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中华实验和临床感染病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (04) : 239 -246. doi: 10.3877/cma.j.issn.1674-1358.2022.04.004

论著

基于动脉自旋标记技术的麻痹性痴呆患者脑血流量特点及其与认知障碍相关性
吴雅丽1, 李晶晶1, 许东梅1,(), 黄宇明1, 寇程1, 崔健1   
  1. 1. 100015 北京,首都医科大学附属北京地坛医院神经内科
  • 收稿日期:2021-10-10 出版日期:2022-08-15
  • 通信作者: 许东梅
  • 基金资助:
    感染病科国家临床重点专科建设项目; 北京市医管局青苗人才计划(No. QML20181806)

Characteristics of cerebral blood flow and its correlation with cognitive impairment in patients with general paralysis of the insane evaluated by arterial spin labeling

Yali Wu1, Jingjing Li1, Dongmei Xu1,(), Yuming Huang1, Cheng Kou1, Jian Cui1   

  1. 1. Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2021-10-10 Published:2022-08-15
  • Corresponding author: Dongmei Xu
引用本文:

吴雅丽, 李晶晶, 许东梅, 黄宇明, 寇程, 崔健. 基于动脉自旋标记技术的麻痹性痴呆患者脑血流量特点及其与认知障碍相关性[J/OL]. 中华实验和临床感染病杂志(电子版), 2022, 16(04): 239-246.

Yali Wu, Jingjing Li, Dongmei Xu, Yuming Huang, Cheng Kou, Jian Cui. Characteristics of cerebral blood flow and its correlation with cognitive impairment in patients with general paralysis of the insane evaluated by arterial spin labeling[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(04): 239-246.

目的

探讨麻痹性痴呆(GPI)患者脑血流量(CBF)特点及其与认知障碍的相关性。

方法

纳入2018年1月至2019年12月于首都医科大学附属北京地坛医院就诊的GPI患者18例和健康体检者18例(健康对照组),采用蒙特利尔认知评估量表评定认知功能。采用磁共振动脉自旋标记技术扫描评估其各个脑区CBF,并进一步应用Spearman相关分析CBF异常区域与认知功能的相关性。

结果

GPI患者蒙特利尔认知评估量表评分低于健康对照组[(16.00 ± 7.19)vs. (27.90 ± 1.21):t =-7.853、P < 0.001)]。18例GPI患者中,头颅MRI正常5例,脑白质病变1例,脑萎缩9例,3例患者同时存在脑萎缩和脑白质病变。健康对照组头颅MRI均未见异常。GPI患者脑13、14、28、37、38、41、42、43、44、46、48、49、50、51、52、69、70、77、78、83、84、88、109、117、165、166、167、168、169、177、178、179、187、188、211、212、213、214、215、216、219、223、227、237和238区CBF显著高于健康对照组(P均< 0.001)。GPI患者认知障碍中的注意力障碍与脑69、70、77、78、166和168区CBF异常有一定的负相关性(r =-0.476、P = 0.046,r =-0.487、P = 0.034,r =-0.604、P = 0.008,r = -0.545、P = 0.019,r =-0.544、P = 0.02,r =-0.522、P = 0.026)。

结论

GPI患者存在全脑血流量升高。GPI患者认知功能障碍中的注意力障碍可能与局部脑区血流量升高有一定相关性。局部CBF越高,注意力障碍越严重。这可能也是GPI发病机制之一。

Objective

To investigate the characteristics and relationship between cerebral blood flow (CBF) and cognitive impairment in patients with general paralysis of the insane (GPI).

Methods

Total of 18 patients with GPI (GPI group) and eighteen healthy controls (HC group) were enrolled from January 2018 to December 2019 in Beijing Ditan Hospital, Capital Medical University. The cognitive function was assessed by montreal cognitive assessment (MoCA). The cerebral blood flow was evaluated by arterial spin labeling, and the relationship between cerebral blood flow and cognitive function was analyzed by Spearman correlation analysis.

Results

The MoCA score of patients with GPI was significantly lower than that of HC group [(16.00 ± 7.19) vs. (27.90 ± 1.21): t = -7.853, P < 0.001]. Among GPI group, 5 cases had normal brain MRI, 1 case had white matter lesions, 9 cases had brain atrophy, and 3 cases had brain atrophy and white matter lesions at the same time. No abnormality head MRI was found in HC group. The cerebral blood flow in 13, 14, 28, 37, 38, 41, 42, 43, 44, 46, 48, 49, 50, 51, 52, 69, 70, 77, 78, 83, 84, 88, 109, 117, 165, 166, 167, 168, 169, 177, 178, 179, 187, 188, 211, 212, 213, 214, 215, 216, 219, 223, 227, 237 and 238 brain regions in the patients with GPI were significantly higher than those of HC group (all P < 0.001). There were negative correlations between lack of concentration and high CBF in 69, 70, 77, 78, 166 and 168 brain regions (r = -0.476, P = 0.046; r =-0.487, P = 0.034; r =-0.604, P = 0.008; r =-0.545, P = 0.019; r =-0.544, P = 0.02; r =-0.522, P = 0.026).

Conclusions

The whole brain blood flow increased in patients with GPI. Concentration may be related to the increase of regional CBF; the higher the regional CBF, the more severe the attention disorder. This may be one of the pathogenesis of GPI.

表1 GPI组和HC组人口学和认知功能
图1 GPI患者头颅MRI注:A和B显示额叶萎缩;C、D和E显示颞叶萎缩,脑白质病变
图2 GPI患者全脑血流量变化注:红色区域显示有明显差异的脑血流量区域,主要分布在脑13、14、28、37、38、41、42、43、44、46、48、49、50、51、52、69、70、77、78、83、84、88、109、117、165、166、167、168、169、177、178、179、187、188、211、212、213、214、215、216、219、223、227、237和238区
图3 GPI组各脑区CBF和认知障碍相关性分析图
表2 GPI组和HC组患者脑血流量(ml/min)
脑区 GPI组(18例) 对照组(18例) Z P
13 9 064.07(8 491.80,9 649.99) 8 118.16 ± 970.65 -3.669 0.005
14 9 249.18(8 613.22,9 913.98) 8 165.06 ± 903.12 -4.092 0.002
28 7 837.01(7 112.80,8 479.31) 6 991.25 ± 610.35 -3.920 0.003
37 7 966.83(7 503.60,8 473.45) 7 153.81 ± 636.42 -4.188 0.002
38 7 610.16(6 976.14,8 318.86) 6 936.82 ± 659.14 -3.339 0.010
41 7 488.41(7 190.61,8 294.95) 7 239.24(6 822.68,7 638.82) -4.745 0.001
42 7 818.38(7 263.19,8 390.20) 6 871.68 ± 761.84 -4.571 0.001
43 7 310.43(6 810.81,7 981.29) 6 868.09(6 032.95,7 119.63) -4.206 0.002
44 7 730.81(7 125.79,8 298.57) 7 044.23(6 461.09,7 302.33) -3.665 0.005
46 7 115.70(6 640.70,7 711.99) 6 714.97(6 353.44,6 940.67) -3.960 0.003
48 6 381.24(6 038.39,6 908.51) 5 558.61 ± 647.00 -3.738 0.004
49 6 778.73(6 126.24,7 410.55) 6 635.09(6 208.05,6 902.18) -4.313 0.002
50 6 653.42(6 146.71,7 342.64) 5 892.41 ± 674.74 -4.091 0.002
51 7 696.34(7 098.76,8 361.64) 6 012.70(5 627.09,6 390.04) -3.944 0.003
52 7 702.64(7 352.05,8 256.19) 5 916.25(5 632.40,6 526.26) -3.870 0.003
69 6 560.87(6 103.92,6 984.77) 5 947.89 ± 382.62 -4.764 0.001
70 6 768.32(6 198.57,6 969.99) 6 278.81(5 782.17,6 519.19) -4.113 0.002
77 7 190.54(6 707.45,7 416.12) 6 388.00 ± 483.46 -4.672 0.001
78 7 075.49(6 492.42,7 504.88) 6 338.73 ± 574.58 -3.841 0.003
83 6 353.43(6 021.06,6 731.86) 5 753.99 ± 466.02 -4.027 0.003
84 6 459.30(5 951.59,6 849.84) 5 900.06 ± 452.15 -3.899 0.003
88 6 525.17(6 029.75,7 073.57) 5 940.50 ± 487.36 -3.345 0.010
109 6 174.88(5 814.81,6 637.44) 5 662.55 ± 412.83 -3.363 0.010
117 6 502.97(6 021.16,6 901.44) 5 904.05 ± 354.79 -3.869 0.003
165 7 377.04(6 866.00,7 799.82) 6 504.13 ± 589.11 -4.797 0.001
166 7 374.62(7 029.69,7 815.46) 6 629.40 ± 559.04 -4.854 0.001
167 7 870.66(7 551.22,8 343.39) 7 080.10 ± 661.57 -4.548 0.001
168 7 640.00(7 064.30,8 419.28) 6 937.51 ± 634.27 -3.948 0.003
169 7 160.47(6 936.86,7 659.08) 6 599.71 ± 375.26 -3.871 0.003
177 8 894.04(8 433.41,9 364.72) 7 742.93 ± 741.59 -4.232 0.002
178 8 698.79(8 432.49,9 251.91) 7 893.45 ± 593.80 -5.011 0.001
179 8 826.29(8 219.88,9 560.20) 7 806.88 ± 818.40 -3.411 0.009
187 7 767.30(7 340.43,8 431.02) 6 733.89 ± 823.94 -4.514 0.001
188 8 288.47(7 925.90,9 083.32) 7 478.22(7 156.59,7 810.21) -4.549 0.001
211 7 013.25(6 745.83,7 341.76) 6 409.92 ± 339.10 -5.069 0.001
212 7 047.13(6 641.97,7 286.65) 6 402.16 ± 423.55 -3.646 0.005
213 6 954.68(6 708.70,7 327.50) 6 405.41 ± 362.07 -3.993 0.003
214 7 035.00(6 681.38,7 286.42) 6 474.11 ± 404.70 -3.597 0.005
215 6 729.83(6 540.93,7 095.84) 6 288.69 ± 338.17 -4.202 0.002
216 6 730.49(6 369.07,7 030.32) 6 241.65 ± 388.33 -3.571 0.006
219 8 374.96(8 084.91,8 850.06) 7 734.34(7 377.76,8 083.10) -4.237 0.002
223 7 405.70(7 093.56,7 735.15) 6 703.02 ± 565.62 -4.093 0.002
227 9 364.50(9 006.09,9 746.76) 8 871.30(8 493.15,9 275.05) -3.616 0.005
237 7 881.82(7 563.10,8 239.13) 7 127.50 ± 711.08 -3.764 0.004
238 7 837.09(7 457.70,8 268.42) 6 963.83 ± 753.81 -3.814 0.003
表3 GPI组各脑区CBF和认知障碍相关性
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