摘要
目的探讨脑白质病变(white matter lesions,WMLs)伴认知功能障碍患者可能存在的局部脑区域的异常活动。方法连续纳入2014年8月至2017年4月于北京天坛医院神经内科住院或门诊治疗的WMLs患者55例,均经头颅磁共振成像FLAIR加权像筛选,再利用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)及临床痴呆评定量表(clinical dementia rating,CDR)的评估结果将患者分为WMLs-非痴呆型血管性认知功能损害(vascular cognitive impairment no dementia,VCIND)组32例和WMLs-痴呆(vascular dementia,VaD)组23例,选取同期30例无脑白质病变且认知正常的志愿者作为对照组。采用Dpabi软件对功能性磁共振成像结果进行数据预处理,根据预处理后的功能像计算各受试者的全脑局部一致性(regional homogeneity,Reho),通过Fisher Z变换将全脑Reho转换为zReho,在全脑灰质区域对3组的zReho值进行单因素方差分析并引入协变量,获得全脑zReho值组间差异有显著性的脑区,将其设为后续研究的感兴趣区域即异常脑区。采用MoCA量表及单项认知功能测评,包括数字符号模式测验、数字连线测验、时钟绘图测试、数字广度测试评价认知功能,然后分别对所有脑白质病变患者的感兴趣区域值与认知功能评分进行偏相关分析。WMLs-VCIND组和对照组单项认知功能比较采用t检验。结果与对照组比较,WMLs-VCIND组与WMLs-VaD组右侧颞叶内侧、左侧壳核、右前额叶背侧及右侧角回等脑区zReho值降低,差异有显著性(P<0.05),与WMLs-VCIND组比较,WMLs-VaD组右侧颞叶内侧、左侧壳核及右前额叶背侧等脑区出现zReho增高,差异有显著性(P<0.05)。偏相关分析显示,右侧颞叶内侧与信息处理速度(r=0.029,P<0.05)和记忆力(r=0.017,P<0.05)呈正相关,左侧壳核与信息处理速度(r=0.027,P<0.05)和执行功能(r=0.038,P<0.05)呈正相关,右前额叶背侧与执行功能(r=0.030,P<0.05)、信息处理速度(r=0.023,P<0.05)和�
Objective To study the abnormal activities of local brain regions that may exist in patients with WMLs.Method Fifty-five patients with WMLs who were treated at Beijing Tiantan Hospital from August 2014 to April 2017.According to the severity of cognitive impairment,the patients in white matter lesions,which were divided into two groups:white matter lesions with mild cognitive impairment(WMLs-VCIND)and white matter lesions with dementia group(WMLs-VaD).In the same period,30 patients with no white matler lesions and normal cognition were selected as the control group.The data was pre-processed with rs-fMRI using Dpabi software.The regional homogeneity(Reho)map was calculated according to the pre-processed functional image,and the whole brain Reho was subjected to Fisher Z transformation,and the whole brain gray matter region was used for three groups.The zReho values were analyzed by one-way analysis of variance(ANOVA)and covariates were introduced to obtain brain regions with significant statistical differences between the whole brain zReho values,which were set as regions of interest(ROI)for subsequent studies.It was set as the region of interest(ROI)for subsequent studies.Using the MoCA scale and individual cognitive function assessments such as:Symbol Digit Modalities Test,Trail Making Test,Clock Drawing Test,Digit Span Forward.Then,the correlated between ROI values and cognitive function scores in all patients with white matter lesions.Result zReho analysis showed that compared in the normal control group(NC group),the WMLs-VCIND group and the WMLs-VaD group,there were decrease in the right temporal lobe,the left putamen,the dorsal of right prefrontal and the right angular gyrus(P<0.05).Compared to the WMLs-VCIND group,zReho of the WMLs-VaD group showed increase in the right temporal lobe,the left putamen,and the dorsal of right prefrontal lobe(P<0.05).Analysis of the partial correlation between the three groups and cognitive function scores:the right temporal lobe was positive correlation in information proce
作者
冯丽
石庆丽
李越秀
王金芳
陈红燕
姚靖璠
张玉梅
FENG Li;SHI Qing-li;LI Yue-xiu;WANG Jin-fang;CHEN Hong-yan;YAO Jing-fan;ZHANG Yu-mei(Neurological Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;Department of Neurology,Third Hospital of Shijiazhuang City,Hebei Shijiazhuang 050011,China;Neuroimaging center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;Department of Rehabilitation Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China)
出处
《中国医刊》
CAS
2020年第2期147-151,共5页
Chinese Journal of Medicine
基金
国家重点研发项目（SQ2018YFC200065-02）
北京市医管局重点医学扶持项目（ZYLX201836）
国家自然科学基金（8137120）
关键词
脑白质病变
认知障碍
静息态功能磁共振
局部一致性
White matter lesions
Cognitive impairment
Resting functional magnetic resonance imaging
Regional homogeneity
