摘要
目的探讨不同程度、不同部位的缺血性脑白质病变(WML)对认知功能的影响及其相关关系。方法 2012年10月至2013年11月于兰州大学第二医院神经内科就诊的患者,根据其颅脑磁共振检查结果,选取缺血性WML患者90例,正常对照组35例。将WML患者根据病变部位不同分为深部WML(DWML)组、近脑室旁白质病变(PVL)组及混合组;应用Fazakas量表评价WML的严重程度,据此将WML患者分为三组(轻度、中度及重度组),并结合简易精神状态量表(MMSE)、蒙特利尔认知功能量表(MoCA)对入选患者和正常对照者进行认知功能评价,分析不同程度、不同部位WML对认知功能的影响并进行相关分析。采用SPSS 19.0进行统计学分析,组间差异比较采用独立样本t检验、单因素方差分析以及χ2检验。结果与正常对照组比较,不同程度WML组MMSE、MoCA量表总分及视空间与执行功能、延迟回忆评分均显著降低,差异均有统计学意义(均P<0.05),重度组除抽象思维能力外,MoCA量表其余6项认知域评分均明显降低(均P<0.05);WML严重程度的Fazekas评分与MMSE和MoCA评分均呈负相关(r=-0.780、-0.817,均P<0.05);DWML组在视空间与执行功能和语言表达评分低于PVL组和对照组,差异有统计学意义(均P<0.05);PVL组的延迟回忆、注意力及计算力方面评分低于DWML组和对照组,差异有统计学意义(均P<0.05);混合组在除抽象功能以外的其余6项认知功能评分低于对照组,差异有统计学意义(均P<0.05)。结论缺血性WML可导致认知功能损害,WML程度越重,认知下降越显著;脑室旁和深部白质病变可能对不同认知域损害不同。
Objective To investigate the impacts of ischemic white matter lesion （WML） of the patients in different extents and locations on cognitive function and its correlation. Methods Ninety patients with ischemic WML and thirty-five gender matched healthy subjects were recruited from the Department of Neurology and those admitted to the Second Hospital of Lanzhou University from October 2012 to November 2013. According to MRI, ninety patients with WML were first classified into 3 subgroups [ deep WML （DWML） group,periventricular lesions（PVL） group and mixed legions group] depending on ihe location, then were classified into 3 subgroups （mild group, moderate group and severe group）depending on the degree. All participants underwent neuropsychological tests by using the mini-mental state examination （MMSE） and the Montreal cognitive assessment （MoCA）. The impact of different extents and locations of WML on cognitive function was assessed by statistical analysis. Statistical analysis was performed by using 2 SPSS 19.0,differences between groups were compared by using independent sample t test,ANOVA and X test. Results Compared with control group,WML in different degree groups had significantly lower scores in total MMSE and MoCA scores ,visual spatial,executive function and delayed memory ability（ all P 〈 0. 05 ）. In severe groups, the scores of MoCA individual cognitive components decreased significantly except the function of abstractions （ all P 〈 0. 05 ） ; Correlation analysis showed that the severity of WML had a negative correlations with the performance of MoCA and MMSE（r = -0. 780, -0. 817,all P 〈0. 05）. The scores of executive function and language in DWML group were lower than in PVL and control group（ all P 〈 0. 05 ）. PVL group had significantly lower scores in delayed memory and attention compared with DWML and control groups （all P 〈 0. 05 ）. In mixed regions group, the scores of MoCA individual cognitive components decreased significantly except the functions of abstractions compared with control group （ all P 〈 0. 05 ）. Conclusion The WML patients with small vessel disease undergo cognitive impairment of different degree. The more serious of WML, the more significant decline in cognitive function. PYL and DWML may have different impacts on cognitive function.
出处
《中华脑科疾病与康复杂志（电子版）》
2014年第1期21-25,共5页
Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）
