血管性痴呆与皮质下缺血性脑梗死CT表现的相关研究

背景皮质下缺血性脑梗死在脑血管病中最为常见,但其具体的影像学表现与血管性痴呆的关系目前仍存在较大争议.目的探讨皮质下缺血性脑梗死CT表现与血管性痴呆之间的关系.设计以诊断为依据,在双肓情况下采用完全随机相互对照的横断面、回顾性病例对照研究.地点和对象研究对象为1999-10/2002-01来西安交通大学第二医院就诊的128例CT证实有皮质下多发脑梗死患者,其中女68例,男60例,年龄54-89岁.方法对比分析皮质下多发性脑梗死有痴呆和无痴呆患者的CT表现.主要观察指标皮质下脑梗死的发生部位、体积及数目;伴随脑白质疏松的程度及脑萎缩指标的测量.结果痴呆组中额叶皮质下、内囊前肢、尾状核、半卵圆中心前部、侧脑室体旁前部白质及丘脑梗死发生率、平均梗死灶数目及平均梗死体积均大于对照组(P＜0.05);3级(3.%,18/60)、4级(32%,19/60)脑白质疏松出现率显著高于对照组(15%,10/68;7%,5/68;x2=4.81,12.22,P＜0.05);脑萎缩指数测量值明显大于对照组(P＜0.05).非条件Logistic回归分析额叶皮质下及丘脑梗死灶数目、侧脑室旁前部白质梗死灶体积、脑白质疏松以及脑皮层萎缩的程度与血管性痴呆的发生显著相关.结论皮质下多发脑梗死性痴呆与梗死灶的部位、数目、体积和脑白质疏松及皮质萎缩的程度密切相关.

Correlation study on vascular dementia and CT findings of subcortical ischemic infarcts

BACKGROUND: Subcortical ischemic infarct is commonly seen in cerebral vascular disease, but the relationship between its CT findings and vascular dementia still remains controversial.OBJECTIVE: To explore the correlation of CT findings of subcortical ischemic vascular disease and vascular dementia.DESIGN: A retrospective cross-sectional trial on the basis of diagnosis.SETTING and PARTICIPANTS: Totally 128 patients confirmed by CT with subcortical multi-infarct were included from October 1999 to January 2002. Among them, 68 were female and 60 were male, aged from 54 to 89.METHOD: Comparative analysis was performed in the CT manifestations of the subcortical infarct patients with or without dementia.MAIN OUTCOME MEASURES: Locations, size and number of subcor tical infarcts, degree of leukoaraiosis (LA) and index of brain atrophy.RESULTS: Frequency, mean number and mean size of the infarcts in subcortex of lobus frontalis, anterior capsula interna, nucleus caudatus,anterior centrum semiovale, and anterior white matter around the body of ventriculus lateralis and thalamus were significantly larger in the dementia group than in the control group ( P ＜ 0. 05 ) . Leukoaraiosis (LA) of grade Ⅲ or grade Ⅳ was more common in the dementia group than in control group ( P ＜ 0.05 ). Mean width of the cerebral sulci, mean width of sulcus lateralis, index of frontal eminence and VBR in the dementia group were significantly larger than in the control group( P ＜ 0. 05). In addition, unconditioned logistic regression analysis showed that the number of infarcts in subcortex of lobus frontalis and thalamus, size of infarcts in anterior white matter around the body of ventriculus lateralis and degree of leukoaraiosis and accompanied brain atrophy were significantly correlated with vascular dementia.CONCLUSION: Subcortical multi-infarct dementia may be closely correlated with the number, location and size of infarcts as well as the degree of leukoaraiosis and brain atrophy.