阿尔茨海默病和路易体痴呆患者脑微出血的临床特点

摘要

目的 研究阿尔茨海默病(AD)和路易体痴呆(DLB)患者脑内脑微出血(CMB)出现的频度. 方法 对156例临床诊断很可能的AD患者,67例DLB患者,认知功能正常的对照组172例进行了回顾性分析,以确定CMB存在频度.推测脑小血管疾病和脑淀粉样血管病可能与痴呆的认知下降的发展有关. 结果 对照组CMB为8.2％(14/172),DLB患者组出现CMB为22.4％(15/67),AD组19.8％(31/156),DLB和AD组均高于对照组(x2=9.182,P=0.002;x2=9.512,P=0.002),但DLB组和AD组间差异无统计学意义.DLB组的枕叶CMB密度最高,AD组则在颞叶深部或颞叶较高. 结论 CMB的出现频度在DLB和AD组与对照组比较均增高,但DLB组和AD组间差异无统计学意义,提示CMB在AD和DLB中的病理、生理机制可能类似.%Objective To investigate the frequency and location of cerebral microbleeds(CMB) in dementia with Lewy bodies(DLB)versus in Alzheimer's disease(AD).Methods This retrospective study included three groups of probable AD patients (n =156),dementia with Lewy bodies (n =67) and normal controls(n=172).Frequencies and location of CMBs in the three groups were calculated and recorded.The foci of MRI signal for CMB were confirmed by two radiologists at moments of unknowingness about diagnosis.The correlations of cerebral small vessel disease and cerebral amyloid angiopathy with the development of cognitive decline in AD were analyzed.Results The incidence rate of CMBs was higher in patients with groups of DLB(22.4 ％,15/67) and AD(19.8 ％,31/156) than in normal controls (8.2 ％,14/172) (P =0.002 and 0.002),while there was no significant difference in incidence rate of CMBs between DLB and AD groups(P＞0.05).The MRI signal intensity of CMBs was the highest in the occipital lobe of the DLB group,and was higher in the deep temporal lobe or temporal lobe in the AD group.Conclusions The frequency of CMB is higher in patients with DLB or AD than in normal controls and there is no significant difference in frequency of CMB between DLB and AD groups,which suggests that the pathophysiological mechanisms of CMB may be similar between AD and DLB.