發(fā)布時間：2018-06-29 21:28

  本文選題：缺血性腦白質(zhì)病變 + 認知功能　； 參考：《安徽醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討不同程度缺血性腦白質(zhì)病變(White matter ischemic lesions,WMIL)對患者認知功能的影響及認知功能障礙的特點;檢測不同程度WMIL患者外周血抗少突膠質(zhì)細胞糖蛋白(Myelin oligodendrocyte glycoprotein,MOG)抗體及細胞間粘附分子-1(Intercellular adhesion molecule-1,ICAM-1)的水平表達情況,分析WMIL的相關因素及與抗-MOG抗體、ICAM-1的相關性。方法:連續(xù)納入2015年11月1日至2016年12月31日安徽醫(yī)科大學附屬宿州醫(yī)院神經(jīng)內(nèi)科住院患者,且經(jīng)顱腦MRI證實為WMIL者115例。選取健康體檢者經(jīng)顱腦MRI證實無明確腦白質(zhì)病變者21例。WMIL組患者根據(jù)Fazekas評分標準分為輕、中、重3組,輕度組為1-4分,中度組5-8分,重度組9-12分。根據(jù)病變部位不同分為腦室旁白質(zhì)病變(PWML)和皮層下深部白質(zhì)病變(DWML)。應用蒙特利爾認知功能評估(Mo CA)量表對研究對象進行認知功能評估。采用酶聯(lián)免疫法(ELISA)測定外周血抗-MOG抗體和ICAM-1水平。結果:1.WMIL組Mo CA量表分值明顯低于健康對照組(P0.05);輕度WMIL組Mo CA量表分值與健康對照組無明顯差異(P0.05);中、重度WMIL組Mo CA量表分值顯著低于健康對照組(P0.05);輕、中、重度WMIL三組患者Mo CA分值存在明顯差異(P0.05),且相關分析顯示Mo CA量表的分值與Fazekas評分呈負相關(P0.05);DWML組患者認知功能較PWML組明顯降低(P0.05)。2.相關危險因素分析結果顯示,WMIL組與健康對照組年齡、吸煙史、血脂、同型半胱氨酸均有明顯差異(P0.05)。3.WMIL組外周血抗-MOG抗體水平明顯高于健康對照組(P0.05);輕、中、重度WMIL三組患者外周血抗-MOG抗體水平存在差異(P0.05),相關分析顯示外周血抗-MOG抗體水平與Fazekas評分呈正相關(P0.05),與Mo CA量表分值呈負相關(P0.05);PWML組外周血抗-MOG抗體明顯高于DWML組(P0.05)。4.WMIL組患者外周血ICAM-1濃度明顯高于健康對照組(P0.05);輕、中、重度WMIL三組患者外周血ICAM-1水平存在差異(P0.05),相關分析顯示外周血ICAM-1與Fazekas評分呈正相關(P0.05),與Mo CA量表分值呈負相關(P0.05);DWML組及PWML組外周血ICAM-1水平無明顯差異(P0.05)。結論:1.外周血抗-MOG抗體水平在WMIL的發(fā)病及病情進展中有一定的作用,可能是WMIL的一項重要危險因素,其可能與PWML有更密切的聯(lián)系。2.外周血ICAM-1水平在WMIL的發(fā)病中起到一定的作用,可能為WMIL的危險因素之一。3.一定程度的WMIL可使患者的認知功能下降,且認知功能的下降程度可能與WMIL的嚴重程度呈正相關,且可能與病變部位有關。4.年齡、吸煙史、血脂異常、高同型半胱氨酸血癥可能均為WMIL的危險因素。
[Abstract]:Objective: to investigate the effects of different degrees of ischemic white matter lesions (WMIL) on cognitive function and the characteristics of cognitive dysfunction. The levels of anti-oligodendrocyte glycoprotein (MOG) antibody and intercellular adhesion molecule-1 (ICAM-1) in peripheral blood of patients with WMIL were detected, and the correlation between WMIL and anti-MOG antibody ICAM-1 was analyzed. Methods: 115 patients were admitted to the Department of Neurology, Suzhou Hospital affiliated to Anhui Medical University from November 1, 2015 to December 31, 2016, and were confirmed as WMIL by craniocerebral MRI. According to the Fazekas score, 21 healthy persons with no clear white matter lesions confirmed by MRI were divided into 3 groups: mild, moderate, severe, 1-4, moderate, 5-8 and 9-12, respectively. According to the location of the lesion, it can be divided into ventricular collateral leukopathy (PWML) and subcortical deep white matter lesion (DWML). The Montreal Cognitive function Assessment (MOCA) scale was used to evaluate the cognitive function of the subjects. The levels of anti-MOG antibody and ICAM-1 in peripheral blood were measured by enzyme linked immunosorbent assay (Elisa). Results 1. The scores of Mo CA in WMIL group were significantly lower than those in the healthy control group (P0.05), there was no significant difference between the mild WMIL group and the healthy control group (P0.05); in the moderate and severe WMIL group, the Mo CA scale score was significantly lower than that in the healthy control group (P0.05); The scores of Mo CA in severe WMIL group were significantly different (P0.05), and the correlation analysis showed that the score of Mo CA scale was negatively correlated with Fazekas score (P0.05). The cognitive function of DWML group was significantly lower than that of PWML group (P0.05). The results of risk factors analysis showed that the age, smoking history, blood lipid and homocysteine levels in WMIL group were significantly higher than those in healthy control group (P0.05). There were significant differences among the three groups of patients with severe WMIL (P0.05). Correlation analysis showed that the level of anti-MOG antibody in peripheral blood was positively correlated with Fazekas score (P0.05), and negatively correlated with the score of Mo CA scale (P0.05). The level of anti-MOG antibody in PWML group was significantly higher than that in DWML group. The concentration of ICAM-1 in peripheral blood in WMIL group was significantly higher than that in healthy control group (P0.05). The level of ICAM-1 in peripheral blood of the three patients with severe WMIL was significantly different (P0.05). The correlation analysis showed that the level of ICAM-1 in peripheral blood was positively correlated with Fazekas score (P0.05), and negatively correlated with the score of Mo CA (P0.05). There was no significant difference in ICAM-1 level between DWML group and PWML group (P0.05). Conclusion 1. The level of anti-MOG antibody in peripheral blood may play an important role in the pathogenesis and progression of WMIL and may be an important risk factor of WMIL, which may be more closely related to PWML. The level of ICAM-1 in peripheral blood may play a role in the pathogenesis of WMIL and may be one of the risk factors of WMIL. To a certain extent, WMIL can decrease the cognitive function of the patients, and the degree of the decline of cognitive function may be positively correlated with the severity of WMIL, and may be related to the location of the lesion. Age, smoking history, dyslipidemia and hyperhomocysteinemia may all be risk factors for WMIL.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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