脑皮质下缺血性血管性痴呆60例患者临床研究

目的：分析脑皮质下缺血性血管性痴呆（subcortical ischemic vascular dementia,SIVD）患者的临床特征.方法：收集60例SIVD患者和45例年龄匹配的非痴呆对照者.收集一般资料,进行全面的体格检查,实验室检查包括同型半胱氨酸（homocysteine,Hcy）、高敏感C反应蛋白（high sensitive C-reactive protein,hs-CRP）及白细胞介素-6（interleukin-6,IL-6）.所有对象进行头颅MRI扫描,记录颅内腔隙性病灶的数量,根据年龄相关白质改变（age related white matter changes,ARWMC）分级方法对侧脑室周围脑白质变性程度进行评分.应用简易智能状态检查量表（mini-mental state examination,MMSE）、蒙特利尔认知测评量表（Montreal cognitive assessment,MoCA）和画钟试验（clock drawing test,CDT）进行认知功能评估.结果：60例SIVD组中临床症状表现为步态不稳19例（31.7%）、构音障碍7例（11.7%）、饮水呛咳5例（8.3%）和尿失禁5例（8.3%）,神经系统体征为上运动神经元受损体征27例（45.0%）、共济失调8例（13.3%）和假性延髓麻痹7例（11.7%）.与对照组比较,SIVD组的危险因素是高血压（P〈0.01）、高脂血症和高血清Hcy（均P〈0.05）.SIVD组脑腔隙性病灶为216个,对照组为28个,差异有统计学意义（P〈0.05）.MMSE及MoCA量表评分两组之间差异有统计学意义（P〈0.01）.结论：（1）SIVD患者主要的临床症状为步态不稳、构音障碍、饮水呛咳和尿失禁,主要的神经系统体征为上运动神经元受损体征、共济失调和假性延髓麻痹.高血压、高血脂和高血清Hcy是SIVD的重要的危险因素.（2）MMSE和MoCA是测评SIVD较敏感的痴呆评定量表.

The clinical study of 60 patients with subcortical ischemic vascular dementia

Objective： To observe the clinical character of the patients with subcortical ischemic vascular dementia（SIVD）. Methods： Collecting 60 SIVD patients and 45 matched nondemented aging. All patients and controls received history taking, detailed clinical examination and laboratory examination, including serum levels of homocysteine（Hcy）, high sensitive Creactive protein（hs-CRP） and interleukin-6（IL-6）. All participants received cognitive handicap assessments, such as minimental state examination（MMSE）, Montreal cognitive assessment（MoCA） and clock drawing test（CDT）. Counting the amount of lacunar infarcts, assess the severity of periventricular leukoaraiosis according age related white matter changes （ARWMC） on conventional brain MRI. Results：In SIVD, the clinical symptoms are gait disorder （31.7%）, dysarthria （11.7%）, water choking（8.3%）, urinary incontinence（8.3%）, and neurological signs are upper motor neuron damage signs（45.0%）, ataxia （13.3%）, pseudobulbar palsy（10.0%）. Compared with the controls, the risks of SIVD are hypertension （P〈0.01）, hypercholes- terolemia and high serum levels of homocysteine（all P〈0.05）. MMSE and MoCA of SIVD were significant lower than that of controls（P〈0.05）. In SIVD group, the amount of lacunar infarct were significance greater then the controls（P〈0.01）. Conclusions： （1）In SIVD, the clinical symptoms are gait disorder, dysarthria, water choking, urinary incontinence, and neurological signs are upper motor neuron damage signs, ataxia, pseudobulbar palsy. The important risks of SIVD are hypertension, hypercholesterolemia and high serum levels of homocysteine. （2） Besides MMSE and MoCA are sensitive for SIVD.