作者：崔羽，冉娟娟，王益，顾平

单位：

214011 江苏省无锡市第五人民医院神经内科；通信作者：顾平，E-mail：wxguping@163.com

关键词：

大脑小血管疾病；认知障碍；磁共振成像；腔隙性脑梗死；脑白质病；脑微出血

Keywords：

Cerebral small vessel disease；Cognition disorders；Magnetic resonance imaging；Infarction，lacunar；Leukoencephalopathies；Cerebral microbleeds

CLC：

R 743

DOI：

DOI：10.3969/j.issn.1008-5971.2020.04.010

Funds：

南京医科大学科技发展基金项目（NMUB2018278）

摘要：

目的　分析脑小血管病（CSVD）患者多模态磁共振成像（MRI）特征及其与认知功能损伤的相关性。方法　选取 2017—2018 年无锡市第五人民医院神经内科收治的 CSVD 患者 184 例，根据多模态 MRI 检查结果分为腔隙性脑梗死（LI）组（n=55）、脑白质高信号（WMH）组（n=48）、脑微出血（CMB）组（n=41）及合并组（n=40）；另选取同期体检健康者 42 例作为对照组。比较五组受试者认知功能指标〔包括简易智能精神状态检查量表（MMSE）评分、蒙特利尔认知评估量表（MoCA）评分、认知障碍发生率、连线测验（TMT）时间、数字符号编码测验（SDMT）评分、数字广度测验（DST）评分、画钟测验（CDT）及词语流畅性测验（VFT）评分〕，有无认知障碍患者 LI、CMB发生率及脑白质病变分级；LI、CMB 病灶及脑白质病变分级与 CSVD 患者 MoCA 评分的相关性分析采用 Spearman 秩相关分析。结果　LI 组、WMH 组、CMB 组及合并组患者 MMSE 评分、MoCA 评分、SDMT 评分、DST 评分、CDT 评分及 VFT 评分低于对照组，认知障碍发生率高于对照组，TMT 时间长于对照组（P<0.05）；合并组患者 MMSE 评分、MoCA 评分、SDMT 评分、DST 评分、CDT 评分及 VFT 评分低于 LI 组、WMH 组、CMB 组，认知障碍发生率高于 LI 组、WMH 组、CMB 组，TMT 时间长于 LI 组、WMH 组、CMB 组（P<0.05）。有认知障碍患者 LI、CMB 发生率高于无认知障碍者，脑白质病变分级劣于无认知障碍者（P<0.05）。Spearman 秩相关分析结果显示，LI 病灶（r s =-0.340）、CMB 病灶（r s =-0.290）及脑白质病变分级（r s =-0.213）与 CSVD 患者 MoCA 评分呈负相关（P<0.05）。结论　CSVD患者存在认知功能损伤，合并 2 种及以上 MRI 异常表现的 CSVD 患者认知功能损伤更严重，且多模态 MRI 检查结果LI、CMB 病灶及脑白质病变分级与 CSVD 患者认知功能损伤程度有关。

Abstract：

Objective　To analyze the characteristics of multimodal MRI and their correlations with cognitiveimpairment in patients with cerebral small vessel disease（CSVD）. Methods　From 2017 to 2018，a total of 184 patientswith CSVD were selected in the Department of Neurology，the Fifth People's Hospital of Wuxi，and they were divided into LIgroup（with lacunar infarction，n=55），WMH group（with high signal in white matter，n=48），CMB group（with cerebralmicrobleeds，n=41）and combination group（n=40）according to multimodal MRI examination results；meanwhile a total of 42healthy people were selected as control group. Indicators of cognitive function（including MMSE score，MoCA score，incidenceof cognitive disorder，TMT time，SDMT score，DST score，CDT score and VFT score）were compared in the five groups；incidence of LI and CMB，as well as classification of white matter lesions were compared in patients complicated with cognitivedisorder or not；correlations of LI nidi，CMB nidi，classification of white matter lesions with MoCA score in patients with CSVDwere analyzed by Spearman rank correlation. Results　MMSE score，MoCA score，SDMT score，DST score，CDT score andVFT score in LI group，WMH group，CMB group and combination group were statistically significantly lower than those incontrol group，incidence of cognitive disorder in LI group，WMH group，CMB group and combination group was statisticallysignificantly higher than that in control group，respectively，TMT time in LI group，WMH group，CMB group and combinationgroup was statistically significantly longer than that in control group，respectively（P<0.05）；MMSE score，MoCA score，SDMT score，DST score，CDT score and VFT score in combination group were statistically significantly lower than those in LIgroup，WMH group and CMB group，incidence of cognitive disorder in combination group was statistically significantly higherthan that in LI group，WMH group and CMB group，TMT time in combination group was statistically significantly longer thanthat in LI group，WMH group and CMB group（P<0.05）. Incidence of LI and CMB in patients complicated with cognitivedisorder was statistically significantly higher than that in patients did not complicate with cognitive disorder，respectively，moreover classification of white matter lesions in patients complicated with cognitive disorder was statistically significantly worsethan that in patients did not complicate with cognitive disorder（P<0.05）. Spearman rank correlation analysis results showedthat，LI nidi（r s =-0.340），CMB nidi（r s =-0.290）and classification of white matter lesions（r s =-0.213） was negativelycorrelated with MoCA score in patients with CSVD（P<0.05）. Conclusion　There is cognitive impairment in patients withCSVD，severity of cognitive impairment is more severe in CSVD patients with 2 or more abnormal findings in MRI，moreover LInidi，CMB nidi and classification of white matter lesions found by multimodal MRI are correlated with the severity of cognitiveimpairment.

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