脑白质高信号伴认知功能障碍患者胆碱能通路损伤与皮质结构改变的关系研究

doi:10.3969/j.issn.1672-6731.2020.10.009

中国现代神经疾病杂志 ›› 2020, Vol. 20 ›› Issue (10): 893-902. doi: 10.3969/j.issn.1672-6731.2020.10.009

2 脑白质高信号伴认知功能障碍患者胆碱能通路损伤与皮质结构改变的关系研究

王诗男¹, 王金芳², 石庆丽², 李越秀¹, 陈红燕³, 张玉梅¹

1 100070 首都医科大学附属北京天坛医院康复医学科;
2 100070 首都医科大学附属北京天坛医院神经病学中心;
3 100070 首都医科大学附属北京天坛医院放射科

收稿日期:2020-09-02 出版日期:2020-10-25 发布日期:2020-10-30
通讯作者: 张玉梅,Email:zhangyumei95@aliyun.com
基金资助:
国家重点研发计划项目（项目编号：2018YFC2002302）；国家重点研发计划项目（项目编号：2018YFC1312303）；国家自然科学基金资助项目（项目编号：81972144）；国家自然科学基金资助项目（项目编号：81972148）；北京市医院管理重点医学专业发展项目（项目编号：ZYLX201836）；河北省重点研发计划项目（项目编号：172777145）；河北省医学科学研究课题（项目编号：20190148）；河北省廊坊市科学技术研究与发展计划项目（项目编号：2018013010）

Analysis the relationship of cholinergic pathway damage and cerebral cortex structure change in patients with cognitive impairment accompanied by white matter hypertensity

WANG Shi-nan¹, WANG Jin-fang², SHI Qing-li², LI Yue-xiu¹, CHEN Hong-yan³, ZHANG Yu-mei¹

1 Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China;
2 Center of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China;
3 Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received:2020-09-02 Online:2020-10-25 Published:2020-10-30
Supported by:
This study was supported by National Key Research and Development Projects (No. 2018YFC2002302, 2018YFC1312303), the National Natural Science Foundation of China (No. 81972144, 81972148), Beijing Municipal Hospital Management Key Medical Professional Development Project (No. ZYLX201836), Key Research and Development Program in Hebei Province (No. 172777145), Hebei Medical Science Research Project (No. 20190148), and Science and Technology Research and Development Program in Langfang, Hebei Province (No. 2018013010).

摘要/Abstract

摘要：

目的探讨脑白质高信号伴不同程度认知损害患者的胆碱能通路损伤与大脑皮质结构改变之间的关系。方法以2016年3月至2018年12月80例脑白质高信号患者为研究对象，根据蒙特利尔认知评价量表（MoCA）和临床痴呆评价量表（CDR）分为脑白质高信号不伴认知损害组（WMH-CN组，43例）、脑白质高信号伴非痴呆型血管性认知损害组（WMH-VCIND组，21例）和脑白质高信号伴血管性痴呆组（WMH-VaD组，16例），胆碱能通路高信号量表（CHIPS）评价胆碱能通路中白质损害程度；MRI标记胆碱能通路中34个大脑皮质兴趣区（ROI），测量层厚和体积。Spearman秩相关分析和偏相关分析探讨左侧和右侧大脑半球CHIPS总评分与同侧皮质兴趣区层厚和体积的相关性。结果（1）WMH-CN组、WMH-VCIND组和WMH-VaD组患者全脑（P=0.023）、左侧大脑半球（P=0.039）和右侧大脑半球（P=0.004）CHIPS评分差异有统计学意义，其中，WMH-VCIND组（P=0.002，0.000，0.001）和WMH-VaD组（P=0.000，0.003，0.000）3个脑区CHIPS评分均高于WMH-CN组，WMH-VaD组3个脑区CHIPS评分亦高于WMH-VCIND组（P=0.008，0.013，0.020）。（2）脑白质高信号患者与正常对照者左侧大脑半球皮质兴趣区层厚（P=0.000）和体积（P=0.000）、右侧大脑半球皮质兴趣区层厚（P=0.000）差异均有统计学意义，其中，WMH-CN组、WMH-VCIND组和WMH-VaD组左侧兴趣区层厚（均P=0.000）和体积（均P=0.000）、右侧兴趣区层厚（均P=0.000）均低于正常对照组；WMH-VaD组左侧兴趣区层厚高于WMH-CN组（P=0.000）和WMH-VCIND组（P=0.036），WMH-CN组左侧兴趣区体积高于WMH-VCIND组（P=0.033）、低于WMH-VaD组（P=0.025），WMH-VCIND组（P=0.001）和WMH-VaD组（P=0.000）右侧兴趣区层厚均高于WMH-CN组。（3）相关分析仅WMH-VCIND组患者左侧大脑半球CHIPS评分与同侧皮质兴趣区层厚呈正相关（r=0.439，P=0.047）。结论脑白质高信号伴认知功能障碍患者随着认知功能障碍的加重，左侧大脑半球胆碱能通路中34个大脑皮质兴趣区体积和层厚均有一定程度的下降，且皮质结构改变与左侧大脑半球胆碱能通路损害程度呈正相关，但上述结构改变在右侧大脑半球并不明显。

关键词: 脑白质病, 进行性多灶性, 认知障碍, 胆碱, 神经纤维, 大脑皮质, 磁共振成像

Abstract:

Objective To investigate the relationship of cholinergic pathway (CP) damage and cerebral cortex structure change in patients with different degree of cognitive impairment accompanied by white matter hyperintensity (WMH). Methods From March 2016 to December 2018, a total of 80 patients with WMH were rolled into WMH with no cognitive impairment group (WMH-CN group, n=43), WMH with vascular cognitive impairment-no dementia group (WMH-VCIND group, n=21) and WMH with vascular dementia group (WMH-VaD group, n=16), according to Montreal Cognitive Assessment (MoCA) and Clinical Dementia Rating Scale (CDR). White matter damage in CP were evaluated by Cholinergic Pathways Hyperintensities Scale (CHIPS). MRI was performed on all patients, 34 regions of interest (ROIs) in cerebral cortex CP were marked, and layer thickness and volume were measured. Spearman rank correlation analysis and partial correlation analysis were performed to explore the correlation between the total CHIPS score of left and right hemispheres and ipsilateral cortical ROIs thickness and volume. Results 1) The CHIPS scores of WMH-CN group, WMH-VCIND group and WMH-VaD group had statistically significant differences in the whole brain (P=0.023), the left hemisphere (P=0.039) and the right hemisphere (P=0.004), respectively. Among them, the CHIPS scores of WMH-VCIND group (P=0.002, 0.000, 0.001) and WMH-VaD group (P=0.000, 0.003, 0.000) were all higher than those of WMH-CN group. The CHIPS scores of three regions in WMH-VaD group were also higher than those in WMH-VCIND group (P=0.008, 0.013, 0.020). 2) The differences of the left hemisphere ROIs layer thickness (P=0.000) and volume (P=0.000), and the right hemisphere ROIs layer thickness (P=0.000) were statistically significant between WMH patients and normal controls. The left hemisphere ROIs layer thickness (P=0.000, for all) and volume (P=0.000, for all), and the right hemisphere ROIs layer thickness (P=0.000, for all) in WMH-CN group, WMH-VCIND group and WMH-VaD group were all lower than those in control group. In WMH-VaD group, the thickness of left ROIs was higher than that of WMH-CN group (P=0.000) and WMH-VCIND group (P=0.036). In WMH-CN group, the volume of left ROIs was higher than that in WMH-VCIND group (P=0.033) and lower than that in WMH-VaD group (P=0.025), and the thickness of right ROIs in WMH-VCIND group (P=0.001) and WMH-VaD group (P=0.000) were both higher than that in WMH-CN group. 3) Correlation analysis showed that only the WMH-VCIND group had a positive correlation between left hemispheric CHIPS score and ipsilateral cortical ROIs (r=0.439, P=0.047). Conclusions When WMH patients with cognitive impairment, as the degree is aggravating, the thickness and volume of 34 ROIs on left hemisphere CP have a certain degree of decline. The cerebral cortex structure change was positively associated with the degree of left hemisphere CP damage, but the structural change is not obvious in right hemisphere.

Key words: Leukoencephalopathy,progressive multifocal, Cognition disorders, Choline, Nerve fibers, Cerebral cortex, Magnetic resonance imaging

王诗男, 王金芳, 石庆丽, 李越秀, 陈红燕, 张玉梅. 脑白质高信号伴认知功能障碍患者胆碱能通路损伤与皮质结构改变的关系研究[J]. 中国现代神经疾病杂志, 2020, 20(10): 893-902.

WANG Shi-nan, WANG Jin-fang, SHI Qing-li, LI Yue-xiu, CHEN Hong-yan, ZHANG Yu-mei. Analysis the relationship of cholinergic pathway damage and cerebral cortex structure change in patients with cognitive impairment accompanied by white matter hypertensity[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(10): 893-902.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I10/893

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2 脑白质高信号伴认知功能障碍患者胆碱能通路损伤与皮质结构改变的关系研究

Analysis the relationship of cholinergic pathway damage and cerebral cortex structure change in patients with cognitive impairment accompanied by white matter hypertensity

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2 脑白质高信号伴认知功能障碍患者胆碱能通路损伤与皮质结构改变的关系研究

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