ERP联合DTI对脑小血管病相关认知功能障碍的初步研究

目的 探讨事件相关诱发电位(Event-related potential,ERP)联合弥散张量成像(Diffusion tensor imaging,DTI)在脑小血管病(Cerebral small vessel disease,CSVD)相关认知功能障碍评估中的应用价值。方法 选取2020年1月-2021年1月本院收治的CSVD患者100例,采用蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)对患者的认知功能进行评估,根据MoCA评分将患者分为认知功能障碍组(MoCA<26分,n=50)和对照组(MoCA≥26分,n=50); 所有患者均接受ERP和DTI检查,比较2组患者的一般资料、实验室指标水平、ERP和DTI相关参数水平的差异,评估ERP,DTI及其联合检测对CSVD相关认知功能障碍的诊断价值。结果 认知功能障碍组的高血压病的发生率明显高于对照组,MoCA、简易精神状态量表(Mini-mental state examination,MMSE)评分明显低于对照组,血清碱性磷酸酶(Alkaline phosphatase,ALP)、同型半胱氨酸水平明显高于对照组(P<0.05)。认知功能障碍组患者的P300潜伏期明显长于对照组,P300波幅明显小于对照组(P<0.05); 认知功能障碍组双侧半卵圆中心、双侧额叶、胼胝体膝部和胼胝体压部的各向异性分数(Fractional anisotropy,FA)值均明显小于对照组(P<0.05),双侧半卵圆中心、双侧额叶的平均弥散率(Mean diffusivity,MD)值明显大于对照组(P<0.05); 患者P300潜伏期、双侧半卵圆中心、双侧额叶、胼胝体膝部和胼胝体压部的FA值与MoCA,MMSE评分呈正相关(r≥0.203,P<0.05); P300波幅、双侧半卵圆中心、双侧额叶的MD值与MoCA,MMSE评分呈负相关(r≤-0.038,P<0.05); 患者双侧额叶FA值与P300潜伏期呈负相关(r=-0.274、-0.318,P<0.05),与P300波幅呈正相关(r=0.248、0.256,P<0.05); 双侧额叶MD值与P300潜伏期呈正相关(r=0.213、0.207,P<0.05),与P300波幅呈负相关(r=-0.327、-0.318,P<0.05)。结论 CSVD患者认知功能障碍的发生与脑微结构病变及电生理改变有关,ERP联合DTI检查或可作为CSVD相关认知功能障碍早期诊断的定量评估指标。

Preliminary study of ERP combined with DTI in the assessment of cognitive dysfunction related to cerebral small vessel disease

Objective To explore the application evaluation of event-related potential(ERP)combined with diffusion tensor imaging(DTI)in the assessment of cognitive dysfunction related to cerebral small vessel disease(CSVD).Methods One hundred patients with CSVD admitted to the hospital from January 2020 to January 2021 were selected. The Montreal Cognitive Assessment Scale(MoCA)was used to evaluate the patients’ cognitive function. According to the MoCA score, the patients were divided into dysfunction group(MoCA score<26, n=50)and control group(MoCA≥26, n=50). All patients were examined by ERP and DTI. General clinical data, laboratory indicators, ERP, DTI and related parameters of these two groups were compared. Value of ERP, DTI and their combined detection for CSVD related cognitive dysfunction was evaluated.Results The percentage of hypertension in the dysfunction group was significantly higher than that in the control group. The MoCA and Mini-Mental State Examination(MMSE)scores in the dysfunction group were significantly lower than those in the control group. Serum alkaline phosphatase(ALP)and homocysteine levels were significantly higher in the dysfunction groupthan those in the control group(P<0.05). The peak latency of P300 in the dysfunction group was significantly longer than that of the control group, while in the dysfunction groupthe amplitude of P300 was significantly smallcompared with control group(P<0.05). The fractional anisotropy(FA)values of bilateral centrum semiovale, bilateral frontal lobes, genu and splenium of corpus callosum in the dysfunction group were significantly smaller than those in the control group(P<0.05), while the mean diffusivity(MD)values of bilateral centrum semiovale and bilateral frontal lobesin the dysfunction group were significantly larger than those in the control group(P<0.05). The P300 latency, FA values of bilateral centrum semiovale, bilateral frontal lobes, genu and splenium of corpus callosum were positively correlated with MoCA and MMSE scores(r≥0.203, P<0.05). P300 amplitude, MD values of bilateral centrum semiovale and bilateral frontal lobes were negatively correlated withMoCA and MMSE scores(r≤-0.038, P<0.05). The FA valuesof bilateral frontal lobes were negatively correlated with P300 latency(r=-0.274, -0.318, P<0.05)and positively correlated with P300 amplitude(r=0.248, 0.256, P<0.05). The MD valuesof bilateral frontal lobes were positively correlated with P300 latency(r=0.213, 0.207, P<0.05)and negatively correlated with P300 amplitude(r=-0.327, -0.318, P<0.05).Conclusion The occurrence of cognitive dysfunction in patients with CSVD was related to brain microstructure lesions and electrophysiological changes. ERP combined with DTI may be used as a quantitative method for early diagnosis of CSVDrelated cognitive dysfunction.