摘要
目的探讨磁共振波谱(MRS)和弥散张量成像(DTI)在非痴呆型脑小血管病性认知障碍(VCIND-SVD)诊断价值。方法应用简易智能状态检查量表(MMSE)和蒙特利尔认知量表(Mo CA)评价50例VCIND-SVD患者和40名健康对照者的认知功能;通过1H-MRS检测双侧额叶、顶叶、颞叶、枕叶的氮-乙酰天冬氨酸(NAA)、肌酸(Cr),通过DTI检测上述部位的各向异性分数(FA),分析两组NAA/Cr比值和FA值的差异;对VCIND-SVD组患者Mo CA总分及其子项评分与NAA/Cr和FA进行相关分析。结果 VCIND-SVD组患者双侧额叶NAA/Cr比值与对照组比较,差异有统计学意义[(左:(1.27±0.13)比(1.48±0.11),右:(1.29±0.13)比(1.46±0.15),P<0.01];VCIND-SVD组患者双侧额叶FA值与对照组比较,差异有统计学意义[左:(0.36±0.05)比(0.40±0.04),右:(0.37±0.04)比(0.42±0.05),P<0.01];VCIND-SVD组患者双侧额叶NAA/Cr比值与FA值呈正相关(左r=0.62,右r=0.59,P<0.01);VCIND-SVD组患者双侧额叶NAA/Cr比值和FA值与Mo CA评分及抽象概括能力、视空间与执行能力、语言功能和注意与计算力等子项评分均呈正相关(r=0.44~0.70,P<0.05,P<0.01)。结论 VCIND-SVD患者认知功能损害可能与双侧额叶代谢异常及白质损伤有关,MRS联合DTI在VCIND-SVD早期诊断中起着重要的作用。
Objective To evaluate the roles of magnetic resonance spectroscopy（MRS） and diffusion tensor imaging（DTI） in vascular cognitive impairment patients with non-demented cerebral small vessel disease（VCIND-SVD）.Methods Fifty VCIND-SVD patients and 40 normal controls were enrolled in this study. Mini-Mental Status Exa mation（MMSE） and Montreal Cognitive Assessment（Mo CA） were conducted to assess cognitive function. The levels of N-acetylaspartartate（NAA）, creatine（Cr） and regional fractional anisotropy（FA） in white matter of bilateral frontal lobe, parietal lobe, temporal lobe and occipital lobe were measured by 1 H-MRS and DTI and were compared between two groups. The relations between NAA/Cr and FA values and the relations between scores of MoCA and its sub-items and the NAA/Cr and FA values were analyzed in VCIND-SVD group. Results Compared with control group, VCIND-SVD group had decreased values of NAA/Cr（left site： 1.27±0.13 vs 1.48±0.11; right site：1.29±0.13 vs 1.46 ±0.15; all P 0.01） and FA（left site： 0.36 ±0.05 vs 0.40 ±0.04; right site： 0.37 ±0.04 vs 0.42 ±0.05; all P0.01） in white matters of bilateral frontal lobe. In VCIND-SVD group, the values of NAA/Cr and FA in bilateral frontal lobe were positively correlated（left site： r=0.62, right site： r=0.59, all P0.01） and the same correlation was also found between NAA/Cr and FA values in white matters of bilateral frontal lobe and the Mo CA total score as well as the sub-scores in tested items of linguistic competence, visuospatial or executive, language and attention（r=0.44~0.70, P0.05 or P0.01）. Conclusion Cognitive impairment in VCIND-SVD patients may be related to altered neurometabolite levels and white matter lesion in bilateral frontal lobe. MRS combined with DTI play an important role in early diagnosis of VCIND-SVD.
出处
《浙江中西医结合杂志》
2017年第1期13-16,20,共5页
Zhejiang Journal of Integrated Traditional Chinese and Western Medicine
基金
浙江省医药卫生科技计划项目(No.2013KYB032)
关键词
认知障碍
非痴呆型脑小血管病
磁共振波谱学
弥散张量成像
神经心理学测验
cognitive disorders
non-demented cerebral small vessel diease
magnetic resonance spectroscopy
diffusion tensor imaging
neuropsychological test
