本文選題：快眼動(dòng)睡眠行為障礙 + α-突觸核蛋白病��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:研究快眼動(dòng)睡眠行為障礙(REM sleep behavior disorder,RBD)及孤立性RSWA(REM sleep without atonia,RSWA)與自主神經(jīng)功能之間的相關(guān)性,并評(píng)價(jià)RBD及孤立性RSWA的動(dòng)態(tài)腦血流自動(dòng)調(diào)節(jié)改變。方法:本研究選取2016年2月至2017年2月期間就診于吉林大學(xué)第一醫(yī)院神經(jīng)內(nèi)科門診及住院的存在“失眠、多夢(mèng)、說夢(mèng)話、尖叫、肢體舞動(dòng)”等表現(xiàn)的患者,經(jīng)視頻多導(dǎo)睡眠監(jiān)測(cè)(v PSG)符合RBD診斷的患者17例(其中特發(fā)性RBD 6例,帕金森病(PD)伴RBD 6例,很可能的多系統(tǒng)萎縮(MSA)伴RBD 5例)、符合孤立性RSWA診斷的患者6例以及健康對(duì)照組6例作為研究對(duì)象。應(yīng)用帕金森病自主神經(jīng)功能評(píng)定量表(Scales for Outcomes in PArkinson’s disease-AUT,SCOPA-AUT)進(jìn)行自主神經(jīng)功能評(píng)估;并采用經(jīng)顱多普勒超聲(transcranial dopple,TCD)與連續(xù)指尖血壓監(jiān)測(cè)儀聯(lián)合,同步記錄連續(xù)10分鐘雙側(cè)大腦中動(dòng)脈血流速度和平均動(dòng)脈血壓,應(yīng)用傳遞函數(shù)分析方法導(dǎo)出動(dòng)態(tài)腦血流自動(dòng)調(diào)節(jié)(dynamic cerebral autoregulation,d CA)的相關(guān)參數(shù):相位差、增益、相關(guān)函數(shù),評(píng)價(jià)RBD及孤立性RSWA的動(dòng)態(tài)腦血流自動(dòng)調(diào)節(jié)的改變。結(jié)果:1.不同組別研究對(duì)象SCOPA-AUT量表得分結(jié)果:(1)SCOPA-AUT總分:孤立性RSWA組、i RBD組、PD伴RBD組、很可能MSA伴RBD組總分得分均值(7.33±3.83、17.83±7.94、19.50±5.79、21.40±10.60)較對(duì)照組(1.67±0.82)明顯升高(P0.05);孤立性RSWA組總分均值介于對(duì)照組及i RBD組之間,RBD各組之間總分差異無顯著性。(2)SCOPA-AUT各系統(tǒng)得分:孤立性RSWA組、i RBD組、PD伴RBD組及很可能的MSA伴RBD組消化系統(tǒng)得分(5.00±2.83、6.00±3.16、7.17±2.32、6.40±4.28)高于對(duì)照組(0.50(1.00))(P0.05);i RBD組、PD伴RBD組、很可能的MSA伴RBD組泌尿系統(tǒng)得分(5.67±2.88、7.00±3.58、11.00(9.00))與對(duì)照組(1.00±0.89)比較明顯增高(P0.05),孤立性RSWA組泌尿系統(tǒng)得分低于很可能的MSA伴RBD組得分(P0.05);與對(duì)照組(0.00(0.00))相比,i RBD組、PD伴RBD組、很可能的MSA伴RBD組的心血管系統(tǒng)得分(1.83±1.17、2.00(2.00)、4.20±2.05)得分明顯升高(P0.05),與孤立性RSWA組相比,很可能的MSA伴RBD組心血管系統(tǒng)得分明顯升高(P0.05);i RBD組、PD伴RBD組及很可能MSA伴RBD組性功能得分(2.33±2.42、1.80±1.10、4.00±1.83)高于對(duì)照組得分(0.00)(P0.05),其中與孤立性RSWA組比較,很可能的MSA伴RBD組性功能得分明顯增高(P0.05)。2.動(dòng)態(tài)腦血流自動(dòng)調(diào)節(jié)相關(guān)參數(shù)結(jié)果:(1)相位差:孤立性RSWA組、i RBD組、PD伴RBD組、很可能MSA伴RBD組的左相位差(44.63±10.29°、37.08±14.5°、40.69±11.16°、38.72±6.04°)與對(duì)照組數(shù)值(58.26±8.28°)比較均明顯下降(P0.05),i RBD組、PD伴RBD組、很可能MSA伴RBD右相位差(36.20±14.89°、40.09±12.62°、41.34±8.74°)與對(duì)照組數(shù)值(56.89±3.64°)比較均明顯下降(P0.05),其中,孤立性RSWA組的左右側(cè)相位差介于對(duì)照組及i RBD組之間。(2)增益:孤立性RSWA組、i RBD組的右側(cè)增益(1.24±0.48、1.13±0.20)與對(duì)照組、PD伴RBD組(0.74(0.10)、0.76±0.20)比較明顯升高(P0.05)。結(jié)論:1.孤立性RSWA患者自主神經(jīng)功能障礙以消化系統(tǒng)系統(tǒng)損害為著。2.特發(fā)性RBD及繼發(fā)性RBD患者自主神經(jīng)功能障礙以消化、泌尿、心血管系統(tǒng)及性功能損害為著。3.孤立性RSWA、特發(fā)性RBD及繼發(fā)性RBD患者d CA受損。
[Abstract]:Objective: To study the correlation between REM sleep behavior disorder (RBD) and isolated RSWA (REM sleep without atonia, RSWA) and autonomic nervous function, and to evaluate the dynamic changes in the dynamic cerebral blood flow regulation of RBD and isolation. Methods: This study was selected from February 2016 to February 2017 at the Jilin University The patients in the Department of Neurology in the first hospital, including "insomnia, dream, dream talk, screaming, limb dancing", were 17 patients with RBD diagnosis by video polysomnography (V PSG), including 6 cases of idiopathic RBD, 6 cases of Parkinson's disease (PD) with RBD, and 5 cases of MSA with RBD, which were in line with isolated RSWA diagnosis. 6 cases of broken patients and 6 healthy controls were used as subjects. The autonomic nervous function assessment was performed by using the Scales for Outcomes in PArkinson 's disease-AUT, SCOPA-AUT, and the combination of transcranial Doppler (transcranial Dopple, TCD) and continuous fingertip blood pressure monitor was used. The blood flow velocity and mean arterial blood pressure of the bilateral middle cerebral arteries were recorded for 10 minutes. The related parameters of dynamic cerebral autoregulation (D CA) were derived by the transfer function analysis method: phase difference, gain, correlation function, and the changes of dynamic cerebral blood flow regulation of RBD and isolated RSWA. Results: 1. The results of the SCOPA-AUT scale in the same group were: (1) the total score of SCOPA-AUT: isolated RSWA group, I RBD group, PD with RBD group, the total score of MSA with RBD group (7.33 + 3.83,17.83 + 7.94,19.50 + 5.79,21.40 + 10.60) was significantly higher than that of the control group (1.67 + 0.82). There was no significant difference in total score between RBD groups. (2) scores of SCOPA-AUT system: isolated RSWA group, I RBD group, PD with RBD group and very likely MSA with RBD (5 + 2.83,6.00 + 3.16,7.17 + 2.32,6.40 + 4.28) were higher than that of the control group (0.50 (1)). The score of 2.88,7.00 + 3.58,11.00 (9)) was significantly higher than that in the control group (1 + 0.89). The score of urinary system in the isolated RSWA group was lower than that of the very likely group of MSA with RBD (P0.05). Compared with the control group (0 (0)), the score of the I RBD group and PD with RBD group was likely to score the score of the cardiovascular system (1.83 + 2) and 4.20 + 2.05) in the MSA companion group. Significantly higher (P0.05), compared with the isolated RSWA group, the possible score of the cardiovascular system in the group of MSA with RBD was significantly higher (P0.05), and in the I RBD group, the score of PD with RBD and the likely MSA companion of the RBD group (2.33 + 2.42,1.80 + 1.83) was higher than that of the control group (0), which was more likely than the isolated group. The function score increased significantly (P0.05).2. dynamic cerebral blood flow automatic regulation related parameters: (1) phase difference: isolated RSWA group, I RBD group, PD accompanied with RBD group, it is very likely that the left phase difference of MSA with RBD group (44.63 + 10.29, 37.08 + 14.5, 40.69 + 11.16, 38.72 + 6.04 degree) and the control group (58.26 + 8.28 degrees) and the control group (P0.05), I RBD group, With the RBD group, it was possible that the right phase difference between MSA and RBD (36.20 + 14.89, 40.09 + 12.62, 41.34 + 8.74) and the control group (56.89 + 3.64 degrees) decreased significantly (P0.05). The left and right side phase differences of the isolated RSWA group were between the control group and the I RBD group. (2) gain: the isolated RSWA group and the right gain of the I RBD group (1.24 + 0.48,1.13 + 0.20). Compared with the control group, PD with RBD group (0.74 (0.10), 0.76 + 0.20) was significantly increased (P0.05). Conclusion: 1. isolated RSWA patients with autonomic dysfunction with digestive system damage to.2. idiopathic RBD and secondary RBD patients with autonomic dysfunction with digestive, urinary, cardiovascular system and sexual dysfunction are.3. isolated RSWA, special hair. D CA in patients with sexual RBD and secondary RBD was impaired.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R740

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