多发性硬化患者认知功能损害与磁共振弥散张量成像相关性研究
发布时间：2018-09-02 07:27
【摘要】：多发性硬化(multiple sclerosis,MS)是中枢神经系统的脱髓鞘疾病,发病年龄高峰约为33岁,女性发病率较高,主要引起肢体无力、麻木及视觉障碍等临床症状,是导致成人残疾的常见原因[1],50%～70%的MS患者存在认知功能障碍,给对个人和社会带来沉重的负担。影响MS认知功能的因素有很多,包括年龄、病程、临床亚型及认知储备等[3],但尚不能作为明确认知障碍的预测因素。MS患者的认知功能受损主要累及记忆、信息处理速度、注意、视空间及执行等多个方面。目前,应用于MS认知功能检测的方法主要有简易重复神经心理学量表(the brief repeatable neuropsychological battery,BRB-N)及多发性硬化认知功能最小评估测验(minimal assessment of cognitive function in multiple sclerosis, MACFIMS),但国内尚无相应的版本,而且操作比较复杂,所需时间较长。因此,本研究选取针对某种功能所设计的相互独立的简易测试,对MS的认知功能障碍进行初步地分析。近年来,随着影像学的不断发展,人们对MS病理变化的认识不断加深,但在传统磁共振(conventional magnetic resonance image, cMRI)上显示的病灶往往不能很好的解释患者的临床症状。非传统MRI的应用在研究认知障碍相关的脑组织损伤上具有显著优势,如磁化传递成像(magnetization transfer imaging, MTI)、弥散张量成像(diffusion tensor imaging, DTI)、磁共振波谱分析(magnetic resonance spectroscopy, MRS)、功能磁共振成像(functional MRI, fMRI)及双翻转恢复序列(double inversion recovery, DIR)等[5],不但可以更加清晰的显示炎性脱髓鞘病灶,还可发现在cMRI上看似正常的脑组织中的隐匿性结构、代谢及功能损伤。本研究主要应用DTI来分析看似正常的脑组织是否存在微结构病变,并与认知功能进行相关性分析,探索MS患者认知功能损害的发病机理。研究目的：研究多发性硬化患者的认知功能损害及弥散张量成像特点,并分析两者的相关关系。研究方法：1.选取自2013年6月至2015年1月于我院神经内科收集的多发性硬化患者23例(MS组),另选23例健康志愿者做对照组。对两组进行认知功能测评,包括整体认知、执行、注意及信息处理速度等方面,整体认知筛查量表采用简明精神状态量表(mini-mental state examnation, MMSE)和蒙特利尔认知功能量表(montreal cognitive assessment, MoCA),其他认知功能评估量表包括词语流畅性测验(verbal fluency test, VFT)、数字广度测验(digit span test, DST)、符号数字模式测验(symbol digit modalities test, SDMT)、连线测验(trail making test, TMT)、 Stroop色词测验(color word test, CWT)。2.对23例多发性硬化患者和23例健康志愿者进行常规MRI和DTI检查,测量看似正常的脑组织(额叶白质、枕叶白质、胼胝体、尾状核及丘脑)的部分各向异性(fractional anisotropy, FA)值和表观弥散系数(apparent diffusion doefficient,ADC)值,分析脑组织的损伤情况。3.MS组MMSE、MoCA、VFI、DST、SDMT、TMT及CWT测评结果与看似正常脑组织的FA值和ADC值进行相关性分析。结果：1.MS患者整体认知功能下降,MMSE及MoCA得分低于对照组(P0.05),MS患者执行、注意及信息处理速度存在功能受损,、VFT、DST及SDMT得分低于对照组(P0.05),CWT及TMT得分高于对照组(P0.05)。MS组SDMT及CWT结果与病程存在相关性(r=-0.430及0.455, P0.05); SDMT结果与扩展的残疾状态量表(expanded disability status scale, EDSS)结果成负相关(r=-0.505,P0.05)。2.MS患者额叶及枕叶白质、胼胝体压部、尾状核的FA值较对照组降低,丘脑FA值较对照组升高(P0.05),额叶及枕叶白质、胼胝体膝部、丘脑的ADC值较对照组升高(P0.05)。3.MS组多项认知功能测验结果与脑内不同部位的FA值和ADC之间存在相关关系：VFT得分与枕叶白质的FA值呈正相关,与额叶白质的ADC值呈负相关(P0.05);Stroop-3得分与枕叶白质及胼胝体压部的FA值呈负相关,与枕叶及胼胝体膝部的ADC值呈正相关(P0.05);DST结果与枕叶白质的ADC值呈负相关(P0.05)；SDMT得分与丘脑的ADC值呈负相关(P0.05)。结论：1.MS患者认知功能存在不同程度的受损,尤其是注意、工作记忆、执行及信息处理速度损害明显,病程及EDSS对认知功能有不同程度的影响。2.MS患者看似正常的脑组织存在隐匿性损伤,FA值和ADC值可量化组织中的微小病变,与多项认知功能存在相关关系。
[Abstract]:Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. The peak age of onset is about 33 years. The incidence of MS is high in women. It mainly causes clinical symptoms such as limb weakness, numbness and visual impairment. It is a common cause of disability in adults [1]. Cognitive impairment exists in 50%-70% of MS patients, and it gives rise to cognitive impairment to individuals and society. There are many factors affecting cognitive function of MS, including age, duration, clinical subtypes and cognitive reserve, but they can not be used as a predictor of cognitive impairment. Functional testing methods mainly include the Brief Repeatable neuropsychological battery (BRB-N) and the minimal assessment of cognitive function in multiple sclerosis (MACFIMS), but there is no corresponding version in China, and the operation is complicated. In recent years, with the continuous development of imaging, people's understanding of the pathological changes of MS has been deepening, but in the traditional magnetic resonance image (cMRI) it is necessary to analyze the cognitive dysfunction of MS. Non-traditional MRI applications have significant advantages in the study of cognitive impairment-related brain tissue damage, such as magnetization transfer imaging (MTI), diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS). Cerebral spectroscopy, MRS, functional magnetic resonance imaging (fMRI) and double inversion recovery (DIR) sequences can not only display inflammatory demyelinating lesions more clearly, but also detect occult structures, metabolism and functional impairment in brain tissues that appear to be normal on cMRI. Objective: To study the characteristics of cognitive impairment and diffusion tensor imaging (DTI) in patients with multiple sclerosis (MS), and to analyze the relationship between them. Methods: 1. Choose from 20 to 20 years. From June 13, 2015 to January 2015, 23 patients with multiple sclerosis (MS group) and 23 healthy volunteers were selected as control group. Cognitive function of the two groups was assessed, including global cognition, execution, attention and speed of information processing. Mini-mental state exa was used as the global cognitive screening scale. Mnation, MMSE and Montreal Cognitive Assessment (MoCA), and other cognitive function assessment scales include verbal fluency test (VFT), digit span test (DST), Symbol Digit Modalities Test (SDMT), trail making test (TCT). St, TMT, and Stroop Color Word Test (CWT). 2. Conventional MRI and DTI were performed in 23 patients with multiple sclerosis and 23 healthy volunteers. Partial anisotropy (FA) values and apparent diffusion coefficient (apparenarenarenarenarently) of normal brain tissues (frontal white matter, occipital white matter, corpus callosum, caudate nucleus and thalamus) were measured. The correlation between the results of MMSE, MoCA, VFI, DST, SDMT, TMT and CWT in MS group and the FA and ADC values in seemingly normal brain tissues was analyzed. Results: 1. The overall cognitive function of MS patients decreased, and the scores of MMSE and MoCA were lower than those in control group (P 0.05). The scores of VFT, DST and SDMT were lower than those of the control group (P 0.05), the scores of CWT and TMT were higher than those of the control group (P 0.05). The FA values of frontal and occipital white matter, corpus callosum pressure, caudate nucleus, thalamus, frontal and occipital white matter, knee of corpus callosum and thalamus were significantly higher than those of the control group (P 0.05). 3. There was a correlation between FA values and ADC values in different parts of brain in MS group: VFT The scores of Stroop-3 were negatively correlated with the FA values of occipital white matter and corpus callosum, and positively correlated with the ADC values of occipital and corpus callosum knees (P 0.05); DST results were negatively correlated with the ADC values of occipital white matter and frontal white matter (P 0.05); SDMT scores were negatively correlated with the ADC values of thalamus and occipital white matter (P 0.05); Conclusion: 1. The cognitive function of MS patients is impaired in different degrees, especially attention, working memory, executive speed and information processing speed. The course of disease and EDSS have different degrees of influence on cognitive function. 2. The seemingly normal brain tissue of MS patients has occult damage, FA value and ADC value can quantify the micro-lesions in the tissue. It is related to multiple cognitive functions.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R744.51
本文编号：2218675
[Abstract]:Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. The peak age of onset is about 33 years. The incidence of MS is high in women. It mainly causes clinical symptoms such as limb weakness, numbness and visual impairment. It is a common cause of disability in adults [1]. Cognitive impairment exists in 50%-70% of MS patients, and it gives rise to cognitive impairment to individuals and society. There are many factors affecting cognitive function of MS, including age, duration, clinical subtypes and cognitive reserve, but they can not be used as a predictor of cognitive impairment. Functional testing methods mainly include the Brief Repeatable neuropsychological battery (BRB-N) and the minimal assessment of cognitive function in multiple sclerosis (MACFIMS), but there is no corresponding version in China, and the operation is complicated. In recent years, with the continuous development of imaging, people's understanding of the pathological changes of MS has been deepening, but in the traditional magnetic resonance image (cMRI) it is necessary to analyze the cognitive dysfunction of MS. Non-traditional MRI applications have significant advantages in the study of cognitive impairment-related brain tissue damage, such as magnetization transfer imaging (MTI), diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS). Cerebral spectroscopy, MRS, functional magnetic resonance imaging (fMRI) and double inversion recovery (DIR) sequences can not only display inflammatory demyelinating lesions more clearly, but also detect occult structures, metabolism and functional impairment in brain tissues that appear to be normal on cMRI. Objective: To study the characteristics of cognitive impairment and diffusion tensor imaging (DTI) in patients with multiple sclerosis (MS), and to analyze the relationship between them. Methods: 1. Choose from 20 to 20 years. From June 13, 2015 to January 2015, 23 patients with multiple sclerosis (MS group) and 23 healthy volunteers were selected as control group. Cognitive function of the two groups was assessed, including global cognition, execution, attention and speed of information processing. Mini-mental state exa was used as the global cognitive screening scale. Mnation, MMSE and Montreal Cognitive Assessment (MoCA), and other cognitive function assessment scales include verbal fluency test (VFT), digit span test (DST), Symbol Digit Modalities Test (SDMT), trail making test (TCT). St, TMT, and Stroop Color Word Test (CWT). 2. Conventional MRI and DTI were performed in 23 patients with multiple sclerosis and 23 healthy volunteers. Partial anisotropy (FA) values and apparent diffusion coefficient (apparenarenarenarenarently) of normal brain tissues (frontal white matter, occipital white matter, corpus callosum, caudate nucleus and thalamus) were measured. The correlation between the results of MMSE, MoCA, VFI, DST, SDMT, TMT and CWT in MS group and the FA and ADC values in seemingly normal brain tissues was analyzed. Results: 1. The overall cognitive function of MS patients decreased, and the scores of MMSE and MoCA were lower than those in control group (P 0.05). The scores of VFT, DST and SDMT were lower than those of the control group (P 0.05), the scores of CWT and TMT were higher than those of the control group (P 0.05). The FA values of frontal and occipital white matter, corpus callosum pressure, caudate nucleus, thalamus, frontal and occipital white matter, knee of corpus callosum and thalamus were significantly higher than those of the control group (P 0.05). 3. There was a correlation between FA values and ADC values in different parts of brain in MS group: VFT The scores of Stroop-3 were negatively correlated with the FA values of occipital white matter and corpus callosum, and positively correlated with the ADC values of occipital and corpus callosum knees (P 0.05); DST results were negatively correlated with the ADC values of occipital white matter and frontal white matter (P 0.05); SDMT scores were negatively correlated with the ADC values of thalamus and occipital white matter (P 0.05); Conclusion: 1. The cognitive function of MS patients is impaired in different degrees, especially attention, working memory, executive speed and information processing speed. The course of disease and EDSS have different degrees of influence on cognitive function. 2. The seemingly normal brain tissue of MS patients has occult damage, FA value and ADC value can quantify the micro-lesions in the tissue. It is related to multiple cognitive functions.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R744.51
【参考文献】
相关期刊论文 前1条
1 段云云;李坤成;刘亚欧;任卓琼;黄靖;叶静;董会卿;陈海;;复发-缓解型多发性硬化患者丘脑扩散张量成像研究[J];中国现代神经疾病杂志;2012年02期
，本文编号：2218675
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