脑小血管病相关轻度认知功能障碍患者边缘系统微结构改变研究

doi:10.3969/j.issn.1673-5765.2021.08.007

摘要/Abstract

摘要： 目的探讨脑小血管病（cerebral small vessel disease，CSVD）相关轻度认知功能障碍（mild cognitive impairment，MCI）患者边缘系统的微结构改变。方法连续入组CSVD患者，以MoCA＜26分为界值分为脑小血管病伴轻度认知障碍组（CSVD-MCI）和对照组。选取扣带回、海马、海马旁回作为感兴趣区，对两组患者进行常规头颅MRI 序列检查及扩散峰度成像（diffusion kurtosis imaging，DKI）扫描。对比两组患者的基本信息、基础病患病率、化验指标、焦虑抑郁状态及DKI相关参数，包括平均扩散系数（mean diffusion，MD）、各项异性分数（fractional anisotropy，FA）、轴向扩散峰度（axial kurtosis，AK）、平均扩散峰度（mean kurtosis，MK）和径向扩散峰度（radial kurtosis，RK）。结果共入组80例患者，CSVD-MCI组55例，对照组25例。与对照组相比，CSVD-MCI组受教育程度低（P =0.003），吸烟（P =0.044）和饮酒（P =0.025）比例高，糖尿病（P =0.014）和高血压（P =0.004）患病率高（P =0.004）。DKI结果显示，与对照组相比，CSVD-MCI组右侧前扣带回MD升高（P =0.032），FA、 AK、MK、RK降低（P =0.046、P =0.001、P＜0.01、P =0.002），左侧前扣带回AK降低（P =0.049），右侧后扣带回MD升高（P =0.030），AK降低（P =0.014），左侧后扣带回FA升高（P =0.036），左侧海马FA、MK、 RK降低（P =0.006、P =0.002、P =0.010）。结论脑小血管病致轻度认知功能障碍患者存在扣带回、海马等边缘系统的微结构改变。

文章导读： MRI-DKI序列可以发现脑组织微结构的改变，本研究通过对CSVD患者进行DKI序列扫描发现，与无认知障
碍的患者相比，伴有轻度认知障碍的CSVD患者的扣带回、海马等边缘系统已经出现了微结构的改变，为早期发现
CSVD相关认知障碍提供了新的临床思路。

关键词: 脑小血管病; 轻度认知功能障碍; 边缘系统; 扩散峰度成像

Abstract: Objective To investigate the microstructural changes of limbic system in patients with mild cognitive impairment (MCI) induced by cerebral small vessel disease (CSVD). Methods The patients with CSVD who were evaluated by MoCA scale were retrospectively analyzed. The patients with MoCA<26 points were included in the CSVD-MCI group, and the other patients were taken as the control group. Cingulate gyrus, hippocampus and parahippocampal gyrus were selected as regions of interest. Routine MRI sequences and diffusion kurtosis imaging (DKI) were performed in two groups. The baseline information, anxiety and depression status and DKI parameters of the two groups were compared. DKI parameters included mean diffusion (MD), fractional anisotropy (FA), axial kurtosis (AK), mean kurtosis (MK) and radial kurtosis (RK). Results A total of 80 patients were included in this study, with 55 cases in the MCI group and 25 in the control group. Compared to the control group, the CSVD-MCI group had lower education level

(P =0.003), higher proportion of smoking (P =0.044) and drinking (P =0.025), and higher prevalence

of diabetes (P =0.014) and hypertension (P =0.004). Compared to the control group, DKI image of the limbic system in the CSVD-MCI group showed the following changes: MD increased (P =0.032), FA, AK, MK and RK decreased (P =0.046, P =0.001, P <0.001, P =0.002, respectively) in the right anterior cingulate gyrus, AK decreased (P =0.049) in the left anterior cingulate gyrus; MD increased (P =0.030) and AK decreased (P =0.014) in the right posterior cingulate gyrus, FA increased (P =0.036) in the left posterior cingulate gyrus; and FA, MK and RK decreased in the left hippocampus (P =0.006, P =0.002, P =0.010, respetctively). Conclusions The limbic systems, such as cingulate gyrus and hippocampus, have microstructural changes in the patients with MCI induced by CSVD.

Key words: Cerebral small vessel disease; Mild cognitive impairment; Limbic systems;Diffusion kurtosis imaging

刘慧琳, 刘东涛, 卜乔, 李坤, 潘振宇, 范小伟, 周立春. 脑小血管病相关轻度认知功能障碍患者边缘系统微结构改变研究[J]. 中国卒中杂志, 2021, 16(08): 793-798.

LIU Hui-Lin, LIU Dong-Tao, BU Qiao, LI Kun, PAN Zhen-Yu, FAN Xiao-Wei, ZHOU Li-Chun. Microstructural Changes of Limbic System in Patients with Mild Cognitive Impairment Induced by Cerebral Small Vessel Disease[J]. Chinese Journal of Stroke, 2021, 16(08): 793-798.

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