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目的探讨皮质下缺血性脑血管病(SIVD)执行功能损害、MRI脑白质病变和DTI脑白质的微结构变化及其临床相关因素。方法应用Stroop色词测验(CWT)、连线测验(TMT)和积木测试(BDT)评价24例SIVD患者和14例认知正常老年人的执行功能,其中SIVD患者分为痴呆(VD)组12例,认知障碍无痴呆(VCIND)组12例;依据年龄相关白质改变的评分方法(ARWMCrs)测量常规MRI上白质病变程度,同时应用DTI分别测定额、颞、顶、枕叶及胼胝体压部白质正常区的各向异性分数(FA)和平均扩散率(MD)值,分析各影像学测量指标与执行功能的相关性。结果 (1)与健康对照组比较,VD组执行功能三项测验均显著减退,VCIND组BDJ评分降低,TMT时间延长,差异有统计学意义(P<0.05);(2)与对照组相比较,VD、VCIND组白质病变评分增高,分别为12.820±3.573、10.500±2.953(P<0.05);胼胝体压部MD值均升高,具有统计学差异(P<0.05);VD患者双额叶、右颞叶、右枕叶、双顶叶及胼胝体压部FA值下降(P<0.05);VCIND组左额叶、双顶叶白质FA值下降(P<0.05);(3)与SIVD患者执行功能相关的影像学指标有:左额叶、双颞叶、右顶叶白质正常区FA值、胼胝体压部MD值(P<0.05)。结论 (1)SIVD患者存在执行功能障碍,与其脑白质病变程度可能有关;(2)DTI可以显示SIVD患者常规MRI无法显示的脑白质选择性微结构损害;(3)SIVD患者的多个脑白质区FA及MD与CWT、TMT和BDT存在相关性,提示白质微结构的损害可能反映执行功能的下降。
Objective To investigate the functional impairment of subcortical ischemic cerebrovascular disease (SIVD), the changes of microscopic structure of MRI white matter lesions and DTI white matter and its clinical related factors. Methods The executive function of 24 cases of SIVD and 14 cases of cognitively normal elderly were evaluated by Stroop color test (CWT), connection test (TMT) and building block test (BDT). SIVD patients were divided into dementia group (12 cases) with VCIND (cognitive impairment without dementia). The white matter lesions of conventional MRI were measured according to the age-related white matter change score (ARWMCrs), and the levels of frontal, temporal, apex, occipital lobe and corpus callosum were measured by DTI The anisotropy fraction (FA) and average diffusivity (MD) values of the normal white matter areas were analyzed, and the correlation between each measurement index and executive function was analyzed. Results (1) Compared with healthy control group, all three tests of executive function of VD group decreased significantly, BDJ score of VCIND group decreased and TMT time prolonged, the difference was statistically significant (P <0.05); (2) Compared with control group , VD, VCIND group, the white matter lesions scores were increased 12.820 ± 3.573,10.500 ± 2.953 (P <0.05); the MD value of corpus callosum body pressure were increased, with statistical significance (P <0.05); VD patients with double frontal lobe, The FA values of right temporal lobe, right occipital lobe, double parietal lobe and corpus callosum were decreased (P <0.05), and FA values of left frontal lobe and double-lobe white matter in VCIND group were decreased (P <0.05). (3) Function related imaging indicators: the left frontal lobe, bilateral temporal lobe, right parietal white matter FA normal area, corpus callosum MD value (P <0.05). Conclusions (1) SIVD patients have executive dysfunction, which may be related to the degree of leukoaraiosis. (2) DTI can show the loss of white matter-selective microstructures that SIVD patients can not show by conventional MRI. (3) The correlation of FA and MD with CWT, TMT and BDT showed that the damage of white matter microstructure might reflect the decline of executive function.