脑白质疏松症患者执行功能障碍的弥散张量成像研究
뇌백질소송증환자집행공능장애적미산장량성상연구
Diffusion tensor imaging of executive dysfunction in the patients with leukoaraiosis
  • 万方数据
    中华老年医学杂志 중화노년의학잡지
    Chinese Journal of Geriatrics
    2012年 3期 200-204 ,共5页

    王双坤%袁俊亮%郝咏刚%李淑娟%胡文立%郭晓娟%刘敏%顾华%张慧博%彭朋

    왕쌍곤%원준량%학영강%리숙연%호문립%곽효연%류민%고화%장혜박%팽붕

    脑白质疏松症%认知%磁共振成像,弥散 腦白質疏鬆癥%認知%磁共振成像,瀰散
    뇌백질소송증%인지%자공진성상,미산
    Leukoaraiosis%Cognition%Diffusion magnetic resonance imaging
    目的 应用弥散张量成像(DTI)技术探讨脑白质疏松症(LA)患者脑白质微结构的改变与执行功能障碍的关系. 方法 对23例LA患者和19例健康对照进行蒙特利尔认知评估(MoCA)和4项执行功能测验包括Stroop色词干扰测验、连线测验(TMT)、数字符号测验(DST)、言语流畅性测验(VF),行DTI扫描,测量LA患者病灶区(WML)、LA患者正常表现白质区(NAWM)、对照组半卵圆中心、脑室前后部周围白质区的各向异性值(FA)、表观扩散系数(ADC)、平均扩散率(MD),并对LA组白质参数与认知功能进行相关性分析. 结果 LA患者存在明显的执行功能障碍,LA患者在Stroop色词干扰测验B、Stroop色词干扰测验C和Stroop色词干扰测验C-B、TMT-A 和TMT -B、DST行为学成绩均较对照组相应测验值差[(69.4±13.4)和(43.3±5.0),t=8.03,P＜0.05]、[(141.4±42.1)和(65.4±10.3),t=7.66,P＜0.05]、[(72.0=41.4)和(22.1±9.6),t=5.13,P＜0.05]、[(73.2±15.3)和(31.2±7.2),t=10.97,P＜0.05]、[(125.6±18.0)和(81.6±5 9),t=10.22,P＜0.05]和[(24.8=5.6)和(36.8±5.1),t=7.19,P＜0.05].WML在半卵圆中心、脑室前部和后部FA显著低于NAWM与对照组的相应区域的检验值[(0.2±0.1),(0.4±0.1)和(0.4±0.1),F=45.08,P＜0.05]、[(0 2±0.0),(0.4±0.1)和(0.4±0.1),F=70.11,P＜0.05]和[(0.3±0.1),(0.4±0.1)和(0.4±0.1),F=8.54,P＜0.05]；而WML在半卵圆中心、脑室前部和后部ADC显著高于NAWM和对照组的相应区域的检验值[(1.2±0.2),(0.8±0.1)和(0.8±0.1),F=46.77,P＜0.05]、[(1.2±0.3),(0.8±0.0)和(0.8±0 1),F=68.22,P＜0.05]和[(1.4±0.3),(0.8±0.0)和(0.9±0.1),F- 17.08,P＜0.05]；WML在半卵圆中心、脑室前部和后部MD显著高于NAWM和对照组的相应区域的检验值[(127.8±14.5),(95.3=25.4)和(100.8±9.4),F=19.72,P＜0.05]、[(127.4±16.0),(101.8±13.9)和(93.4±5.6), F=39.26, P＜0.05]和[(134.4=21.2),(114.8±14.5)和(114.4±11.7),F=10.66,P＜0.05].相关性分析得出LA患者脑室前角旁白质FA与Stroop C-B(r =-0.46,P＜0.05)、TMT-A(r=0.48,P＜0.05)和TMT-B(r=0.46,P＜0.05)呈负相关,与DST测验呈正相关(r=0.42,P＜0.05). 结论 DTI能够准确显示LA患者的特征性脑白质微结构的改变,且这种改变与执行功能密切相关.LA患者的执行功能障碍可能与前额叶皮层下环路功能受损有关.
    목적 응용미산장량성상(DTI)기술탐토뇌백질소송증(LA)환자뇌백질미결구적개변여집행공능장애적관계. 방법 대23례LA환자화19례건강대조진행몽특리이인지평고(MoCA)화4항집행공능측험포괄Stroop색사간우측험、련선측험(TMT)、수자부호측험(DST)、언어류창성측험(VF),행DTI소묘,측량LA환자병조구(WML)、LA환자정상표현백질구(NAWM)、대조조반란원중심、뇌실전후부주위백질구적각향이성치(FA)、표관확산계수(ADC)、평균확산솔(MD),병대LA조백질삼수여인지공능진행상관성분석. 결과 LA환자존재명현적집행공능장애,LA환자재Stroop색사간우측험B、Stroop색사간우측험C화Stroop색사간우측험C-B、TMT-A 화TMT -B、DST행위학성적균교대조조상응측험치차[(69.4±13.4)화(43.3±5.0),t=8.03,P＜0.05]、[(141.4±42.1)화(65.4±10.3),t=7.66,P＜0.05]、[(72.0=41.4)화(22.1±9.6),t=5.13,P＜0.05]、[(73.2±15.3)화(31.2±7.2),t=10.97,P＜0.05]、[(125.6±18.0)화(81.6±5 9),t=10.22,P＜0.05]화[(24.8=5.6)화(36.8±5.1),t=7.19,P＜0.05].WML재반란원중심、뇌실전부화후부FA현저저우NAWM여대조조적상응구역적검험치[(0.2±0.1),(0.4±0.1)화(0.4±0.1),F=45.08,P＜0.05]、[(0 2±0.0),(0.4±0.1)화(0.4±0.1),F=70.11,P＜0.05]화[(0.3±0.1),(0.4±0.1)화(0.4±0.1),F=8.54,P＜0.05]；이WML재반란원중심、뇌실전부화후부ADC현저고우NAWM화대조조적상응구역적검험치[(1.2±0.2),(0.8±0.1)화(0.8±0.1),F=46.77,P＜0.05]、[(1.2±0.3),(0.8±0.0)화(0.8±0 1),F=68.22,P＜0.05]화[(1.4±0.3),(0.8±0.0)화(0.9±0.1),F- 17.08,P＜0.05]；WML재반란원중심、뇌실전부화후부MD현저고우NAWM화대조조적상응구역적검험치[(127.8±14.5),(95.3=25.4)화(100.8±9.4),F=19.72,P＜0.05]、[(127.4±16.0),(101.8±13.9)화(93.4±5.6), F=39.26, P＜0.05]화[(134.4=21.2),(114.8±14.5)화(114.4±11.7),F=10.66,P＜0.05].상관성분석득출LA환자뇌실전각방백질FA여Stroop C-B(r =-0.46,P＜0.05)、TMT-A(r=0.48,P＜0.05)화TMT-B(r=0.46,P＜0.05)정부상관,여DST측험정정상관(r=0.42,P＜0.05). 결론 DTI능구준학현시LA환자적특정성뇌백질미결구적개변,차저충개변여집행공능밀절상관.LA환자적집행공능장애가능여전액협피층하배로공능수손유관.
    Objective To determine the relationship between characteristic damages in white matter and its executive dysfunction by magnetic resonance diffusion tensor imaging (DTI) in the patients with leukoaraiosis (LA). Methods A total of 23 patients with LA and 19 age,sex and education-matched healthy people as control were enrolled.Montreal cognitive assessment (MoCA),Stroop test,trail making test (TMT),digit-symbol test(DST),verbal fluence (VF) were applied to assess cognitive and executive functions.Fractional anisotropy (FA),apparent diffusion coefficient (ADC) and mean diffusivity (MD) in white matter lesion (WML) and normal appearing white matter (NAWM) were measured in LA group,the bilateral centrum semiovale,anterior and posterior periventricular white matter in control group were measured by DTI. The white matter DTI parameters were compared between the groups, the relationship between DTI parameters and executive function was investigated in LA group. Results In LA patients,distinct executive dysfunction were found.The scores of Stroop B [(69.4± 13.4) vs.(43.3 ± 5.0),t =8.03,P＜0.05)],Stroop C [(141.4±42.1) vs.(65.4±10.3),t=7.66,P＜0.05)]and Stroop C B[ (72.0±41.4) vs.(22.1±9.6),t=5.13,P＜0.05)],TMT-A[(73.2±15.3)vs.(31.2±7.2),t 10.97,P＜0.05) ],TMTB[(125.6±18.0) vs.(81.6±5.9),t=10.22,P＜0.05) ] andDST[ (24.8±5.6 )vs.(36.8±5.1),t=7.19,P＜0.05) ] were inferior in LA group to control group.The values of FA in centrum semiovale [(0.2±0.1) vs.(0.4±0.1) and (0.4±0.1),F =45.08,P＜0.05)],anterior periventricular white matter [(0.2±0.0) vs.(0.4±0.1) and (0.4±0.1),F =70.11,P＜0.05)] and posterior perivcntricular white matter[ (0.3±0.1) vs.(0.4±0.1) and (0.4±0.1),F=8.54,P＜0.05) ]of WML were reduced as compared with those of NAWM and control group.The values of ADC(×10- 3mm2/s) in the above three regions of WML [(1.2±0.2) vs.(0.8±0.1) and (0.8±0.1),F=46.77,P＜0.05)],[(1.2±0.3) vs.(0.8±0.0) and (0.8±0.1),F=68.22,P＜0.05)]and [(1.4±0.3) vs.(0.8±0.0) and (0.9±0.1),F=17.08,P＜0.05) ] were elevated,as compared with those of NAWM and control group,and the values of MD ( × 10-5 mm2/s) in the three regions of WML[ (127.8±14.5) vs. (95.3±26.4) and (100.8±9.4),F 19.72,P＜0.05) ],[(127.4±16.0) vs.(101.8±13.9) and (93.4±5.6),F=39.26,P＜0.05) ] and [(134.4±21.2)vs.(114.8=14.5) and (114.4±11.7),F=10.66,P＜0.05) ]were also increased,as compared with those of NAWM and control group.There was negative correlation of FA with Stroop C-B (r=-0.46,P＜0.05),TMT-A (r=-0.48,P＜0.05) and TMT-B (r=0.46,P＜0.05),while FA was positively related with DST test (r=0.42,P＜0.05) in anterior periventricular white matter.Conclusions DTI can detect the characteristic damages of white matter,which is strongly related with executive function impairments possibly induced by the damage of prefrontal-subcortical loop in the patients with LA.
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