CAJ | 학술논문

目的明确皮质下型血管性认知障碍（ s-VCI）的影像标志物。方法92例皮质下缺血性血管病（ SIVD）患者，经神经心理检查和临床访谈，分为无认知障碍（NCI）组29例、血管性轻度认知障碍（VaMCI）组39例和血管性痴呆（VaD）组24例。登记并比较不同认知组患者的人口学、血管危险因素和影像学资料。结果三组患者在皮质下白质腔隙性梗死（ LI）数量、白质病变（WML）评分、内侧颞叶萎缩（MTA）（均P＜0.01）和皮质萎缩（CA）（P＜0.05）评分方面的差异有统计学意义。其中，VaMCI和VaD组的白质LI数目高于NCI组（分别P＜0.01和P＜0.05））；VaD组的WML程度重于VaMCI组和NCI组（均P＜0.01）；VaD组的MTA评分高于NCI组（ P＜0.01）；VaD组和VaMCI组的CA评分高于NCI组（均P＜0.05）。两个认知障碍组的WML程度、MTA评分、CA评分、皮质下白质LI数目（均P＜0.01）和所有LI总数高于NCI组（ P＜0.05）。 Logistic回归分析显示教育程度低、糖尿病、白质的LI、MTA和CA评分是s-VCI的独立危险因素。结论 s-VCI与低教育水平、糖尿病、皮质下白质损伤和皮质及内侧颞叶萎缩独立相关。
목적명학피질하형혈관성인지장애（ s-VCI）적영상표지물。방법92례피질하결혈성혈관병（ SIVD）환자，경신경심리검사화림상방담，분위무인지장애（NCI）조29례、혈관성경도인지장애（VaMCI）조39례화혈관성치태（VaD）조24례。등기병비교불동인지조환자적인구학、혈관위험인소화영상학자료。결과삼조환자재피질하백질강극성경사（ LI）수량、백질병변（WML）평분、내측섭협위축（MTA）（균P＜0.01）화피질위축（CA）（P＜0.05）평분방면적차이유통계학의의。기중，VaMCI화VaD조적백질LI수목고우NCI조（분별P＜0.01화P＜0.05））；VaD조적WML정도중우VaMCI조화NCI조（균P＜0.01）；VaD조적MTA평분고우NCI조（ P＜0.01）；VaD조화VaMCI조적CA평분고우NCI조（균P＜0.05）。량개인지장애조적WML정도、MTA평분、CA평분、피질하백질LI수목（균P＜0.01）화소유LI총수고우NCI조（ P＜0.05）。 Logistic회귀분석현시교육정도저、당뇨병、백질적LI、MTA화CA평분시s-VCI적독립위험인소。결론 s-VCI여저교육수평、당뇨병、피질하백질손상화피질급내측섭협위축독립상관。
Objective To explore the neuroimaging markers of subcortical vascular cognitive impairment ( s-VCI) . Methods Based on the detailed neuropsychological tests and clinical interview , 92 subjects with subcortical ischemic vascular disease ( SIVD ) were recruited and classified into three groups according to their cognitive state, 29 patients with no cognitive impairment (NCI), 39 patients with vascular mild cognitive impairment ( VaMCI ) , and 24 patients with vascular dementia ( VaD ) . Their demographic , vascular risk factors and neuroimaging data were compared . Results The differences between the three groups in the number of subcortical white matter lacunar infarcts ( LI) as well as the scores of the white matter lesions ( WML) , medial temporal atrophy (MTA) and cerebral atrophy (CA) were statistically significant .Pairwised analysis showed that the numbers of LI within subcortical white matter in the VaMCI ( P<0.01 ) or VaD group ( P<0.05 ) were significantly higher than that in the NCI group .The scores of WML in the VaD group were significantly higher than that in the VaMCI or NCI group ( all P<0.01 ) .The scores of MTA in the VaD group were also significantly higher than that in the NCI group ( P<0.01 ) .The scores of CA in both groups of VaMCI and VaD were significantly higher than that in the NCI group (all P<0.05).The scores of WML, MTA, and CA, as well as the numbers of LI within subcortical white matter ( all P<0.05 ) and total LI numbers ( P<0.05 ) in patients with VCI were significantly higher than that in patients with NCI .Logistic regression analysis showed that low level of education , diabetes mellitus , the numbers of LI within subcortical white matter , the scores of MTA and CA were independent risk factors for s-VCI . Conclusion s-VCI is independently related to low level of education , diabetes mellitus , subcortical white matter injuries , as well as cortical and medial temporal atrophy .