摘要目的:探讨脑灌注与脑白质高信号（white matter hyperintensities, WMHs）患者认知功能的相关性。方法:纳入2022年9月至2023年9月期间徐州医科大学第二附属医院神经内科因"记忆下降"就诊且头颅MRI检出WMHs的患者，根据Fazekas量表分为轻度WMHs组（1~2分）和中重度WMHs组（3~6分）。利用三维伪连续动脉自旋标记（three-dimensional pseudo-continuous arterial spin labeling, 3D-pCASL）灌注成像技术测定全脑及局部脑血流量（cerebral blood flow, CBF）。采用蒙特利尔认知评估量表（Montreal Congnitive Assessment, MoCA）评估整体认知功能，中文听觉词汇学习测验（Chinese Auditory Verbal Learning Test, CAVLT）评估记忆功能，符号数字转换测验（Symbol Digit Modalities Test, SDMT）评估注意功能，数字颜色连线测试（Color Trail Test, CTT）评估执行功能，动物流畅性测验（Animals Fluency Test, AFT）和波士顿命名测验中文版15项（Boston Naming Test-15, BNT-15）评估语言功能，汉密尔顿焦虑量表（Hamilton Anxiety Scale, HAMA）和汉密尔顿抑郁量表（Hamilton Depression Scale, HAMD）评估情绪状态，神经精神科问卷知情者版（Neuropsychiatric Inventory Questionnaire, NPI-Q）评估精神行为，功能活动问卷（Functional Activity Questionnaire, FAQ）评估日常生活能力。应用多元线性回归分析确定脑灌注与WMHs患者认知功能的相关性。结果:总共纳入44例WMHs患者，男性21例（47.7%），年龄（65.84±7.56）岁；轻度WMHs组16例（36.4%），中重度WMHs组28例（63.6%）；MoCA评分（20.68±4.71）分，38例（86.4%）存在认知损害。与轻度WMHs组比较，中重度WMHs组高血压和饮酒的患者构成比显著更高，左侧全脑灌注CBF显著较低，CTT-1和CTT-2完成时间显著延长（ P均<0.05）。多元线性回归分析显示，WMHs患者MoCA得分与左侧杏仁核CBF呈正相关（ r=0.296； P=0.039），SDMT得分与左侧枕叶CBF呈正相关（ r=0.356； P=0.018），CTT-1完成时间与左侧杏仁核CBF呈负相关（ r=-0.404； P=0.003），CTT-2完成时间与左侧颞中回CBF呈负相关（ r=-0.473； P=0.001），HAMD得分与右侧顶叶CBF呈正相关（ r=0.413； P=0.005），FAQ得分与右侧海马旁回CBF呈正相关（ r=0.391； P=0.009）。 结论:WMHs患者脑灌注变化与认知功能之间关系密切，整体认知功能与左侧杏仁核灌注量呈正相关，注意功能与左侧枕叶灌注量呈正相关，执行功能与左侧杏仁核及左侧颞中回灌注量呈正相关，抑郁情绪与右侧顶叶灌注量呈负相关，日常生活能力与右侧海马旁回灌注量呈负相关。

abstractsObjective:To investigate the association of cerebral perfusion with cognitive function in patients with white matter hyperintensities (WMHs).Methods:Patients visited the Department of Neurology, the Second Affiliated Hospital of Xuzhou Medical University due to "memory decline" and had WMHs detected on their head MRI from September 2022 to September 2023 were included. They were divided into mild WMHs group (1-2 points) and moderate-to-severe WMHs group (3-6 points) according to the Fazekas scale. The three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL) perfusion imaging technology was used to measure the global and local cerebral blood flow (CBF). The Montreal Cognitive Assessment (MoCA) was used to evaluate overall cognitive function, the Chinese Auditory Verbal Learning Test (CAVLT) was used to evaluate the memory function, the Symbol Digit Modalities Test (SDMT) was used to evaluate the attention function, the Color Trail Test (CTT) was used to evaluate the executive function, the Animal Fluency Test (AFT) and the Boston Naming Test-15 (BNT-15) were used to evaluate the language function, the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to assess the emotional status, the Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to assess the mental behavior, and the Functional Activity Questionnaire (FAQ) was used to assess the daily living ability. Multiple linear regression analysis was used to determine the association of cerebral perfusion with cognitive function in patients with WMHs.Results:A total of 44 patients with WMHs were enrolled, including 21 males (47.7%) with an age of 65.84±7.56 years. There were 16 patients (36.4%) in the mild WMHs group and 28 (63.6%) in the moderate-to-severe WMHs group. The MoCA score was 20.68±4.71, and 38 patients (86.4%) had cognitive impairment. Compared with the mild WMHs group, the proportion of patients with hypertension and alcohol consumption in the moderate-to-severe WMHs group was significantly higher, with significantly lower CBF in the left whole brain perfusion, and significantly longer completion times for CTT-1 and CTT-2 (all P<0.05). Multiple linear regression analysis showed that the MoCA score in patients with WMHs was positively correlated with the left amygdala CBF ( r=0.296; P=0.039), SDMT score was positively correlated with the left occipital CBF ( r=0.356; P=0.018), CTT-1 completion time was negatively correlated with the left amygdala CBF ( r=-0.404; P=0.003), CTT-2 completion time was negatively correlated with the left middle temporal gyrus CBF ( r=-0.473; P=0.001), HAMD score was positively correlated with the right parietal lobe CBF ( r=0.413; P=0.005), and the FAQ score was positively correlated with CBF in the right parahippocampal gyrus ( r=0.391; P=0.009). Conclusions:There is a close relationship between changes in cerebral perfusion and cognitive function in patients with WMHs. Overall cognitive function is positively correlated with the left amygdala perfusion, attention function is positively correlated with the left occipital lobe perfusion, executive function is positively correlated with the left amygdala and left middle temporal gyrus perfusion, depression mood is negatively correlated with the right parietal lobe perfusion, and daily living ability is negatively correlated with the right parahippocampal gyrus perfusion.