目的： 白质高信号（white matter hyperintensity，WMH） 是脑小血管病（cerebral small vessel disease，CSVD）的重要影像学特征。本研究应用数据驱动法对WMH 进行定量分析，与传统的半定量评定方法进行比较，旨在探讨WMH 与CSVD（脑卒中后）早期认知损害的相关性。

方法：2015 年7 月—2018 年2 月上海交通大学医学院附属仁济医院脑卒中专病门诊连续登记的117 例CSVD 患者符合病例选择标准，其中72 例为轻度认知损害（mild cognitive impairment，MCI） 患者，45 例为无认知损害（no cognitive impairment，NCI）患者。2 组患者的基线人口社会学和血管危险因素的差异无统计学意义（P ＞ 0.05）。对所有患者进行神经心理学检查，并进行多模态磁共振成像检查，采用Fazekas 量表对WMH 进行半定量评分，并对WMH 体积进行定量计算。比较2 组患者的认知功能，并对WMH 半定量评分和WMH 体积定量计分对认知功能进行相关性分析。

结果：MCI 与NCI 患者的认知功能（注意- 执行、视空间、语言和记忆功能）差异均有统计学意义（P ＜ 0.05），WMH 半定量Fazekas 评分的差异无统计学意义（P ＝ 0.090），而WMH 体积定量计分差异有统计学意义（P ＝ 0.004）。在校正年龄、性别和受教育年限后，WMH 半定量Fazekas 评分与认知功能均无相关性（P ＞ 0.05），而WMH 体积定量计分与认知功能均有显著相关性（P ＜ 0.05）。深部WMH 体积主要与注意- 执行（P ＜ 0.05）和视空间功能（P ＜ 0.05）显著相关，而侧脑室旁WMH 体积与认知功能均显著相关（P ＜ 0.05）。

结论：WMH 与CSVD 患者认知功能下降密切相关。WMH 体积定量计分较WMH 半定量Fazekas 评分能够更敏感地评估CSVD 患者早期认知功能的变化，且不同部位WMH 与认知功能的相关性存在异质性。

Objective: White matter hyperintensity (WMH) is an important imaging feature of cerebral small vessel disease (CSVD). In this study, a data-driven method was used to conduct quantitative analysis of WMH, which was compared with the traditional semi-quantitative assessment, to explore the correlation between WMH and early cognitive impairment in post-stroke patients with CSVD.

Methods: From July 2015 to February 2018, 117 post-stroke patients with CSVD who met the selection criteria were recruited consecutively from the Stroke Clinic of Renji Hospital, Shanghai Jiao Tong University School of Medicine, comprising 72 individuals with mild cognitive impairment (MCI) and 45 with no cognitive impairment (NCI). There were no significant differences in baseline demographic sociology and vascular risk factors between the two groups (P > 0.05). Detailed neuropsychological assessments and multimodal magnetic resonance imaging (MRI) were performed in all patients. The WMH was semiquantitatively scored by Fazekas scale and the volume of WMH was quantitatively calculated. The cognitive function was compared between the two groups, and the correlation between WMH semi-quantitative Fazekas score and quantitative score of WMH volume and cognitive function was analyzed.

Results: There were significant differences in cognitive domains including attentionexecution, visual space, language and memory functions between MCI and NCI patients (P < 0.05), but there was no significant difference in WMH semi-quantitative Fazekas score (P = 0.090), while the quantitative score of WMH volume was significant different between MCI and NCI patients (P = 0.004). After adjusting for age, gender and years of education, there was no correlation between WMH semi-quantitative Fazekas score and cognitive functions (P > 0.05), but quantitative score of WMH volume was significantly correlated with cognitive function (P < 0.05). Deep WMH volume was significantly correlated with attentionexecution and visual space functions (P < 0.05), while the periventricular WMH volume was significantly correlated with cognitive functions (P < 0.05).

Conclusion: WMH is closely related to cognitive decline in post-stroke patients with CSVD. Quantitative score of WMH volume is more sensitive than WMH semi-quantitative Fazekas score in assessing early cognitive function changes in patients with CSVD, and the relationship of WMH location with cognitive fuction exhibits heterogeneity.