發(fā)布時(shí)間：2018-01-01 08:33

  本文關(guān)鍵詞：輕度OSAHS患者合并認(rèn)知功能障礙相關(guān)因素分析　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 阻塞性睡眠呼吸暫停低通氣綜合征 認(rèn)知功能障礙 彌散張量成像 炎癥反應(yīng)

【摘要】：目的:睡眠呼吸暫停低通氣綜合征(Obstructive Sleep Apnea Hypopnea Syndrome,OSAHS)容易造成認(rèn)知功能障礙,但機(jī)制尚不明確。本研究對(duì)輕度OSAHS認(rèn)知功能障礙患者行磁共振彌散張量成像(Diffusion Tensor Imaging,DTI)觀察腦白質(zhì)結(jié)構(gòu)變化,檢測(cè)超敏C反應(yīng)蛋白(highsensitivity C-reactive protein,hsCRP),評(píng)估低氧參數(shù)包括呼吸暫停低通氣指數(shù)(Apnea-Hypopnea Index,AHI)、最低血氧飽和度(Lowest 02 saturation,LSa02)、平均血氧飽和度(Mean O2 saturation,MSa02),分析輕度OSAHS認(rèn)知功能障礙與腦白質(zhì)結(jié)構(gòu)變化、hsCRP、AHI、LSa02、MSa02相關(guān)性,探討輕度OSAHS認(rèn)知功能障礙可能發(fā)病機(jī)制,為輕度OSAHS認(rèn)知功能障礙患者早期干預(yù)提供依據(jù)。方法:收集輕度OSAHS認(rèn)知功能障礙患者12例(OSAHS組),其中男5例,女7例;與之匹配的單純打鼾非認(rèn)知功能障礙患者12例(對(duì)照組),其中男6例,女6例。通過(guò)PSG檢查獲取兩組患者低氧參數(shù):AHI、LSa02、MSa02。檢測(cè)兩組患者晨間空腹血清中的hsCRP水平。入組患者均接受DTI檢查,選取感興趣區(qū)(Region of Interest,ROI)觀察白質(zhì)區(qū)域部分各向異性(fractional anisotropy,FA)圖,分別測(cè)量FA值。分析MoCA和MMSE評(píng)分與FA值、hsCRP、PSG參數(shù)、ESS評(píng)分之間的相關(guān)性。統(tǒng)計(jì)采用SPSS 20.0軟件包處理。結(jié)果:1.OSAHS 組與對(duì)照組比較,MoCA 評(píng)分降低(25.3±1.42vs27±1.33,p=0.013),AHI 升高(7.44±2.28 vs 1.99±1.63,P=0.000),hsCRP 升高(1.96±1.72 vs 0.61±0.90,P=0.041),差異有統(tǒng)計(jì)學(xué)意義;MMSE評(píng)分降低(27.9±1.73vs28.1±1.47),差異無(wú)統(tǒng)計(jì)學(xué)意義;LSa02、MSa02、ESS評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義。2.OSAHS組與對(duì)照組FA值比較,左側(cè)大腦腳(0.721±0.09vs0.824±0.046,P=0.009)、右側(cè)后扣帶回(0.25±0.14 vs 0.43±0.024,P=0.045)、左側(cè)內(nèi)囊后肢(0.56±0.24vs0.75±0.04,P=0.016)、右側(cè)內(nèi)囊后肢(0.57±0.21vs0.72±0.05,P=0.028)、左側(cè)海馬旁回(0.25±0.11vs0.35±0.06,P=0.033)下降,差異有統(tǒng)計(jì)學(xué)意義;右側(cè)大腦腳、雙側(cè)額葉白質(zhì)、胼胝體膝、胼胝體干、胼胝體壓、雙側(cè)前扣帶回、左側(cè)后扣帶回、左側(cè)內(nèi)囊前肢、雙側(cè)內(nèi)囊膝部、雙側(cè)半卵圓中心、雙側(cè)前角周圍白質(zhì)、雙側(cè)后角周圍白質(zhì)、雙側(cè)丘腦、右側(cè)海馬旁回的FA值與對(duì)照組差異無(wú)統(tǒng)計(jì)學(xué)意義。3.Spearsman秩相關(guān)分析發(fā)現(xiàn):MoCA評(píng)分與AHI呈負(fù)相關(guān)(r=-0.708,P=0.022),而與年齡、BMI、高血壓、糖尿病、吸煙、飲酒、平均FA值、LSa02、MSa02均無(wú)相關(guān)性(P0.05)。4.線性回歸分析提示MoCA評(píng)分與AHI之間存在數(shù)量關(guān)系(B=-0.440,T=-2.838,P=0.022),即AHI每增加1次/分,MoCA評(píng)分下降0.44分。結(jié)論:(1)輕度OSAHS患者存在輕度認(rèn)知功能障礙,炎癥反應(yīng)可能參與其發(fā)病,AHI是其獨(dú)立危險(xiǎn)因素,AHI每增加1次/分,MoCA評(píng)分下降0.44分;(2)輕度OSAHS患者發(fā)生輕度認(rèn)知功能障礙時(shí)存在腦白質(zhì)結(jié)構(gòu)改變,部位主要分布在左側(cè)大腦腳、右側(cè)后扣帶回、雙側(cè)內(nèi)囊后肢、左側(cè)海馬旁回。
[Abstract]:Objective: sleep apnea hypopnea syndrome (Obstructive Sleep Apnea Hypopnea Syndrome, OSAHS) can cause cognitive dysfunction, but the mechanism is not clear. The study of OSAHS for mild cognitive dysfunction in patients with magnetic resonance diffusion tensor imaging (Diffusion Tensor, Imaging, DTI) to observe the changes of cerebral white matter structure, high sensitive C reactive protein (highsensitivity C-reactive protein, hsCRP), hypoxia evaluation parameters including apnea hypopnea index (Apnea-Hypopnea, Index, AHI), the lowest oxygen saturation (Lowest 02 saturation, LSa02), the average oxygen saturation (Mean O2, saturation, MSa02, OSAHS) analysis of mild cognitive impairment and brain white matter changes, hsCRP, AHI, LSa02, MSa02 to explore the possible correlation between the mild cognitive impairment, the pathogenesis of OSAHS, for the avoidance of cognitive function in mild OSAHS patients because of early intervention. Methods: to collect light The degree of cognitive dysfunction in patients with OSAHS 12 cases (OSAHS group), 5 cases were male, 7 were female; and simple snoring, non cognitive dysfunction in patients with 12 cases (control group), 6 cases were male, 6 were female. Two groups of patients with hypoxia parameters are obtained through AHI, LSa02, PSG examination: the level of hsCRP MSa02. the two groups were detected in the morning fasting serum. The patients underwent DTI examination, the region of interest (Region of, Interest, ROI) to observe the white matter fractional anisotropy (fractional anisotropy, FA), FA values were measured. The analysis of MoCA and MMSE score and FA, hsCRP, PSG parameters, correlation the ESS score between the statistics. Using SPSS 20 software. Results: comparing 1.OSAHS group with control group, MoCA score was lower (25.3 + 1.42vs27 + 1.33, p=0.013), AHI increased (7.44 + 2.28 vs 1.99 + 1.63, P=0.000), hsCRP increased (1.96 + 1.72 vs 0.61 + 0.90, P=0.041), difference there was statistically significant Yi; MMSE score was lower (27.9 + 1.73vs28.1 + 1.47), the difference was not statistically significant; LSa02, MSa02, ESS score was no significant difference between.2.OSAHS group and control group FA values compared with left cerebral peduncle (0.721 + 0.09vs0.824 + 0.046, P=0.009), right posterior cingulate (0.25 + 0.14 vs 0.43 + 0.024, P=0.045), the left posterior limb of the internal capsule (0.56 + 0.24vs0.75 + 0.04, P=0.016), right posterior limb of the internal capsule (0.57 + 0.21vs0.72 + 0.05, P=0.028), left parahippocampal gyrus (0.25 + 0.11vs0.35 + 0.06, P=0.033) decreased, the difference was statistically significant; on the right side of the brain, frontal white matter, genu of corpus callosum, corpus callosum the stem, corpus callosum, bilateral anterior cingulate, left posterior cingulate gyrus, left anterior limb, bilateral genu, bilateral centrum semiovale, bilateral anterior horn of the surrounding white matter, white matter around the bilateral posterior horn, bilateral thalamus, right parahippocampal gyrus FA and the control group had no significant difference.3.Spearsman Rank correlation analysis showed that MoCA scores was negatively correlated with AHI (r=-0.708, P=0.022), and with age, BMI, hypertension, diabetes, smoking, alcohol consumption, the average value of FA, LSa02, MSa02 had no correlation (P0.05).4. linear regression analysis of relationship between the number of MoCA score (B=-0.440, T=-2.838, and AHI P=0.022), each additional AHI 1 / min, MoCA score decreased 0.44 points. Conclusion: (1) mild OSAHS patients have mild cognitive impairment, inflammatory response may be involved in the pathogenesis of AHI, are the independent risk factors for every 1 increase in AHI / min, MoCA score decreased 0.44 points; (2) patients with mild OSAHS had mild cognitive when there is dysfunction of cerebral white matter changes in the structure, the main sites in the left cerebral peduncle, right posterior cingulate, bilateral posterior, left parahippocampal gyrus.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R766;R749.1

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