亚急性期缺血性卒中后非痴呆认知障碍患者的弥散张量成像研究

关键词：亚急性期脑卒中  认知障碍  弥散张量成像

Keywords:subacute ischemic stroke  cognitive impairment  diffusion tensor imaging

摘要：

      摘要 目的：探讨亚急性期缺血性卒中后非痴呆认知障碍患者的认知功能和脑白质微结构变化。 方法：对30例卒中后非痴呆认知障碍(post-stroke cognitive impairment no dementia， PSCIND)患者和30例健康人进行神经心理评定和弥散张量成像(diffusion tensor imaging， DTI)检查。采用白质骨架的空间统计方法分析全脑体素、无阈值簇群增强进行组间校正(多重比较校正P<0.05)，并分析两组差异脑区DTI参数与神经心理量表评分的相关性。 结果：PSCIND组的神经心理测试评分显著低于健康人(P<0.05)，胼胝体体部、压部，双侧前、上放射冠、左丘脑后辐射、右侧外囊及双侧上纵束的各向异性分数(fractional anisotropy， FA)值低于对照组(P<0.05)，平均扩散系数(mean diffusivity， MD)、轴向扩散系数(axial diffusivity， AD)、径向扩散系数(radial diffusivity， RD)值均高于对照组(P<0.05)。偏相关显示PSCIND组放射冠、外囊、上纵束的FA值与连线测试A呈正相关(P<0.05)，MD值与之呈负相关(P<0.05)；右侧外囊、上纵束的FA值与连线测试B呈正相关(P<0.05)，左上纵束MD值与之呈负相关(P<0.05)。 结论：亚急性期PSCIND患者的神经心理测试得分、白质纤维束微结构均有改变，上纵束等纤维束损伤与执行功能存在相关，提示脑卒中后应尽早开展认知评定与康复治疗。

Abstract:

      Abstract Objective： To evaluate cognitive function and white matter microstructural characteristics of non-dementia cognitive impairment subjects following subacute ischemic stroke. Method： Thirty participants with post-stroke cognitive impairment no dementia (PSCIND) and thirty healthy controls (HC) underwent clinical and neuropsychological evaluations and structural MRI brain scans including DTI sequences. The whole-brain analysis with tract-based spatial statistics and threshold-free cluster enhancement were used to compare DTI metrics of two groups (multiple comparison correction P<0.05). The partial correlation was performed between neuropsychological evaluations scores and DTI values in PSCIND group. Result： Compared with HC，participants with PSCIND showed decreased neuropsychological evaluations scores， decreased FA and increased MD， AD， RD values in the genu of corpus callosum， body of corpus callosum， bilateral anterior corona radiata， bilateral superior corona radiata， left posterior thalamic radiation， right external capsule， bilateral superior longitudinal fasciculus. After adjustment for age， gender， education， the FA of corona radiata， external capsule， superior longitudinal fasciculus was positively related with TMT-A(P<0.05)， while the MD was negatively related with TMT-A (P<0.05). Also， the FA of right external capsule， superior longitudinal fasciculus was positively related with TMT-B(P<0.05)， while the MD of left superior longitudinal fasciculus was negatively related with TMT-B (P<0.05). Conclusion： The scores of neuropsychological evaluations are declined and abnormalities of microstructural white matter are observed in subacute PSCIND patients. In addition， the damaged superior longitudinal fasciculus is correlated with executive function. Therefore, cognitive evaluation and rehabilitation therapy should be performed as early as possible.