score were lower than the control group,the difference was statistically significant( P < 0. 05). Pearson correlation analysis showed that the Mo CA scores included spatial execution ability,naming ability,memory,attention,abstraction,language,orientation ability and total score was positively correlated with the FA of basal ganglia,cerebral cortex,white matter,thalamus,cerebellum and brainstem,and negatively correlated with MD. Conclusion DTI detection,FA value,MD value and CMBs score of patients with Mo CA have some relevance,which can be used to guide the recovery of cognitive impairment.
Objective To investigate the correlation between diffusion tensor imaging( DTI) parameters and cognitive impairment in patients with cerebral hemorrhage( CMBs). Methods Totally 98 patients with cerebral hemorrhage in the Department of neurology were collected as observation group. In addition,80 cases of brain micro bleeding were detected in our hospital as the control group. Daily life ability scale( ADL) was used to assess daily life. The Montreal cognitive rating scale( Mo CA) was used to assess the cognitive function of the subjects. All subjects were performed by DTI imaging test. The number and distribution of CMBs lesions were observed. The correlation of two groups of Mo CA and ADL score,DTI parameter,FA,MD value and Mo CA score were analyzed by Pearson. Results A total of325 CMBs lesions were detected. The basal ganglia area was 44. 31%,cerebral cortex and cortex was accounted for 26. 46%,thalamus was8. 31%,white matter was 8%,cerebellum was 6. 77%,and brainstem was 6. 15%. The FA value of the white matter,thalamus and cerebellum in the observation group was lower than that in the control group,and the MD value was higher than that of the control group,and the difference was statistically significant( P < 0. 05). The spatial execution ability,naming ability,memory,attention,abstraction ability,language,orientation ability and total score of the observation group were lower than those of the control group,the difference was statistically significant( P < 0. 05). In observation group,ADL walking,transfer,up and down stairs and other scores and total score were lower than the control group,the difference was statistically significant( P < 0. 05). Pearson correlation analysis showed that the Mo CA scores included spatial execution ability,naming ability,memory,attention,abstraction,language,orientation ability and total score was positively correlated with the FA of basal ganglia,cerebral cortex,white matter,thalamus,cerebellum and brainstem,and negatively correlated with MD. Conclusion DTI detection,FA value,MD value and CMBs score of patients with Mo CA have some relevance,which can be used to guide the recovery of cognitive impairment.
引文
1陈玲,张微微,王国强.脑微出血研究进展[J].中国脑血管病杂志,2014,11(9):500-504
2肖桂荣,孙新芳,王赵伟.脑微出血磁敏感加权成像检出情况及其与认知功能的关系[J].中国全科医学,2014,13(21):2532-2535
3陈庆华,徐青青,殷信道.弥散张量成像对基底节区脑出血致皮质脊髓束损伤转归评估[J].中国临床医学影像杂志,2015,26(5):309-312
4刘光云.多发性硬化患者认知功能损害与磁共振弥散张量成像相关性研究[D].济南:山东大学,2015
5 Shiraishi N,Suzuki Y,Matsumoto D,et al.Effects of a self-exercise program on activities of daily living in patients after acute stroke:a propensity score analysis based on the Japan Association of Rehabilitation Database[J].Arch Physic Med Rehabil,2017,98(3):434-441
6 Tu Q Y,Hui J,Ding B R,et al.Reliability,validity,and optimal cutoff score of the montreal cognitive assessment(Changsha Version)in ischemic cerebrovascular disease patients of Hunan Province,China[J].Dement Geriatr Cognitive Disord Extra,2013,3(1):25-36
7许丹丹.脑微出血MRI检测的分布特征及与认知功能障碍的关系[J].中国实用医药,2017,12(5):57-58
8韩忠奎,任明山,夏元亮,等.首发急性腔隙性脑梗死患者脑微出血与早期神经功能恶化的关联研究[J].医学研究生学报,2015,28(11):1160-1163
9熊婧彤,苗强,伍建林,等.磁敏感加权成像检测糖尿病患者脑微出血及其与认知功能的相关性[J].中国医学影像技术,2015,31(12):1792-1796
10 Arnold TD,Niaudet C,Pang MF,et al.Excessive vascular sprouting underlies cerebral hemorrhage in mice lackingαVβ8-TGFβsignaling in the brain[J].Development,2014,141(23):4489-4499
11张国华,郑素君,郑辉,等.磁敏感加权成像在高血压脑微出血中应用价值的探讨[J].医学影像学杂志,2011,21(1):1-4
12王国珍,刘祖欣,吴君仓.脑淀粉样血管病变与脑微出血[J].中国临床神经科学,2012,20(6):694-697
13韦铁民,周利民,纪建松,等.MRI梯度回波对脑微出血的检出及其临床意义[J].中华医学杂志,2013,93(37):2979-2981
14刘骁,毛健,李娟,等.早产儿微小型脑白质损伤的MRI-DTI评价[J].中国当代儿科杂志,2015,17(6):554-559
15李瑞利,李宏军,米海峰,等.0期无症状HIV相关性痴呆脑白质微细结构的DTI研究[J].临床放射学杂志,2014,33(12):1813-1817
16 Esiri M,Chance S,Joachim C,et al.Cerebral amyloid angiopathy,subcortical white matter disease and dementia:literature review and study in OPTIMA.[J].Brain Pathol,2015,25(1):51-62
17王亚平,史勇红,刘桂雪,等.基于DTI技术的健康成人胼胝体、扣带回、中脑白质纤维束密度随年龄变化关系的研究[J].神经解剖学杂志,2016,32(4):429-435
18贾少杰,李立冬,刘欣,等.MMSE和Mo CA量表在椎动脉型颈椎病患者早期认知障碍中的应用[J].中国老年学杂志,2015,35(22):6563-6564
19陈桂玲,张宗军,张龙江,等.磁敏感加权成像对脑微出血的检测及与认知功能障碍关系的研究[J].中华老年心脑血管病杂志,2012,14(3):227-230
20 Li XQ,Su DF,Chen HS,et al.Clinical neuropathological analysis of10 cases of cerebral amyloid angiopathy-related cerebral lobar hemorrhage[J].J Korean Neurosurg Soc,2015,58(1):30-35
2肖桂荣,孙新芳,王赵伟.脑微出血磁敏感加权成像检出情况及其与认知功能的关系[J].中国全科医学,2014,13(21):2532-2535
3陈庆华,徐青青,殷信道.弥散张量成像对基底节区脑出血致皮质脊髓束损伤转归评估[J].中国临床医学影像杂志,2015,26(5):309-312
4刘光云.多发性硬化患者认知功能损害与磁共振弥散张量成像相关性研究[D].济南:山东大学,2015
5 Shiraishi N,Suzuki Y,Matsumoto D,et al.Effects of a self-exercise program on activities of daily living in patients after acute stroke:a propensity score analysis based on the Japan Association of Rehabilitation Database[J].Arch Physic Med Rehabil,2017,98(3):434-441
6 Tu Q Y,Hui J,Ding B R,et al.Reliability,validity,and optimal cutoff score of the montreal cognitive assessment(Changsha Version)in ischemic cerebrovascular disease patients of Hunan Province,China[J].Dement Geriatr Cognitive Disord Extra,2013,3(1):25-36
7许丹丹.脑微出血MRI检测的分布特征及与认知功能障碍的关系[J].中国实用医药,2017,12(5):57-58
8韩忠奎,任明山,夏元亮,等.首发急性腔隙性脑梗死患者脑微出血与早期神经功能恶化的关联研究[J].医学研究生学报,2015,28(11):1160-1163
9熊婧彤,苗强,伍建林,等.磁敏感加权成像检测糖尿病患者脑微出血及其与认知功能的相关性[J].中国医学影像技术,2015,31(12):1792-1796
10 Arnold TD,Niaudet C,Pang MF,et al.Excessive vascular sprouting underlies cerebral hemorrhage in mice lackingαVβ8-TGFβsignaling in the brain[J].Development,2014,141(23):4489-4499
11张国华,郑素君,郑辉,等.磁敏感加权成像在高血压脑微出血中应用价值的探讨[J].医学影像学杂志,2011,21(1):1-4
12王国珍,刘祖欣,吴君仓.脑淀粉样血管病变与脑微出血[J].中国临床神经科学,2012,20(6):694-697
13韦铁民,周利民,纪建松,等.MRI梯度回波对脑微出血的检出及其临床意义[J].中华医学杂志,2013,93(37):2979-2981
14刘骁,毛健,李娟,等.早产儿微小型脑白质损伤的MRI-DTI评价[J].中国当代儿科杂志,2015,17(6):554-559
15李瑞利,李宏军,米海峰,等.0期无症状HIV相关性痴呆脑白质微细结构的DTI研究[J].临床放射学杂志,2014,33(12):1813-1817
16 Esiri M,Chance S,Joachim C,et al.Cerebral amyloid angiopathy,subcortical white matter disease and dementia:literature review and study in OPTIMA.[J].Brain Pathol,2015,25(1):51-62
17王亚平,史勇红,刘桂雪,等.基于DTI技术的健康成人胼胝体、扣带回、中脑白质纤维束密度随年龄变化关系的研究[J].神经解剖学杂志,2016,32(4):429-435
18贾少杰,李立冬,刘欣,等.MMSE和Mo CA量表在椎动脉型颈椎病患者早期认知障碍中的应用[J].中国老年学杂志,2015,35(22):6563-6564
19陈桂玲,张宗军,张龙江,等.磁敏感加权成像对脑微出血的检测及与认知功能障碍关系的研究[J].中华老年心脑血管病杂志,2012,14(3):227-230
20 Li XQ,Su DF,Chen HS,et al.Clinical neuropathological analysis of10 cases of cerebral amyloid angiopathy-related cerebral lobar hemorrhage[J].J Korean Neurosurg Soc,2015,58(1):30-35