阿尔茨海默病和帕金森病扩大的血管周围间隙分布特点

目的 探讨阿尔兹海默病、帕金森病及高血压病患者扩大的脑内血管周围间隙（EPVS）分布特点及其临床意义。方法 纳入从2012年1月起就诊于中国医科大学附属盛京医院神经内科的阿尔兹海默病（AD组）、帕金森病（PD组）患者各100例，同时纳入年龄、性别基本匹配且无以上疾病的高血压（HBP组）患者100例、健康中老年人（N组）100例。所有受试者均经3.0 T头部磁共振成像检查，通过观察半卵圆中心区、基底节区以及海马区这三个层面的T2WI和FLAIR的成像表现，比较4组受试者EPVS数量和分布特点，分析EPVS数目与年龄之间的关系以及AD组MMSE评分与EPVS数量之间的关系。结果 4组受试者无论是在半卵圆中心区还是基底节区，EPVS均存在解剖学分布差异（P<0.001）。4个组间的EPVS数目差异具有统计学意义（P<0.001），AD组、HBP组、PD组均高于N组。在半卵圆中心区，AD组的EPVS数目（11.23）高于其他3组（HBP=8.97、PD=7.88、N=3.00）。在基底节区，HBP组的EPVS数目（7.21）高于其他3组（PD=5.85、AD=4.87、N=2.95）。在海马区，AD组、HBP组、PD组之间的EPVS数目无显著性差异。进一步计算半卵圆中心区的EPVS占全部脑区EPVS数目的比值发现，AD组的EPVS百分比（69.41%）高于其他3组（HBP=54.75%、PD=57.49%、N=46.35%），AD组与HBP组的百分比差异具有统计学意义（P<0.001）。Spearman相关分析发现，AD组、HBP组、PD组的EPVS数目与年龄呈正相关（r_s=0.34、0.41、0.49，P<0.01），而与N组无相关性。AD组半卵圆中心区的EPVS数目与MMSE评分之间呈负相关（r_s=-0.251，P<0.05），在基底节区两者之间无相关性。结论 AD组的EPVS分布以半卵圆中心为主，HBP组的EPVS分布以基底节区为主，PD组的EPVS未发现脑区间分布差异的特点。AD、HBP、PD组患者的EPVS数目随年龄增长而增多。AD组患者半卵圆中心区层面的EPVS数目越多，认知功能障碍越严重。EPVS数目可能对评估认知障碍程度有重要价值。

A study of distribution characteristics of enlarged perivascular spaces in Alzheimer's disease and Parkinson's disease

Objective To investigate the distribution characteristics of enlarged perivascular spaces (EPVS) in patients with Alzheimer''s disease (AD), Parkinson''s disease (PD), and high blood pressure (HBP) and their clinical significance, and to deepen the radiological understanding of this common cerebral small vessel disease.Methods A retrospective study was performed on equal numbers (n=100) of age-and gender-matched patients with AD, PD, and HBP who were admitted to our hospital from January 2012. An equal number of healthy middle-aged and elderly volunteers were used as control (N). All the subjects received 3.0-T magnetic resonance imaging of the brain. Based on the T2-weighted and fluid attenuation inversion recovery images in the centrum semiovale (CSO), basal ganglia (BG), and hippocampus (HC), the number and distribution characteristics of EPVS were compared between the four groups. The correlation of EPVS number with age in all patients and the mini-mental state examination (MMSE) score in AD patients was analyzed.Results There were significant differences in anatomical distribution of EPVS in the CSO and BG between the four groups (all P<0.001). The AD, HBP, and PD groups had significantly larger numbers of EPVS than the control group (all P<0.001). In the CSO, the AD group had a substantially larger number of EPVS than the other three groups (AD=11.23, HBP=8.97, PD=7.88, N=3.00). In the BG, the HBP group had a substantially higher number of EPVS than the other three groups (HBP=7.21, PD=5.85, AD=4.87, N=2.95). In the HC, there was no significant difference in the number of EPVS between the AD, HBP, and PD groups. The percentage of CSO-EPVS in the whole brain was substantially higher in the AD group than the other three groups (AD=69.41%, HBP=54.75%, PD=57.49%, N=46.35%). Particularly, the AD group had a significantly higher percentage of CSO-EPVS than the HBP group (P<0.001). According to the results of Spearman correlation analysis, the EPVS number was positively correlated with age in the AD, HBP, and PD groups (r_s=0.34, 0.41, 0.49, all P<0.01), while there was no such correlation in the control group. In the AD group, the EPVS number was negatively correlated with the MMSE score in the CSO (r_s=-0.251, P<0.05), while there was no such correlation in the BG.Conclusions EPVS in AD and HBP patients are mainly located in the CSO and BG, respectively, while there is no regional distribution for EPVS in PD patients. The number of EPVS increases with age in AD, HBP, and PD patients. In AD patients, the more EPVS in the CSO, the worse cognitive function. The EPVS number may be of great value in predicting the degree of cognitive impairment.