中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2018, Vol. 13 ›› Issue (11): 1913-1918.doi: 10.4103/1673-5374.239441

• 原著:退行性病与再生 • 上一篇    下一篇

额叶-皮质下环路微出血可预测血管性非痴呆性认知功能障碍患者的痴呆转化

  

  • 收稿日期:2018-07-02 出版日期:2018-11-15 发布日期:2018-11-15
  • 基金资助:

    广东省医学科研基金项目（A2015160）

Microbleeds in fronto-subcortical circuits are predictive of dementia conversion in patients with vascular cognitive impairment but no dementia

Yang-Kun Chen1, Wei-Min Xiao1, Wei Li1, Zhuo-Xin Ni1, 2, Yong-Lin Liu1, Li Xu1, Jian-Feng Qu1, Chee H. Ng3, Yu-Tao Xiang4   

  1. 1 Department of Neurology, Dongguan People’s Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
    2 Faculty of Neurology, Guangdong Medical University, Zhanjiang, Guangdong Province, China
    3 Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
    4 Faculty of Health Sciences, University of Macau, Macao SAR, China
  • Received:2018-07-02 Online:2018-11-15 Published:2018-11-15
  • Contact: Wei-Min Xiao, MD,xwm1115@126.com
  • Supported by:

    This work was supported by the Medical Scientific Research Foundation of Guangdong Province, China (No. A2015160).

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摘要：

脑小血管病是血管性非痴呆性认知功能障碍的常见病因。研究显示脑小血管病的特征之一脑微出血可导致认知障碍。但是脑微出血与非痴呆性认知功能障碍的痴呆转化的关系尚不可知。作者拟分析脑微出血在脑小血管病患者从非痴呆性认知功能障碍转变为痴呆的预测作用。此次前瞻性研究在中国东莞市人民医院神经内科招募了85例确诊为非痴呆性认知功能障碍的脑小血管病患者，在入组后及1年随访时对患者进行中文版蒙特利尔认知评估量表评分以及临床痴呆评定量表评分，并进行MRI评估分析患者腔隙性梗死、白质高信号、脑微出血和内侧颞叶萎缩等变化。82例患者完成了为期1年的随访，其中24例（29%）患者被确认出现痴呆转化，这些患者存在更频繁的额叶-皮质下环路微出血。多因素Logistic回归分析显示，额叶-皮质下环路脑微出血(OR=4.4; 95% CI: 1.602-12.081, P=0.004)和额叶-皮质下环路脑微出血病灶数量在5个以上者(OR=17.6, 95%CI: 3.23-95.84, P=0.001)在1年随访中发展为痴呆的风险更高。这些提示说明额叶-皮质下环路区域中的脑微出血似乎可预测非痴呆性认知功能障碍患者发生痴呆转化的指标，这些数据显著扩大了脑微出血的临床意义。

orcid:0000-0003-0824-1442(Yang-Kun Chen)

 

关键词: 脑血管病, 卒中, 脑微出血, 认知障碍, 额叶-皮质下环路, 脑小血管病, 白质高信号, 腔隙性梗死, 磁共振成像, 皮质下缺血性血管疾病

Abstract:

Cerebral small vessel disease (CSVD) is a common etiology of vascular cognitive impairment with no dementia (V-CIND). Studies have revealed that cerebral microbleeds (CMBs), a feature of CSVD, contribute to cognitive impairment. However, the association between CMBs and dementia conversion in individuals with V-CIND is still unclear. Here, we analyzed the predictive role of CMBs in the conversion from V-CIND to dementia in CSVD patients. We recruited and prospectively assessed 85 patients with CSVD and V-CIND. V-CIND was evaluated using a series of comprehensive neuropsychological scales, including the Chinese version of the Montreal Cognitive Assessment and the Clinical Dementia Rating. MRI assessments were used to quantify lacunar infarcts, white matter hyperintensities, CMBs, and medial temporal lobe atrophy. Eighty-two of the 85 patients completed the assessment for dementia conversion at a 1-year follow-up assessment. Multivariate logistic regression analyses were conducted to examine independent clinical and MRI variables associated with dementia conversion. Twenty-four patients (29.3%) had converted to dementia at the 1-year follow-up, and these individuals had significantly more CMBs in the fronto-subcortical circuits. Multivariate logistic regression analyses revealed that the patients with CMBs in the fronto-subcortical circuits (odds ratio = 4.4; 95% confidence interval: 1.602–12.081, P = 0.004) and 5 or more CMBs overall (odds ratio = 17.6, 95% confidence interval: 3.23–95.84, P = 0.001) had a significantly increased risk of dementia at the 1-year follow-up. These findings indicate that CMBs in the fronto-subcortical circuits may be predictive of dementia conversion in CSVD patients with V-CIND, and thus extend the clinical significance of CMBs. This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800017077). Protocol version: 1.0.

Key words: cerebrovascular disease, stroke, cerebral microbleeds, cognitive impairment, fronto-subcortical circuits, small vessel disease, white matter hyperintensities, lacunar infarct, magnetic resonance imaging, subcortical ischemic vascular disease