谭庆晶 刘永辉 杨俊威

[摘要] 目的 研究腦微出血患者神经影像学特点并探讨其与患者认知功能障碍的相关性。 方法 选取2017年12月～2019年10月广西中医药大学第一附属医院脑病科二区收治的60例脑微出血患者作为观察组，健康受试者60名作为对照组。采用简易精神状态检查量表（MMSE）、蒙特利尔认知评估（MoCA）评定患者认知功能损害程度，采用磁共振平扫及多模态磁共振成像技术观察异性值（FA）和平均弥散系数（ADC）以及脑内微出血数目与患者认知功能损害之间的关系。 结果 观察组MMSE、MoCA评分显著低于对照组（P < 0.05）。观察组额颞叶、顶叶、基底节区FA值显著低于对照组（P < 0.05），额颞叶、顶叶、基底节区ADC值高于对照组（P < 0.05）;两组枕叶FA值及ADC值比较，差异无统计学意义（P > 0.05）。观察组脑内微出血数目明显多于对照组（P < 0.05）。脑小血管病患者认知功能障碍与其额颞叶FA、ADC值及脑内微出血数目有相关性（P < 0.05）。 结论 脑微出血患者认知功能障碍与其脑白质的损伤程度以及脑微出血数目存在着密切相关性。

[关键词] 脑微出血;脑小血管病;认知功能;多模态影像学

[中图分类号] R743          [文献标识码] A          [文章编号] 1673-7210（2020）07（a）-0089-04

[Abstract] Objective To study the association between the neuroimaging features and cognitive impairment of patients with cerebral microbleeds. Methods From December 2017 to October 2019， 60 patients with cerebral microhemorrhage who admitted to the District Two， Department of Encephalopathy in the First Affiliated Hospital of Guangxi University of Chinese Medicine were selected as the observation group and 60 healthy subjects as the control group. The degree of cognitive impairment was assessed using the mini-mental state examination （MMSE） and the montreal cognitive assessment （MoCA）， and the relationship between the fractional anisotropy （FA） and average diffusion coefficient （ADC） as well as the number of intracerebral microhemorrhages and cognitive impairment was observed using magnetic resonance plain scan and multimodal magnetic resonance imaging. Results The MMSE score and MoCA score of the observation group were significantly lower than those of the control group （P < 0.05）. FA values of frontotemporal， parietal and basal ganglia regions in the observation group were significantly lower than those in the control group （P < 0.05）， ADC values of frontotemporal， parietal and basal ganglia regions were higher than those in the control group （P < 0.05）. There was no significant difference in FA and ADC values between the two groups （P > 0.05）. The number of intracerebral microhemorrhage in the observation group was significantly higher than that in the control group （P < 0.05）. Cognitive dysfunction in patients with cerebral microvascular disease was correlated with the FA and ADC values of frontotemporal lobe and the number of intracerebral microhemorrhage （P < 0.05）. Conclusion The cognitive impairment in patients with cerebral microbleeds is strongly associated with the severity of white matter damage and the number of microbleeds.

[Key words] Cerebral microbleeds; Cerebral small vessel disease; Cognitive function; Multi-mode imagining

脑微出血（cerebral microbleeds，CMBs）是一种亚临床的脑小血管病变导致的脑组织微量渗血或含铁血黄素沉积，与腔隙性脑梗死、脑白质疏松同属于脑小血管病（cerebral small vessel disease，CSVD）[1]。由于出血量少，临床上无典型症状和体征。CMBs在影像上的定义为：磁敏感性加权成像（susceptibility weighted imaging，SWI）、T2*梯度回波（T2*gradient-recall echo，GRE）序列上表现为小的、圆形或椭圆形的低信号区域，病灶直径为2～5 mm[2]。CMBs在不同研究中的大小定义不一，最大不超过10 mm[3]。在不同类型的疾病中，CMBs发生率不尽相同，在高血压脑病和脑淀粉样血管病（CAA）患者中CMBs发生率最高，其次为脑卒中和阿尔茨海默病（Alzheimer′s disease，AD）患者，健康老年人亦可出现;在不同类型的脑卒中疾病中，CMBs发生率也不同，在出血性卒中患者中的发生率为60.4%，缺血性卒中患者中的发生率为33.5%[4]。目前，随着CMBs诊断技术的不断进步，CMBs的检出率明显提高，其相关危险因素及在脑血管病中的作用也受到越来越多人的关注。……