目的 通过脑CT灌注成像(CTP)评估脑血流灌注情况,探讨脑血流灌注与血管性认知障碍(VCI)的相关性。方法 收集2016年12月至2017年5月于中国医科大学附属第四医院神经内科住院治疗且进行脑CTP检查的缺血性脑卒中患者103例,行简易精神状态检查(MMSE)评价和画钟测试(CDT),按认知功能受损的程度分为认知功能正常组(对照组,n=43)、非痴呆性血管性认知障碍(VCIND)组(n=48)和血管性痴呆(VD)组(n=12)。分析各组CTP不同大脑部位感兴趣区的脑血流灌注特点。结果 三组糖尿病发生率有显著性差异(χ2=7.556, P=0.023),VCIND组和VD组发生率高于对照组。年龄和糖尿病病史是VCI发生的独立危险因素(OR>1, P<0.05)。三组间相比,额叶、颞叶、顶叶的局部脑血容量(CBV)有显著性差异(F>3.216, P<0.05);VD组额叶、颞叶、顶叶的CBV低于对照组(P<0.05),且VD组额叶、颞叶CBV低于VCIND组(P<0.05)。三组左侧的颞叶、顶叶和半卵圆中心的平均通过时间(MTT)和达峰时间(TTP)以及左侧枕叶的TTP有显著性差异(F>3.116, P<0.05);VD组高于对照组和VCIND组(P<0.05)。三组在局部脑血流量(CBF)及右侧脑叶的MTT和TTP方面无显著性差异(P>0.05)。额叶、顶叶及右侧颞叶的CBV与MMSE评分呈正相关(r>0.203, P<0.05)。顶叶和左侧额叶的CBV与CDT评分呈正相关(r>0.214, P<0.05)。结论 不同程度VCI均存在脑血流灌注降低,以额叶、颞叶、顶叶降低明显,且血流灌注随着认知障碍程度的进展而进一步降低,左侧半球受损早于右侧。脑CTP可为VCI的早期识别提供影像学依据。
Objective To evaluate cerebral perfusion through brain computed tomography perfusion imaging (CTP) in order to investigate the relationship between cerebral perfusion and vascular cognitive impairment (VCI).Methods A total of 103 patients with ischemic stroke were recruited, who received thrombolytic therapy and CTP test in the Fourth Affiliated Hospital of China Medical University from December, 2016 to May, 2017. The patients were divided into normal cognitive function group (control group, n=43), vascular cognitive impairment-no dementia group (VCIND group, n=48), and vascular dementia group (VD group, n=12) according to the degree of impairment in cognitive function after the assessment of Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT). The characteristics of cerebral blood flow perfusion in region of interest of brain CTP were analyzed.Results There was difference in incidence of diabetes among three groups (χ2=7.556, P<0.05). The rate of diabetes was higher in VCIND group and VD group than in the control group. Age and diabetes were the independent risk factors for VCI (OR>1, P<0.05). There was difference in cerebral blood volume (CBV) in frontal lobe, temporal lobe, and parietal lobe among three groups (F>3.216, P<0.05). CBV in frontal lobe, temporal lobe, and parietal lobe reduced in VD group than in the control group (P<0.05), while CBV in frontal lobe and temporal lobe reduced in VD group than in VCIND group (P<0.05). There was difference in mean transit time (MTT) in left temporal lobe, left parietal lobe, and centrum semiovale among three groups, while there was difference in left occipital lobe in time to peak (TTP) among three groups (F>3.116, P<0.05). MTT and TTP were higher in VD group than in the control group and VCIND group (P<0.05). There was no difference in cerebral blood flow (CBF) in both left and right brain, and MTT and TTP in right brain among three groups (P>0.05). CBV in frontal lobe, parietal lobe and right temporal lobe demonstrated positive relationship with the scores of MMSE (r>0.203, P<0.05). CBV in parietal lobe and left frontal lobe also demonstrated positive relationship with the scores of CDT (r>0.214, P<0.05).Conclusion The cerebral blood flow perfusion reduced in different levels of VCI, especially in frontal lobe, temporal lobe and parietal lobe. Cerebral blood flow perfusion reduced with the progress of cognitive impairment, and the left hemisphere injured earlier than the right one. Brain CTP may be applied in the early recognition of VCI.
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