血管性痴呆与阿尔茨海默病患者海马区MRI影像学特征及与认知功能的关系

Magnetic resonance imaging features of the hippocampus in patients with vascular dementia or Alzheimer's disease and their association with cognitive function

摘要:

目的 探讨血管性痴呆（VD）与阿尔茨海默病（AD）患者海马区MRI影像学特征及与认知功能的关系。方法 选择2020年4月至2022年10月于新疆医科大学第二附属医院住院治疗的141例痴呆患者为研究对象，其中AD患者66例，VD患者75例。对比分析两组患者的临床资料、认知功能评分，比较两组患者MRI诊断结果、MRI线性测量参数，观察两组患者海马区指标差异，采用皮尔逊相关系数分析认知功能与海马区MRI影像学指标的关系。采用多元线性回归分析探讨认知功能与海马区MRI影像学指标的相关性。结果 AD患者各项认知功能评分均低于VD患者（P<0.05）。两组患者海马萎缩、脑室改变、脑出血及脱髓鞘改变比较，差异均具有统计学意义（P<0.05）。AD组患者外侧裂宽度、大脑纵裂宽度、第三脑室宽度及尾状核头间径均高于VD组患者（P<0.05）。AD组患者左右侧海马区海马高度、海马体积、杏仁核体积指标均低于VD组，颞角宽度高于VD组（P<0.05）。AD组患者海马高度、颞角宽度、岛叶厚度及杏仁核体积与认知功能呈显著正相关（P<0.05）。VD组患者海马高度、海马体积、岛叶厚度及杏仁核体积与认知功能呈显著正相关（P<0.05）。多元线性回归分析结果表明，随着简易智力状态检查量表总分增加，海马高度、海马体积、岛叶厚度及杏仁核体积也随之增加（P<0.05）。结论 VD与AD患者海马区参数可通过MRI进行评估，且海马区指标与认知功能存在密切关系。

Abstract:

Objective To investigate the association between magnetic resonance imaging （MRI） features of the hippocampus and cognitive function in patients with vascular dementia （VD） or Alzheimer's disease （AD）.Methods A total of 141 patients with dementia who were admitted to The Second Affiliated Hospital of Xinjiang Medical University from April 2020 to October 2022 were enrolled as subjects， among whom there were 66 patients with AD and 75 patients with VD. The two groups were compared in terms of clinical data， cognitive function scores， MRI diagnosis results， MRI linear measurement parameters， and related parameters of the hippocampus. The Pearson correlation coefficient was used to investigate the correlation between cognitive function and MRI parameters of the hippocampus. The multiple linear regression analysis was used to investigate the association between cognitive function and MRI parameters of the hippocampus.Results The patients with AD had significantly lower cognitive function scores than those with VD （P<0.05）. There were significant differences between the two groups in hippocampal atrophy， ventricular changes， cerebral hemorrhage， and demyelination changes （P<0.05）. Compared with the patients with VD， the patients with AD had significantly larger lateral fissure width， cerebral longitudinal fissure width， width of the third ventricle， forehead angle index， and intercephalic diameter of the caudate nucleus （P<0.05）. Compared with the patients with VD， the patients with AD had significantly lower hippocampal height， hippocampal volume， and amygdala volume and a significantly higher temporal angle width （P<0.05）. Hippocampus height， hippocampus volume， insula thickness， and amygdala volume were significantly positively correlated with cognitive function in the VD group （P<0.05）. The multiple linear regression analysis showed that hippocampus height， hippocampus volume， insula thickness， and amygdala volume increased significantly with the increase in the total score of Mini-Mental State Examination （P<0.05）.Conclusions MRI can be used to assess hippocampal parameters in patients with VD or AD， and hippocampal indicators are closely associated with cognitive function.