脑小血管病相关认知障碍患者ERP-P300与静息态fNIRS特征及其与脑白质病变的相关性

Characteristics of ERP-P300 and Resting-State fNIRS in Patients with Cerebral Small Vessel Disease-related Cognitive Impairment and Their Correlation with White Matter Lesions

中文关键词:  【】:脑小血管病  认知障碍  功能性近红外光谱  事件相关电位

英文关键词:cerebral small vessel disease  cognitive impairment  functional near-infrared spectroscopy  event-related potential

中文摘要:

      背景 脑小血管病（CSVD）在中老年人群中的患病率、致残率、死亡率较高，给社会和家庭带来巨大负担。在脑小血管病的诸多临床表现中，认知障碍是其最常见的临床表现，亦是最核心、最具致残性，且与精神医学实践关联最为密切的神经精神综合征。既往针对脑小血管病伴认知障碍的研究多集中在影像学，无创电生理及脑血流的研究较少。目的 明确脑小血管病伴认知障碍（CSVD-CI）患者事件相关电位（ERP）及功能性近红外光谱（fNIRS）的特征，了解其与脑白质病变严重程度的相关性，为脑小血管病相关认知损害的早期识别与客观评估提供参考。方法 选取2024年12月—2025年12月川北医学院附属医院收治的40例符合《中国脑小血管病诊治指南2021版》诊断标准且伴有认知障碍的CSVD-CI患者为病例组，同期招募性别、年龄、受教育程度匹配的40名健康志愿者为对照组。两组均接受简易精神状态检查（MMSE）评定、事件相关电位P300（ERP-P300）检测及静息态功能性近红外光谱（fNIRS）检测。比较两组ERP-P300指标、fNIRS全脑及认知相关感兴趣区（ROI）功能连接强度的差异，因Fazekas脑白质病变分级属于有序分类变量，P300潜伏期、fNIRS脑区功能连接强度不满足正态分布前提，采用Spearman秩相关检验，分别探究Fazekas分级与ERP-P300潜伏期、fNIRS 功能连接强度的相关性。结果 CSVD-CI组与对照组性别构成、年龄受教育年限比较，差异均无统计学意义（均P＞0.05），CSVD-CI组MMSE评分低于对照组（Z=-6.250，P<0.01），ERP-P300潜伏期长于对照组（t=12.291，P<0.01），差异有统计学意义。两组ERP-P300波幅比较，差异无统计学意义（P＞0.05）。不同Fazekas分级的CSVD-CI患者MMSE评分及P300潜伏期比较，Ⅰ级亚组MMSE评分高于Ⅱ-Ⅲ级亚组（Z=-2.420，P<0.05），P300潜伏期低于Ⅱ-Ⅲ级亚组（Z=-4.210，P<0.01），差异均有统计学意义。CSVD-CI组与对照组静息态全脑功能连接强度分别为（0.294±0.122）、（0.616±0.157）。与对照组相比，CSVD-CI组全脑功能连接强度差异有统计学意义（t=10.243，P<0.05）。与对照组相比，CSVD-CI组左侧PMC、右侧PMC、左侧FPC、右侧FPC、左侧DLPFC、右侧DLPFC、左侧OFC和右侧OFC区域内的功能连接强度差异均有统计学意义（P<0.05，FDR校正）。与对照组相比，CSVD-CI组在多个前额叶相关脑区间连接强度差异均有统计学意义（P＜0.05，FDR校正）。脑白质病变损伤程度与P300潜伏期延长呈正相关（rs=0.891，P＜0.05），与fNIRS的连接强度呈负相关（rs=-0.359，P＜0.05）。结论 CSVD-CI患者存在ERP-P300潜伏期延长及静息态脑功能连接广泛降低，且与脑白质病变程度相关；ERP-P300潜伏期随脑白质病变分级升高而显著延长，并与Fazekas评分呈显著正相关。ERP-P300潜伏期及静息态脑功能连接检测可为脑小血管病相关认知障碍的早期识别与客观评估提供参考。

英文摘要:

      Background Cerebral small vessel disease (CSVD) exhibits high prevalence, disability rate, and mortality among middle-aged and elderly populations, imposing substantial burdens on society and families. Among the various clinical manifestations of CSVD, cognitive impairment represents its most common presentation, as well as the most central and disabling neuropsychiatric syndrome most closely associated with psychiatric practice. Previous research on CSVD with cognitive impairment has predominantly focused on neuroimaging, while studies utilizing non-invasive electrophysiology and cerebral blood flow remain relatively scarce.Objective To characterize the event-related potential (ERP) and functional near-infrared spectroscopy (fNIRS) findings in patients with cerebral small vessel disease-related cognitive impairment (CSVD-CI), and to explore their correlations with the severity of white matter hyperintensities, so as to provide objective evidence for early identification and quantitative evaluation of CSVD-associated cognitive dysfunction. Methods Forty patients with CSVD-CI who met the diagnostic criteria specified in the Chinese Guidelines for the Diagnosis and Treatment of Cerebral Small Vessel Disease (2021) and were hospitalized at the Affiliated Hospital of North Sichuan Medical College between December 2024 and December 2025 were enrolled as the case group. Meanwhile, 40 healthy volunteers matched for gender, age and education level were recruited as the control group. All subjects underwent Mini-Mental State Examination (MMSE), ERP-P300 recording and resting-state functional near-infrared spectroscopy (fNIRS) examination. ERP-P300 parameters and whole-brain as well as cognition-related region-of-interest (ROI) functional connectivity derived from fNIRS were compared between the two groups. Since Fazekas grading of white matter lesions was an ordinal categorical variable, while P300 latency and fNIRS-based functional connectivity did not conform to normal distribution, Spearman’s rank correlation analysis was adopted to explore the correlations of Fazekas grades with P300 latency and fNIRS functional connectivity, respectively. Results No significant intergroup differences in gender composition, age or years of education were observed between the CSVDCI group and control group (all P＞0.05). The CSVDCI group exhibited significantly lower MMSE scores (Z = ?6.250, P＜0.01) and prolonged P300 latency (t = 12.291, P＜0.01) relative to controls, whereas no betweengroup difference in P300 amplitude was found (P＞0.05).Stratified by Fazekas grade within CSVDCI patients, patients with grade Ⅰ lesions had higher MMSE scores (Z = ?2.420, P＜0.05) and shorter P300 latency (Z = ?4.210, P＜0.01) than those with grade Ⅱ–Ⅲ lesions.The wholebrain functional connectivity was( 0.294±0.122 )in the CSVDCI group and( 0.616±0.157 )in the control group, with a statistically significant difference (t = 10.243, P＜0.05). After FDR correction, significantly reduced regional functional connectivity was detected in the CSVDCI group in bilateral PMC, FPC, DLPFC and OFC (P＜0.05 for all). In addition, multiple interregional prefrontal connectivity values were markedly decreased in CSVDCI patients (FDRcorrected P＜0.05).Fazekas grade of white matter lesions was positively correlated with prolonged P300 latency (r? = 0.891, P＜0.05) and negatively correlated with fNIRS functional connectivity strength (r? = ?0.359, P＜0.05).Conclusion Prolonged ERP-P300 latency and widespread reduction of resting-state brain functional connectivity were observed in patients with CSVD-CI, and these abnormalities were correlated with the severity of white matter lesions. ERP-P300 latency increased significantly along with the elevation of Fazekas grade and showed a significant positive correlation with Fazekas scores. Combined detection of ERP-P300 latency and resting-state brain functional connectivity helps facilitate early identification and objective evaluation of cognitive impairment secondary to cerebral small vessel disease.