中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2019, Vol. 14 ›› Issue (5): 858-867.doi: 10.4103/1673-5374.249234

• 原著:退行性病与再生 • 上一篇    下一篇

血管性认知障碍微观结构损伤模式：烟雾病与脑血管动脉粥样硬化的比较

  

  • 出版日期:2019-05-15 发布日期:2019-05-15
  • 基金资助:

    中国国家自然科学基金项目(81771237)；国家重点基础研究发展计划（973计划）(2014CB541604)；上海市教委与上海市教育发展基金联合曙光项目(16SG02)；复旦大学华山医院(2016QD082)

Microstructural damage pattern of vascular cognitive impairment: a comparison between moyamoya disease and cerebrovascular atherosclerotic disease

Jia-Bin Su 1 , Si-Da Xi 2 , Shu-Yi Zhou 3 , Xin Zhang 1 , Shen-Hong Jiang 1 , Bin Xu 1 , Liang Chen 1 , Yu Lei 1 , Chao Gao 1 , Yu-Xiang Gu 1   

  1. 1 Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
    2 Shanghai Medical College, Fudan University, Shanghai, China
    3 Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
  • Online:2019-05-15 Published:2019-05-15
  • Contact: Chao Gao, MD, thunderstormer@126.com; Yu Lei, MD, piliyouxia_lei@126.com.
  • Supported by:

    This study was supported by the National Natural Science Foundation of China, No. 81771237 (to YXG); the National Key Basic Research Program of China (973 Program), No. 2014CB541604 (to YXG); the “Shu Guang” Project of Shanghai Municipal Education Commission and Shanghai Education Development Foundation, China, No. 16SG02 (to LC); the Scientific Research Project of Huashan Hospital of Fudan University of China, No. 2016QD082 (to YL).

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摘要：

烟雾病与脑血管动脉粥样硬化均属于慢性缺血性疾病，患者存在相似的血管性认知障碍表现，但脑影响的微观变化是否有区别呢？试验设计在复旦大学附属华山医院招募了34例烟雾病患者(43.9±9.2岁，男20例，女14例)和27例脑血管动脉粥样硬化患者(44.6±7.6岁，男17例，女10例)以及31例健康对照者(43.6±7.3岁，男18例，女13例)，以简易智力状态检查量表、听觉词语学习测试、连线测验B和符号-数字模式测验评估认知功能，以单光子发射计算机断层扫描检查脑灌注情况，然后进行基于体素的形态测量和基于Tract的空间统计，以确定患者和健康对照者的灰质萎缩和白质恶化情况。结果显示(1)烟雾病与脑血管动脉粥样硬化患者的认知障碍严重程度接近，且均存在不明原因的幕上血流动力学异常；(2)双侧中扣带皮质和额叶皮质均出现明显的灰质萎缩，且烟雾病患者的灰质萎缩情况更为弥漫和严重；(3)烟雾病与脑血管动脉粥样硬化患者胼胝体膝部和体部、前辐射冠、上辐射冠以及丘脑后辐射均出现明显的白质退化，且烟雾病患者白质退化的情况更为严重；(4)结果表明，血管性认知障碍存在特异性微观结构损伤部位，且其灰质和白质损伤可能存在联系；(5)试验结果对深入了解血管性认知障碍的病理生理学特征有所帮助。试验已2014-12-2在ClinicalTrials.gov注册，注册号NCT02305407，版本号为1.0。

orcid: 0000-0003-2245-0582 (Jia-Bin Su)

关键词: 血管性认知障碍, 烟雾病, 脑血管动脉粥样硬化, 磁共振成像, 扩散张量成像, 灰质体积, 基于体素的形态测量, 单光子发射计算机断层扫描, 神经再生

Abstract:

Moyamoya disease and cerebrovascular atherosclerotic disease are both chronic ischemic diseases with similar presentations of vascular cognitive impairment. The aim of the present study was to investigate the patterns of microstructural damage associated with vascular cog¬nitive impairment in the two diseases. The study recruited 34 patients with moyamoya disease (age 43.9 ± 9.2 years; 20 men and 14 women, 27 patients with cerebrovascular atherosclerotic disease (age: 44.6 ± 7.6 years; 17 men and 10 women), and 31 normal controls (age 43.6 ± 7.3 years; 18 men and 13 women) from Huashan Hospital of Fudan University in China. Cognitive function was assessed using the Mini-Mental State Examination, long-term delayed recall of Auditory Verbal Learning Test, Trail Making Test Part B, and the Symbol Digit Modalities Test. Single-photon emission-computed tomography was used to examine cerebral perfusion. Voxel-based morphometry and tract-based spatial statistics were performed to identify regions of gray matter atrophy and white matter deterioration in patients and normal controls. The results demonstrated that (1) the severity of cognitive impairment was similar between the two diseases in all tested domains. Patients with moyamoya disease and those with cerebrovascular atherosclerotic disease suffered from disturbed supratentorial hemodynamics. (2) Gray matter atrophy in bilateral middle cingulate cortex and parts of the frontal gyrus was prominent in both diseases, but in general, was more severe and more diffuse in those with moyamoya disease. (3) White matter deterioration was significant for both diseases in the genu and body of corpus callosum, in the anterior and superior corona radiation, and in the posterior thalamic radiation, but in moyamoya dis¬ease, it was more diffuse and more severe. (4) Vascular cognitive impairment was associated with regional microstructural damage, with a potential link between, gray and white matter damage. Overall, these results provide insight into the pathophysiological nature of vascular cognitive impairment. This study was approved by the Institutional Review Board in Huashan Hospital, China (approval No. 2014-278). This study was registered with ClinicalTrials.gov on December 2, 2014 with the identifier NCT02305407.

Key words: nerve regeneration, vascular cognitive impairment, moyamoya disease, cerebrovascular atherosclerotic disease, magnetic resonance imaging, diffusion tensor imaging, gray matter volume, tract-based spatial statistics, single-photon emission computed tomography, neural regeneration