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脑小血管病是因多种原因所致颅内小动脉、微动脉及小静脉的病理性改变,临床上主要以静灶性脑梗死或无症状性脑梗死、腔隙综合征及认知功能障碍为表现[1];影像学上脑小血管病有腔隙性脑梗死、脑白质病变及脑微出血等表现[2]。脑卒中病人中1/5为脑小血管病,脑小血管病可引起病人血管性认知功能障碍[3]。而关于不同脑小血管病影像学类型对病人认知功能的损害的影响研究较少,且临床上脑小血管病病人常同时具有多种影像学类型表现,病情更为复杂,对病人的认知功能影响可能更为严重[4],且早期脑小血管病变症状较为隐匿常被忽视,因此有必要对脑小血管病病人与血管性认知功能障碍的相关性进行研究,以期为脑小血管病相关性血管性认知功能障碍的早期诊断提供参考。
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选择2018-2019年广西梧州市工人医院神经内科门诊、住院的脑小血管病病人96例(观察组)进行研究。入选标准: (1)年龄40~85岁;(2)符合《中国脑小血管病诊治共识》[5]的相关诊断,并经MRI影像学方法确诊;(3)符合2018年全球专家共同制定的血管损伤认知障碍分类研究指南中的血管性认知功能障碍诊断标准[6];(4)病人知情同意。排除标准: (1)足以解释记忆或其他认知损害的其他影像学改变或疾病, 如无皮质和/或皮质下的非腔隙性梗死、脑出血, 脑白质特殊原因(多发性硬化、结节病、脑部放疗), 脑部病变(阿尔茨海默病、路易体痴呆、额颞叶痴呆、帕金森病、肿瘤、脑积水、外伤、梅毒、获得性免疫缺陷综合征、克雅氏病等), 严重精神疾病及癫痫、酗酒及药物滥用、中毒和代谢异常等;(2)排除脑小血管病其他的类型,比如遗传性的CADASIL、CARASIL等;(3)合并严重心、肝、肺、肾功能障碍;(4)因交流障碍而影响认知功能的评价,如言语、视力及听力障碍等;(5)教育程度低于小学无法配合认知功能评估者。另选择40~85岁,经认知功能测定及影像学检查均无异常的正常人90名为对照组。观察组男53例,女43名;年龄45~83岁;体质量指数(BMI)19.84~27.33 kg/m2。对照组男47名,女43名;年龄45~79岁;BMI 19.32~27.18 kg/m2。2组研究对象性别、年龄、BMI差异均无统计学意义(P>0.05)(见表 1),具有可比性。
分组 n 男 女 年龄/岁 BMI/(kg/m2) 观察组 96 53 43 66.45±5.03 22.41±2.59 对照组 90 47 43 67.18±4.20 22.19±2.47 t — 0.17* 1.07 0.59 P — >0.05 >0.05 >0.05 *示χ2值 表 1 2组病人一般资料的比较(x±s)
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(1) 影像学检查: 研究对象入组后均采用GE Signa 3.0T EXCITE HDMR系统进行头颅MRI平扫+DWI+SWI+MRA检查,由2个副主任医师级别的磁共振专科医生进行读片。参照《中国脑小血管病诊治共识》[4],脑小血管病影像学特点主要表现为腔隙性脑梗死、脑白质变性、脑微出血、血管周围间隙扩大,根据头颅MRI检查结果,将研究对象分为单一类型脑小血管病组、合并2种类型脑小血管病组、合并3种类型脑小血管病组、合并4种类型脑小血管病组及正常对照组。(2)认知功能评价: 由同一名经培训后具5年以上资历的神经内科医生采用蒙特尔认知评估量表[7](MoCA)、简易精神状态评价量表[8](MMSE)对研究对象进行测评, 为保证效果测评在独立房间进行,房间内仅有测试者及研究对象,每个量表测评在10 min内完成,2次测评间隔应在30 min以上。MoCA主要包括6个认知领域,共11个检查项目,总分30分,得分越高认知功能越好,26分以上认为是正常。MMSE包括6个维度共24个条目,该表内部一致性系数Cronbach′s α系数为0.984。总表得分为30分,得分越高认知功能越好,27分以下认为是认知功能障碍。
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采用t检验、单因素方差分析和LSD-t检验、Spearman相关分析。
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观察组病人MoCA及MMSE水平均明显低于对照组(P < 0.00.01)(见表 2)。
分组 n MoCA MMSE 观察组 96 24.18±2.11 25.29±2.04 对照组 90 27.03±1.25 28.17±1.42 t — 8.62 8.77 P — < 0.01 < 0.01 表 2 2组研究对象MoCA及MMSE得分比较(x±s;分)
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不同类型脑小血管病病人MoCA及MMSE得分差异具有统计学意义(P < 0.00.01),MoCA及MMSE得分依次为单一脑小血管病组>合并2种类型脑小血管病组>合并3种类型脑小血管病组>合并4种类型脑小血管病组(P < 0.00.05)(见表 3)。
分组 n MoCA MMSE 单一脑小血管病组 31 25.51±2.20 26.13±2.07 合并2种类型脑小血管病组 39 23.16±1.95* 25.11±1.39* 合并3种类型脑小血管病组 17 21.53±1.77*△ 23.49±1.18*△ 合并4种类型脑小血管病组 9 18.25±1.39*△# 22.10±0.95*△# F — 37.40 20.26 P — < 0.01 < 0.01 MS组内 — 10.74 7.86 LSD-t检验: 与单一脑小血管病组比较*P < 0.00.05;与合并2种类型脑小血管病组比较△P < 0.00.05;与合并3种类型脑小血管病组比较#P < 0.00.05 表 3 不同类型脑小血管病变MoCA及MMSE得分对比(x±s;分)
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将脑血小管病病人类型按0=单一脑小血管病组,1=合并2种类型脑小血管病组,2=合并3种类型脑小血管病组,3=合并4种类型脑小血管病组进行赋值与MoCA、MMSE行Spearman相关性分析,结果显示脑小血管病病情复杂程度与MoCA、MMSE均呈负相关关系(rs=-0.592和rs=-0.534,P < 0.00.01)。
不同合并类型的脑小血管病与血管性认知功能障碍的相关性研究
Correlation between different concomitant types of cerebral small vessel disease and vascular cognitive dysfunction
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摘要:
目的探讨不同合并类型的脑小血管病与血管性认知功能障碍的相关性。 方法选择门诊、住院的脑小血管病病人96例为观察组, 经认知功能测定及影像学检查均无异常的正常人90例为对照组。研究对象入组后均采用GE Signa 3.0T EXCITE HDMR系统进行头颅MRI平扫+DWI+SWI+MRA检查, 由2个副主任医师级别的磁共振专科医生进行读片, 按照头颅MRI检查结果, 将研究对象分为单一类型脑小血管病组、合并2种类型脑小血管病组、合并3种类型脑小血管病组、合并4种类型脑小血管病组及正常对照组。并对研究对象采用采用蒙特尔认知评估量表(MoCA)、简易精神状态评价量表(MMSE)进行认知功能评定。比较不同研究对象MoCA及MMSE水平, 并对脑小血管病复杂程度与MoCA、MMSE进行相关性分析。 结果观察组病人MoCA及MMSE水平均明显低于对照组(P < 0.01)。不同类型脑小血管病病人MoCA及MMSE得分差异均有统计学意义(P < 0.01), MoCA及MMSE得分依次为单一脑小血管病组>合并2种类型脑小血管病组>合并3种类型脑小血管病组>合并4种类型脑小血管病组(P < 0.05)。相关性分析结果显示脑小血管病复杂程度与MoCA、MMSE均呈负相关关系(P < 0.01)。 结论脑小血管病病人血管性认知功能障碍的发生明显高于健康人群, 且随脑小血管病复杂程度升高而更严重。 Abstract:ObjectiveTo investigate the correlation between different concomitant types of cerebral small vessel disease and vascular cognitive dysfunction. MethodsA total of 96 outpatients and inpatients with cerebrovascular disease were selected as the observation group, while 90 normal subjects with normal cognitive function and imaging examination were selected as the control group.After enrollment, all subjects were subjected to GE Signa 3.0T EXCITE HDMR system for head MRI scan+DWI+SWI+MRA, and the films were read by two MRI specialists at the associate chief physician level.According to the results of the head MRI, the subjects were divided into single type of cerebral small vessel disease group, two types of cerebral small vessel disease group, three types of cerebral small vessel disease group, four types of cerebral small vessel disease group and normal control group.Neurological evaluation was performed on the patients using the Montrel cognitive assessment(MoCA) and the mini mental state examination(MMSE).The levels of MoCA and MMSE in different subjects were compared, and the correlation between the complexity of cerebral small vessel disease and MoCA and MMSE was analyzed. ResultsThe levels of MoCA and MMSE in the observation group were significantly lower than those in the control group(P < 0.01).The differences of MoCA and MMSE scores in patients with different types of cerebral small vessel disease were statistically significant(P < 0.01).The scores of MoCA and MMSE were as follows: single cerebral small vessel disease group>two types of cerebral small vessel disease group >three types of cerebral small vessel disease group >four types of cerebral small vessel disease group(P < 0.05).Correlation analysis showed that the complexity of cerebral small vessel disease was negatively correlated with MoCA and MMSE(P < 0.01). ConclusionsThe vascular cognitive dysfunction in patients with cerebral small blood vessel disease is significantly higher than that in healthy people, and the vascular cognitive impairment is more serious with the complexity of cerebral small vessel disease. -
Key words:
- cerebral small vessel disease /
- cognitive dysfunction
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表 1 2组病人一般资料的比较(x±s)
分组 n 男 女 年龄/岁 BMI/(kg/m2) 观察组 96 53 43 66.45±5.03 22.41±2.59 对照组 90 47 43 67.18±4.20 22.19±2.47 t — 0.17* 1.07 0.59 P — >0.05 >0.05 >0.05 *示χ2值 表 2 2组研究对象MoCA及MMSE得分比较(x±s;分)
分组 n MoCA MMSE 观察组 96 24.18±2.11 25.29±2.04 对照组 90 27.03±1.25 28.17±1.42 t — 8.62 8.77 P — < 0.01 < 0.01 表 3 不同类型脑小血管病变MoCA及MMSE得分对比(x±s;分)
分组 n MoCA MMSE 单一脑小血管病组 31 25.51±2.20 26.13±2.07 合并2种类型脑小血管病组 39 23.16±1.95* 25.11±1.39* 合并3种类型脑小血管病组 17 21.53±1.77*△ 23.49±1.18*△ 合并4种类型脑小血管病组 9 18.25±1.39*△# 22.10±0.95*△# F — 37.40 20.26 P — < 0.01 < 0.01 MS组内 — 10.74 7.86 LSD-t检验: 与单一脑小血管病组比较*P < 0.00.05;与合并2种类型脑小血管病组比较△P < 0.00.05;与合并3种类型脑小血管病组比较#P < 0.00.05 -
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