脑白质疏松症患者认知功能与海马代谢关系的研究

目的探讨脑白质疏松症患者认知损害与海马代谢间的关系。方法对108例性别、受教育程度和脑血管病危险因素相匹配且有记忆力减退主诉的患者进行神经心理学评价，通过氢质子磁共振波谱测量左侧海马区N-乙酰天冬氨酸／肌酸、肌醇／肌酸、胆碱复合物／肌酸，以及谷氨酸和谷氨酰胺复合物a峰／肌酸比值，以观察与记忆相关脑区的代谢物变化。结果脑白质疏松症组患者简易智能状态检查量表（24．00）和蒙特利尔认知评价量表（16．50）中位数评分低于对照组（27．00和21．00），组间差异有统计学意义（均P=0．000）；其中以视觉执行能力（1．00：3．00）、注意力（4．00：5．00）、语言（1．00：2．00）、延迟回忆（0．00：2．00）等项评分降低最为显著（P〈0．05或P〈0．01）。韦氏记忆量表中文修订版进一步测验显示，脑白质疏松症组患者瞬时记忆（5．06±2．86）和短时记忆（32．76±13．31）评分均显著低于对照组（7．68±4．41）和（46．95±14．81）]，且差异具有统计学意义（P〈0．05或P〈0．01）；左侧海马区N-乙酰天冬氨酸、肌醇、胆碱复合物与肌酸比值测定，两组差异无统计学意义（P〉0．05）。结论脑白质疏松症引起的认知损害主要表现为视觉执行能力、注意力、语言及记忆（瞬时记忆和短时记忆）显著降低，未发现这一改变与左侧海马代谢变化有关。

Study of the relationship between cognitive function and hippocampus metabolic changes in patients with leukoaraiosis

Objective To investigate the relationship between cognitive function and hippocampus metabolic changes measured by 1H- magnetic resonance spectroscopy （1H- MRS） in patients with leukoaraiosis. Methods One hundred and eight patients with hypomnesis were recruited. There was 54 cases in leukoaraiosis （LA） group and also 54 in non-leukoaraiosis （non-LA） group. Mini-Mental State Examination （MMSE）, Montreal Cognitive Assessment Scale （MoCA） and Weehsler Memory Scale-Chinese Revised （WMS-CR） were used for assessment. A 3.0T MR was used for STEAM 1H-MRS analysis. The value of N-acetylaspartate （NAA）, creatine and phosphoereatine （Cr）, myoinositol （mI）, choline-containing compounds （Cho） and glutamate complex-a （Glx-a） were measured in the left hippocampus. The ratio including NAA/Cr, mI/Cr, Cho/Cr and Glx-a/Cr were calculated. The differences between two groups were compared. Results Both MMSE and MoCA scores （24.00 and 16.50） in LA group were significantly lower than those in non-LA group （27.00 and 21.00） （P= 0.000）. In MoCA, the scores of LA group and non-LA group were as follow： 1.00 and 3.00 in visuospatial execution, 4.00 and 5.00 in attention, 1.00 and 2.00 in language, 0.00 and 2.00 in delayed recall （P 〈 0.05）. In WMS-CR, immediate memory scores （5.06±2.86） and short-term memory scores （32.76± 13.31） of LA group were lower than those in the non-LA group which were （7.68± 4.41） and （46.95±14.81） （P 〈 0.05）. No significant difference was shown in NAA/Cr, mI/Cr, Cho/Cr and Glx-ct/Cr ratio among two groups. Conclusion Leukoaraiosis may damage cognitive function, mainly in visual execution, attention, language and memory （especially immediate memory and short-term memory）. No metabolic change in hippoeampus via IH-MRS scan was found between LA group and non-LAgroup. No relation between these changes and left hippocampus metabolic changes was seen.