目的:探讨尼莫地平治疗脑小血管病（CSVD）认知功能损害的疗效及磁共振弥散张量成像（DTI）对CSVD的应用价值。方法:选取2018年2月至2019年2月南京医科大学附属苏州医院收治的CVSD伴认知功能障碍患者80例，采用随机数字表法分为对照组和观察组，各40例。对照组采用基础治疗、口服多奈哌齐治疗；观察组在对照组基础上加用尼莫地平。两组均随访12个月，于治疗前和治疗后6、12个月记录患者蒙特利尔认知评估量表（MoCA）评分、日常生活能力量表（ADL）评分、Tinetti平衡步态量表（TGA）评分以及患者治疗前后总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、同型半胱氨酸（Hcy）及血清超敏C反应蛋白（hs-CRP）水平，并进行比较。记录两组患者治疗前、治疗后12个月DTI数据变化。结果:两组治疗后6、12个月MoCA、ADL、TGA评分均高于本组治疗前，且治疗后12个月MoCA、ADL、TGA评分高于治疗后6个月，差异均有统计学意义（n P<0.05）。观察组治疗后6、12个月MoCA、ADL评分均高于对照组[6个月：（24.61 ± 2.54）分比（22.21 ± 2.83）分、（71.53 ± 6.25）分比（69.51 ± 6.81）分；12个月：（26.39 ± 2.16）分比（23.76 ± 2.64）分、（78.39 ± 5.76）分比　（72.39 ± 6.12）分]，差异有统计学意义（n P<0.05）；两组治疗后6、12个月视空间与执行能力、延时记忆、定向力评分均高于治疗前，且观察组治疗后12个月定向力评分高于治疗后6个月　[（5.97 ± 1.37）分比（5.36 ± 1.29）]（n P<0.05）。观察组治疗后视空间与执行能力、抽象思维、延时记忆、定向力评分均高于同时期对照组（n P<0.05）；两组患者治疗后6、12个月TC、TG、LDL-C、Hcy、hs-CRP水平均低于治疗前，且治疗后12个月上述指标均低于治疗后6个月，差异均有统计学意义（n P<0.05）。观察组治疗后12个月Hcy、hs-CRP水平均低于对照组，且治疗后6个月Hcy水平低于对照组，差异均有统计学意义（n P<0.05）。两组患者治疗后双侧半卵圆中心、额叶、顶叶各向异性分数值均较治疗前升高，且观察组治疗前后差值均高于对照组（n P<0.05）。两组患者治疗后双侧额叶、顶叶平均弥散率值均较治疗前降低，且观察组治疗前后差值均高于对照组（n P<0.05）。n 结论:尼莫地平治疗CVSD具有较好疗效，可有效改善患者认知功能损害等症状，DTI可敏感感知患者白质完整性和脑血流灌注，对CVSD防治具有积极意义。“,”Objective:To explore the efficacy of nimodipine in treating cognitive impairment of cerebral small vessel disease (CSVD) and the value of magnetic resonance diffusion tensor imaging (DTI) in CSVD.Methods:A total of 80 patients with CVSD and cognitive dysfunction who admitted to Suzhou Municipal Hospital from February 2018 to February 2019 were selected, and the patients were divided into control group (40 patiengts) and observation group (40 patients) by random number table method. The control group received basic treatment and donepezil, and the observation group added nimodipine on the basis of control group. All patients were followed up for 12 months. Before treatment, 6 months after treatment and 12 months after treatment, the patients’Montreal cognitive assessment scale (MoCA) score, daily living ability scale (ADL) score, and Tinetti balance and gait analysis(TGA) were recorded. The levels of total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), homocysteine (Hcy) and high-sensitivity C-reactive protein (hs-CRP) before and after treatment were recorded. The changes of DTI data before and after 12 months′ treatment in the two groups were recorded.Results:The MoCA score, ADL score, and TGA score of the two groups were higher than those before treatment and at 6 months and 12 months after treatment, and those 12 months after treatment were higher than those at 6 months after treatment. There were significant differences (n P<0.05). The MoCA and ADL scores of the observation group were higher than those of the control group at 6 and 12 months after treatment at 6 months: (24.61 ± 2.54) scores vs. (22.21 ± 2.83) scores, (71.53 ± 6.25) scores vs. ( 69.51 ± 6.81) scores; 12 months: (26.39 ± 2.16) scores vs. (23.76 ± 2.64) scores, (78.39 ± 5.76) scores vs. (72.39 ± 6.12) scores,n P<0.05. At 6 months and 12 months after treatment, the visual space and execution ability, delayed memory, and orientation scores were higher than those before treatment, and in the observation group 12 months after treatment was higher than those 6 months after treatment: (5.97 ± 1.37) scores vs. (5.36 ± 1.29) scores,n P<0.05. The observation group′s visual space and executive ability, abstract thinking, delayed memory, and orientation score were higher than those in the control group at the same period (n P<0.05). The levels of TC, TG, LDL-C, Hcy and hs-CRP of the two groups after treatment for 6 and 12 months were lower than those before treatment, and the levels of these index at 12 months after treatment were lower than those at 6 months after treatment (n P<0.05). The levels of Hcy and hs-CRP in the observation group were lower than those in the control group at 12 months after treatment, and Hcy was lower than that in the control group at 6 months after treatment (n P<0.05). After treatment, the fractional anisotropy (FA) values of the center, frontal lobe, and parietal lobe of both sides of the two groups were higher than those before treatment, and the difference in the observation group before and after treatment was higher than that of the control group (n P<0.05). After treatment, the mean diffusivity (MD) values of both frontal lobe and parietal lobe of the two groups were lower than those before treatment, and the difference between the observation group before and after treatment was higher than that of the control group (n P<0.05).n Conclusions:Nimodipine has a good effect on the treatment of CVSD, which can effectively improve the patients′ cognitive impairment and other symptoms. DTI can sensitively sense the white matter integrity and cerebral blood flow perfusion of patients, which has a positive significance for the prevention and treatment of CVSD.