李国勤 郭春茂 曾子娟

【摘要】 目的：研究脑小血管病（CSVD）磁共振成像（MRI）的表现与血管性认知功能障碍的相关性。方法：选取2017年6月-2020年2月笔者所在医院CSVD患者80例，其中血管性认知功能障碍（VCI）患者36例为VCI组，认知功能正常（NCI）患者44例为NCI组。两组均行MRI检查，比较表观弥散系数（ADC值）、脑白质变性（WML）发生率及蒙特尔认知评估量表（MoCA）与ADC值相关性。结果：VCI组左侧尾状核及丘脑ADC值均高于NCI组（P<0.05）;VCI组WML发生率为58.33%，高于NCI组的31.82%（P<0.05）;经Pearson相关性分析，CSVD患者MoCA评分与左侧丘脑ADC值呈负相关（r=-0.378，P<0.05）。结论：CSVD合并VCI患者的左侧尾状核及丘脑ADC值较高，可促进WML发生，且认知功能与左侧丘脑ADC值具有显著相关性。

【关键词】 脑小血管病 磁共振成像 血管性认知功能障碍 相关性

doi：10.14033/j.cnki.cfmr.2020.13.026 文献标识码 B 文章编号 1674-6805（2020）13-00-03

Study on the Correlation between MRI Findings and Vascular Cognitive Impairment in Cerebral Small Vessel Disease/LI Guoqin， GUO Chunmao， ZENG Zijuan. //Chinese and Foreign Medical Research， 2020， 18（13）： -66

[Abstract] Objective： To investigate the correlation between magnetic resonance imaging （MRI） findings and vascular cognitive impairment in cerebral small vessel disease （CSVD）. Method： Eighty patients with CSVD in our hospital from June 2017 to February 2020 were selected， among whom 36 patients with vascular cognitive impairment （VCI） were in the VCI group and 44 patients with normal cognitive impairment （NCI） were in the NCI group. MRI was performed on both groups， and the apparent dispersion coefficient （ADC value）， the incidence of white matter lesions （WML） and the correlation between MoCA and ADC value were compared between the two groups. Result： The ADC values of left caudate nucleus and thalamus in the VCI group were higher than those of the NCI group （P<0.05）. The incidence of WML in the VCI group was 58.33%， which was higher than 31.82% of the NCI group （P<0.05）. According to Pearson correlation analysis， MoCA score of CSVD patients was negatively correlated with ADC value in the left thalamus （r=-0.378， P<0.05）. Conclusion： The left caudate nucleus and thalamus of CSVD patients combined with VCI had higher ADC values， which promoted the occurrence of WML， and the cognitive function was significantly correlated with ADC values of left thalamic.

[Key words] Cerebral small vessel disease Magnetic resonance imaging Vascular cognitive impairment Correlation

First-authors address： Huizhou Hospital of Traditional Chinese Medicine， Huizhou 516001， China

腦小血管病（CSVD）导致血管性认知功能障碍（VCI）占比高达70%，若干预不及时易发展为血管性痴呆，临床应早期诊断并延缓病情进展[1-2]。磁共振成像（MRI）中脑白质变性（WML）、腔隙性脑梗死（LI）、脑微出血（CMB）等均为CSVD的主要诊断指标，且与患者发生认知功能障碍具有一定关联性[3-4]。临床应及时判断患者病情并预防血管性痴呆形成。本研究选取笔者所在医院CSVD患者80例，旨在探讨CSVD的MRI表现与VCI的相关性，报道如下。

1 资料与方法

1.1 一般资料

选取2017年6月-2020年2月笔者所在医院CSVD患者80例。纳入标准：（1）经MRI或CT检查确诊为CSVD;（2）具有脑白质疏松症（LA）或LI至少1项;（3）皮下无直径>15 mm病灶;（4）无分水岭和皮质梗死。排除标准：（1）合并大血管闭塞或狭窄、大面积脑梗死;（2）由精神疾病、癫痫、药物滥用、酗酒等其他因素导致的认知功能障碍;（3）合并阿尔兹海默症;（4）无法配合扫描或合并MRI禁忌证。其中VCI患者36例为VCI组，男18例，女18例;年龄48～63岁，平均（57.21±2.78）岁;合并症：高血压8例，糖尿病6例，高血脂12例，冠心病7例。认知功能正常（NCI）患者44例为NCI组，男23例，女21例;年龄49～64岁，平均（57.42±2.92）岁;合并症：高血压10例，糖尿病8例，高血脂14例，冠心病10例。两……