胆碱能通路损伤在脑白质病变后认知障碍中的作用

doi:10.3969/j.issn.1006-9771.2018.03.013

《中国康复理论与实践》 ›› 2018, Vol. 24 ›› Issue (3): 313-318.doi: 10.3969/j.issn.1006-9771.2018.03.013

胆碱能通路损伤在脑白质病变后认知障碍中的作用

王诗男^1,2, 贾伟丽¹, 冯丽¹, 陈红燕¹, 石庆丽¹, 李越秀¹, 张玉梅¹

1.首都医科大学附属北京天坛医院神经内科,北京市 100050;
2.河北燕达医院神经内科,河北廊坊市 065201

收稿日期:2017-11-20 修回日期:2018-02-11 出版日期:2018-03-25 发布日期:2018-03-27
通讯作者: 张玉梅。E-mail: zhangyumei5@aliyun.com
作者简介:王诗男(1985-),女,汉族,河北邢台市人,硕士,主治医师,主要研究方向：脑血管病、认知障碍。通讯作者：张玉梅,博士研究生导师。
基金资助:
1.国家自然科学基金项目(No. 81371201); 2.首都医科大学基础与临床合作重点项目(No. 16JL03); 3.北京市医院管理局临床医学发展专项经费项目(No. ZYLX201836)

Impact of Cholinergic Pathway Damage on Cognitive Impairment Caused by Cerebral White Matter Lesions

WANG Shi-nan^1,2, JIA Wei-li¹, FENG Li¹, CHEN Hong-yan¹, SHI Qing-li¹, LI Yue-xiu¹, ZHANG Yu-mei¹

1. Department of Neurology, Beijing Tiantan Hosptial, Capital Medical University, Beijing 100050, China;
2. Department of Neurology, Hebei Yanda Hosptial, Langfang, Hebei 065201, China

Received:2017-11-20 Revised:2018-02-11 Published:2018-03-25 Online:2018-03-27
Contact: ZHANG Yu-mei. E-mail: zhangyumei5@aliyun.com
Supported by:
Supported by National Natural Science Foundation of China (No. 81371201), Capital Medical University Basic and Clinical Medical Cooperation Project (Key) (No. 16JL03) and Beijing Municipal Administration of Hospitals Special Funding for Clinical Medicine Development (No. ZYLX201836)

摘要/Abstract

摘要： 目的探讨脑白质病变(WML)并发不同程度认知障碍所致的执行功能障碍与胆碱能通路损伤之间的关系。方法连续纳入2016年3月至2017年12月符合入组标准的患者115例,收集其人口学资料和血管病危险因素;经头颅MRI T₂加权筛选出WML患者80例,根据蒙特利尔认知评估(MoCA)及临床痴呆评定(CDR)结果,将WML患者分为WML伴认知正常(CN)组41例、WML伴非痴呆型血管性认知障碍(VCIND)组21例和WML伴痴呆(VaD)组18例;其余35例无WML且认知正常患者为对照组。采用胆碱能通路高信号量表(CHIPS)对患者MRI下脑白质损伤情况进行评定;采用Stroop色词干扰测验、数字连线测验、数字符号模式测验、言语流畅性测验对并发认知障碍的患者进行执行功能评定;对CHIPS评分与执行功能评分进行相关性分析。结果 4组间年龄、性别、受教育程度、血管病危险因素无显著性差异(P>0.05),MoCA和CHIPS评分有非常高度显著性差异(F>25.781, P<0.001),VaD组MoCA总分最低(P<0.01),CHIPS各项评分均最高(P<0.001)。VCIND组和VaD组全脑和左半球CHIPS评分与各项执行功能评分呈负相关(P<0.05),右半球CHIPS评分与部分执行功能评分呈负相关(P<0.05)。结论 WML并发认知障碍时,胆碱能通路损伤与执行功能下降关系密切,左侧大脑半球胆碱能通路损伤影响更为明显。

关键词: 脑白质病变, 认知障碍, 胆碱能通路, 执行功能

Abstract: Objective To investigate the relationship between cholinergic pathway damage and the executive dysfunction of patients with different degrees of cognitive impairment caused by cerebral white matter lesions (WML). Methods From March, 2016 to December, 2017, 115 patients were recruited, whose characteristics, such as age, gender, education, and history of hypertension, diabetes and stroke were recorded. According to the T₂-weighted MRI, 80 patients were defined as WML. WML patients were divided into cognitively normal (CN) group (n=41), vascular cognitive impairment of none dementia (VCIND) group (n=21) and vascular dementia (VaD) group (n=18) according to the result of Montreal Cognitive Assessment (MoCA) and Clinical Dementia Rating (CDR). Other 35 cases without WML and cognitive impairment were as control group. WML under MRI were evaluated with Cholinergic Pathways Hyperintensities Scale (CHIPS). All the WML patients were assessed with Stroop Color-Word Test, Trail Making Test, Symbol Digital Modalities Test, and Verbal Fluence Test. The correlation between the scores of CHIPS and the executive tests were analysed. Results There was no significant difference in age, gender, level of education, and cardiovascular disease risk factors among four groups (P>0.05), but there were significant differences in scores of MoCA and CHIPS (F>25.781, P<0.001), while the score of MoCA was the least (P<0.01) and the scores of CHIPS were the most in VaD group (P<0.001). The CHIPS scores of left and bilateral hemisphere negatively correlated with all the scores of executive tests (P<0.05), while that of the right hemisphere just correlated with the scores of some executive tests (P<0.05).Conclusion For cognitive impairment after WML, cholinergic pathway damage may relate with the executive function impairment, especially the damage in left cerebral hemisphere.

Key words: cerebral white matter lesion, cognitive impairment, cholinergic pathway, executive function

中图分类号:

R749.1

王诗男, 贾伟丽, 冯丽, 陈红燕, 石庆丽, 李越秀, 张玉梅. 胆碱能通路损伤在脑白质病变后认知障碍中的作用[J]. 《中国康复理论与实践》, 2018, 24(3): 313-318.

WANG Shi-nan, JIA Wei-li, FENG Li, CHEN Hong-yan, SHI Qing-li, LI Yue-xiu, ZHANG Yu-mei. Impact of Cholinergic Pathway Damage on Cognitive Impairment Caused by Cerebral White Matter Lesions[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(3): 313-318.

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胆碱能通路损伤在脑白质病变后认知障碍中的作用

Impact of Cholinergic Pathway Damage on Cognitive Impairment Caused by Cerebral White Matter Lesions

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