中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
10期
724-728
,共5页
彭万达%陈锐%蒋震%徐孝秋%王婧%李洁%刘春风
彭萬達%陳銳%蔣震%徐孝鞦%王婧%李潔%劉春風
팽만체%진예%장진%서효추%왕청%리길%류춘풍
睡眠呼吸暂停,阻塞性%海马%脑白质%认知%蒙特利尔认知评估量表
睡眠呼吸暫停,阻塞性%海馬%腦白質%認知%矇特利爾認知評估量錶
수면호흡잠정,조새성%해마%뇌백질%인지%몽특리이인지평고량표
Sleep apnea,obstructive%Hippocampus%Cerebral white matter%Cognition%Montreal Cognitive Assessment
目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者颅脑MRI显像中海马体积及脑白质的变化与认知功能之间的关系.方法 顺序纳入2012年3月至2013年8月因打鼾在苏州大学附属第二医院睡眠中心行多导睡眠图(PSG)监测的患者81例,依据睡眠呼吸暂停低通气指数(AHI)分为轻度OSAHS组(23例)、中度OSAHS组(18例)、重度OSAHS组(23例)及单纯鼾症组(17例).采用颅脑MRI常规序列及垂直于双侧海马的液体衰减反转恢复(FIAIR)序列进行成像,根据Scheltens标准及Fukudas法分别对大脑海马体积萎缩、脑白质病变相关的侧脑室周围高信号灶(PVH)的严重程度进行评分；应用蒙特利尔认知评估量表(MoCA)、简易智能状态量表(MMSE)评估认知功能变化,分析以上参数在四组患者之间的变化,以及认知功能评分与海马、脑白质结构改变及PSG参数之间的相关性.结果 随着OSAHS严重程度的加重,患者认知评分尤其是MoCA评分在组间呈下降趋势,海马体积萎缩程度及PVH评分均呈升高趋势.与单纯鼾症组比较,重度OSAHS组海马体积萎缩评分升高[(2.4±1.2)比(1.5±1.2)分,P=0.007],PVH评分升高[(3.6±1.0)比(1.6±1.5)分,P =0.000],MoCA和MMSE评分降低[(24.5±2.7)比(28.0±1.9)分,P=0.000和(27.5±1.4)比(28.7±1.3)分,P=0.013],认知功能受损主要表现在视空间与执行力、延迟记忆力等方面.海马体积萎缩、PVH评分与MoCA评分负相关(r=-0.30、-0.30,P=0.010、0.006).多元线性回归分析提示,决定MoCA评分的主要危险因素为AHI、海马体积萎缩程度(标化回归系数为:-0.386、-0.247,P=0.000、0.020).OSAHS患者海马体积萎缩、PVH评分与AHI、氧减指数(ODI)、呼吸相关微觉醒指数(RI)正相关,与最低脉氧饱和度(LSaO2)、平均脉氧饱和度(MSaO2)负相关(均P＜0.05).结论 OSAHS患者海马体积萎缩和脑白质病变与其认知功能障碍密切相关；颅脑MRI技术可为诊断OSAHS患者的认知功能障碍提供客观影像学依据.
目的 探討阻塞性睡眠呼吸暫停低通氣綜閤徵(OSAHS)患者顱腦MRI顯像中海馬體積及腦白質的變化與認知功能之間的關繫.方法 順序納入2012年3月至2013年8月因打鼾在囌州大學附屬第二醫院睡眠中心行多導睡眠圖(PSG)鑑測的患者81例,依據睡眠呼吸暫停低通氣指數(AHI)分為輕度OSAHS組(23例)、中度OSAHS組(18例)、重度OSAHS組(23例)及單純鼾癥組(17例).採用顱腦MRI常規序列及垂直于雙側海馬的液體衰減反轉恢複(FIAIR)序列進行成像,根據Scheltens標準及Fukudas法分彆對大腦海馬體積萎縮、腦白質病變相關的側腦室週圍高信號竈(PVH)的嚴重程度進行評分；應用矇特利爾認知評估量錶(MoCA)、簡易智能狀態量錶(MMSE)評估認知功能變化,分析以上參數在四組患者之間的變化,以及認知功能評分與海馬、腦白質結構改變及PSG參數之間的相關性.結果 隨著OSAHS嚴重程度的加重,患者認知評分尤其是MoCA評分在組間呈下降趨勢,海馬體積萎縮程度及PVH評分均呈升高趨勢.與單純鼾癥組比較,重度OSAHS組海馬體積萎縮評分升高[(2.4±1.2)比(1.5±1.2)分,P=0.007],PVH評分升高[(3.6±1.0)比(1.6±1.5)分,P =0.000],MoCA和MMSE評分降低[(24.5±2.7)比(28.0±1.9)分,P=0.000和(27.5±1.4)比(28.7±1.3)分,P=0.013],認知功能受損主要錶現在視空間與執行力、延遲記憶力等方麵.海馬體積萎縮、PVH評分與MoCA評分負相關(r=-0.30、-0.30,P=0.010、0.006).多元線性迴歸分析提示,決定MoCA評分的主要危險因素為AHI、海馬體積萎縮程度(標化迴歸繫數為:-0.386、-0.247,P=0.000、0.020).OSAHS患者海馬體積萎縮、PVH評分與AHI、氧減指數(ODI)、呼吸相關微覺醒指數(RI)正相關,與最低脈氧飽和度(LSaO2)、平均脈氧飽和度(MSaO2)負相關(均P＜0.05).結論 OSAHS患者海馬體積萎縮和腦白質病變與其認知功能障礙密切相關；顱腦MRI技術可為診斷OSAHS患者的認知功能障礙提供客觀影像學依據.
목적 탐토조새성수면호흡잠정저통기종합정(OSAHS)환자로뇌MRI현상중해마체적급뇌백질적변화여인지공능지간적관계.방법 순서납입2012년3월지2013년8월인타한재소주대학부속제이의원수면중심행다도수면도(PSG)감측적환자81례,의거수면호흡잠정저통기지수(AHI)분위경도OSAHS조(23례)、중도OSAHS조(18례)、중도OSAHS조(23례)급단순한증조(17례).채용로뇌MRI상규서렬급수직우쌍측해마적액체쇠감반전회복(FIAIR)서렬진행성상,근거Scheltens표준급Fukudas법분별대대뇌해마체적위축、뇌백질병변상관적측뇌실주위고신호조(PVH)적엄중정도진행평분；응용몽특리이인지평고량표(MoCA)、간역지능상태량표(MMSE)평고인지공능변화,분석이상삼수재사조환자지간적변화,이급인지공능평분여해마、뇌백질결구개변급PSG삼수지간적상관성.결과 수착OSAHS엄중정도적가중,환자인지평분우기시MoCA평분재조간정하강추세,해마체적위축정도급PVH평분균정승고추세.여단순한증조비교,중도OSAHS조해마체적위축평분승고[(2.4±1.2)비(1.5±1.2)분,P=0.007],PVH평분승고[(3.6±1.0)비(1.6±1.5)분,P =0.000],MoCA화MMSE평분강저[(24.5±2.7)비(28.0±1.9)분,P=0.000화(27.5±1.4)비(28.7±1.3)분,P=0.013],인지공능수손주요표현재시공간여집행력、연지기억력등방면.해마체적위축、PVH평분여MoCA평분부상관(r=-0.30、-0.30,P=0.010、0.006).다원선성회귀분석제시,결정MoCA평분적주요위험인소위AHI、해마체적위축정도(표화회귀계수위:-0.386、-0.247,P=0.000、0.020).OSAHS환자해마체적위축、PVH평분여AHI、양감지수(ODI)、호흡상관미각성지수(RI)정상관,여최저맥양포화도(LSaO2)、평균맥양포화도(MSaO2)부상관(균P＜0.05).결론 OSAHS환자해마체적위축화뇌백질병변여기인지공능장애밀절상관；로뇌MRI기술가위진단OSAHS환자적인지공능장애제공객관영상학의거.
Objective To explore the relationship between cognitive impairment and the changes of hippocampal structure and cerebral white matter on brain magnetic resonance imaging (MRI) in subjects with obstructive sleep apnea hypopnea (OSAHS).Methods A total of 81 snoring patients were monitored by overnight polysomnography (PSG) at Sleep Center,Second Affiliated Hospital,Soochow University from March 2012 to August 2013.Based on the results of apnea-hypopnea index (AHI),they were divided into mild (n =23),moderate (n =18),severe OSAHS (n =23) and primary snoring (n =17) groups.Periventricular hyperintensity (PVH) related to the severity of cerebral white matter lesions and hippocampal atrophy on brain MRI were evaluated according to the Fukudas method and Scheltens standard.The sequences of regular and perpendicular to bilateral hippocampal fluid attenuated inversion recovery (FIAIR) were used.Montreal cognitive assessment (MoCA) and mini-mental state examination (MMSE) were performed to evaluate the changes of cognitive function in all subjects.Results The cognitive function scores,especially MoCA,progressively decreased and the scores of hippocampal atrophy and PVH increased as the severity of OSAHS aggravated among these groups.Compared to primary snoring group,MoCA and MMSE scores decreased (24.5 ± 2.7 vs 28.0 ± 1.9,P =0.000 ; 27.5 ± 1.4 vs 28.7 ± 1.3,P =0.013) and hippocampal atrophy and PVH scores increased (2.4 ± 1.2 vs 1.5 ± 1.2,P =0.007 ; 3.6 ± 1.0 vs 1.6 ± 1.5,P =0.000) in the severe OSAHS group.The evaluations of MoCA subdomains further revealed selective reduction in visual space,execution function and delayed memory.PVH scores and hippocampal atrophy scores were negatively correlated with MoCA scores (r =-0.30,P =0.010 ; r =-0.30,P =0.006).Multiple linear regression analysis indicated that the degrees of AHI and hippocampal atrophy were the major risk factors for MoCA scores (standardized regression coefficient:-0.386,-0.247; P =0.000,0.020).The scores of hippocampal atrophy and PVH were positively correlated with AHI,oxygen reduction index (ODI) and respiratory related arousal index (RI) and negatively with minimum oxygen saturation (LSaO2) and average oxygen saturation (MSaO2) (P ＜ 0.05).Conclusions The changes of MRI in hippocampus and cerebral white matter are closely related with cognitive dysfunction.And it may become an objective indicator of assessing cognitive function in OSAHS patients.
