脑小血管病患者认知功能障碍与脑白质完整性及脑血流灌注的关系

目的:探讨脑小血管病(CSVD)患者轻度认知功能障碍(MCI)与脑白质完整性、脑血流灌注的关系。方法:选取52例CSVD伴MCI患者为MCI组,同期健康体检者40例为对照组。采用蒙特利尔认知量表(MoCA)评价认知功能,采用磁共振动脉自旋标记(ASL)灌注成像测定脑血流量(CBF)和磁共振弥散张量技术(DTI)测定各向异性分数(FA)、平均弥散系数(ADC)等。结果:MCI组MoCA量表总分、视空间/执行、命名、注意/计算力、语言、抽象思维及延迟记忆评分均低于对照组(P<0.05);与对照组相比,MCI组双侧半卵圆中心、额叶、顶叶FA值、CBF均降低(P<0.05),双侧额叶、顶叶的ADC值高于对照组(P<0.05);右侧半卵圆中心、双侧额叶、顶叶的FA值与CBF呈正相关(P<0.05),双侧额叶和顶叶的ADC值与CBF呈负相关(P<0.05);右侧半卵圆中心、双侧额叶的FA值与MoCA评分呈正相关(P<0.05),双侧额叶的ADC值与MoCA评分呈负相关(P<0.05);双侧额叶、顶叶的CBF与MoCA评分呈正相关(P<0.05)。结论:脑白质完整性损伤尤其是颞叶损伤是CSVD患者伴发MCI的重要标志,且与脑血流灌注有关。

Relationship between Cognitive Impairment and White Matter Integrity, Cerebral Blood Flow Perfusion in Patients with Cerebral Small Vessel Disease

To investigate the relationship between mild cognitive impairment (MCI) and white matter integrity, cerebral blood flow perfusion in patients with cerebral small vessel disease (CSVD). Methods: A total of 52 CSVD patients with MCI were recruited and assigned to the MCI group, and 40 healthy volunteers were selected as the control group. Cognitive function was evaluated by the Montreal Cognitive Assessment Scale (MoCA); cerebral blood flow (CBF) was measured by Arterial Spin Labeling (ASL) of MR perfusion imaging technique; fractional anisotropy (FA) values and the apparent diffusion coefficient (ADC) were measured by diffusion tensor imaging (DTI). Results were analyzed to evaluate the relationship between severity of cognitive impairment and cerebral blood flow perfusion. Results: The total MoCA scale scores and visual space/execution, naming, attention/calculation, language, abstract thinking, and delayed memory scores in MCI group were significantly lower than those in control group (P<0.05). Compared with the control group, the MCI group showed decreased FA values and CBF in the bilateral centrum semiovale, bilateral frontal lobe, and apical frontal lobe (P<0.05) and increased ADC in the bilateral frontal lobe and apical frontal lobe (P<0.05). FA values in the right centrum semiovale, bilateral frontal lobe, and apical frontal lobe were positively correlated with CBF (P<0.05), and the ADC in the bilateral frontal lobe and apical frontal lobe were negatively correlated with CBF (P<0.05). FA values in the right centrum semiovale and bilateral frontal lobe were positively correlated with the MoCA score (P<0.05), and the ADC in the bilateral frontal lobe was negatively correlated with the MoCA score (P<0.05). CBF in the bilateral frontal lobe and apical frontal lobe was positively correlated with the MoCA score (P<0.05). Conclusion: In CSVD patients, the integrity of white matter is an important imaging marker of MCI and shows a relationship to cerebral perfusion.