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目的对脑血管病人群MR图像上的白质高信号(WMH)进行体积定量测量的随访研究,探讨影响其发展的危险因素。方法对138例临床诊断为脑血管病的患者间隔1年先后进行2次头颅MRI检查。严格记录所有患者研究初始阶段的年龄、收缩压、血糖、血脂、烟酒嗜好以及有无高血压、糖尿病、高脂血症病史等情况,并进行了简易精神状态检查评分(MMSE)和美国国立卫生研究院卒中量表(NIH Stroke Scale,NIHSS)评分。先采用半自动体积测量软件测量患者前后2次WMH体积以及初始状态下的新近脑梗死灶体积,然后采用多元回归方法筛选对WMH的增加存在影响的危险因素,并分析临床评分、梗死灶体积与WMH增加量之间的相关性。结果初始WMH体积为(13155±18782)mm3,WMH增加量为(7687±9079)mm3。多元回归方程显示初始WMH体积、灰质梗死、白质梗死对WMH的增加有影响作用。WMH增加量与MMSE评分存在低度负相关(r=-0.266,P=0.002);WMH增加量与NIH评分存在低度正相关(r=0.257,P=0.002)。患者脑内灰白质梗死体积之和为(5080.958±12709.2136)mm3,脑梗死体积与WMH增加量存在中度正相关(r=0.416,P<0.001)。结论WMH的发生和发展不但有自身的规律,还会受到脑血管病的影响,尤其与新近脑梗死的体积关系密切。WMH的增加可能与认知功能的下降有关。
Objective To investigate the quantitative measurement of white matter hyperintensities (WMH) in MR images of patients with cerebrovascular disease and to explore the risk factors influencing their development. Methods One hundred and thirty-eight patients with clinically diagnosed cerebrovascular disease were examined twice by head MRI one year later. All patients were carefully recorded for age, systolic blood pressure, blood glucose, blood lipids, smoking and drinking habits and the presence or absence of hypertension, diabetes, hyperlipidemia history and other conditions, and the Mini-Mental State Examination Score (MMSE) and the United States NIH Stroke Scale (NIHSS) score. First, semi-automatic volume measurement software was used to measure the volumes of WMH before and after 2 times and the initial volume of infarct volume. Then multiple risk factors influencing the increase of WMH were screened by multivariate regression analysis. The clinical scores, infarct volume and WMH Increase the correlation between quantities. Results The initial volume of WMH was (13155 ± 18782) mm3 and the increase of WMH was (7687 ± 9079) mm3. Multivariate regression equations showed that the initial WMH volume, gray matter infarction, and white matter infarction had an effect on the increase of WMH. There was a low negative correlation between WMH increase and MMSE score (r = -0.266, P = 0.002). There was a low positive correlation between WMH increase and NIH score (r = 0.257, P = 0.002). There was a moderate positive correlation between infarct size and increase of WMH (r = 0.416, P <0.001) in patients with brain gray matter infarction volume (5080.958 ± 12709.2136) mm3. Conclusion The occurrence and development of WMH not only have their own laws, but also are affected by cerebrovascular disease, especially closely related to the volume of recent cerebral infarction. The increase of WMH may be related to the decline of cognitive function.