發(fā)布時(shí)間：2018-02-04 15:52

  本文關(guān)鍵詞： 阻塞性睡眠呼吸暫停低通氣綜合征 海馬 腦白質(zhì) 認(rèn)知 蒙特利爾認(rèn)知評(píng)估量表　出處：《蘇州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討阻塞性睡眠呼吸暫停低通氣綜合征（OSAHS）患者顱腦磁共振（MRI）顯像中海馬體積及腦白質(zhì)的改變和認(rèn)知功能變化，分析認(rèn)知功能評(píng)分與海馬體積、腦白質(zhì)變化之間的相關(guān)性，評(píng)估顱腦MRI在評(píng)價(jià)OSAHS患者認(rèn)知功能障礙中的臨床價(jià)值。 方法：從2012年3月至2013年8月因打鼾在蘇州大學(xué)附屬第二醫(yī)院睡眠中心行多導(dǎo)睡眠圖（PSG）監(jiān)測(cè)的患者中，納入符合本研究入排標(biāo)準(zhǔn)的患者81例，依據(jù)睡眠呼吸暫停低通氣指數(shù)（AHI）分為輕度OSAHS組（23例）、中度OSAHS組（18例）、重度OSAHS組（23例）及單純鼾癥組（17例）。采用顱腦MRI常規(guī)序列及垂直于雙側(cè)海馬的液體衰減反轉(zhuǎn)恢復(fù)（FIAIR）序列進(jìn)行成像，并根據(jù)Scheltens標(biāo)準(zhǔn)及Fukudas法分別對(duì)大腦海馬體積萎縮、腦白質(zhì)病變相關(guān)的側(cè)腦室周圍高信號(hào)灶（PVH）的嚴(yán)重程度進(jìn)行評(píng)分，分析不同嚴(yán)重程度OSAHS對(duì)大腦相關(guān)結(jié)構(gòu)的影響。應(yīng)用蒙特利爾認(rèn)知評(píng)估（MoCA）量表、簡(jiǎn)易精神狀態(tài)（MMSE）量表評(píng)估各組OSAHS患者認(rèn)知功能的變化，并分析認(rèn)知功能評(píng)分與海馬、腦白質(zhì)結(jié)構(gòu)改變及PSG參數(shù)的相關(guān)性。檢測(cè)部分OSAHS患者空腹血脂、凝血功能指標(biāo)及紅細(xì)胞壓積的變化，分析血清指標(biāo)與大腦結(jié)構(gòu)改變的關(guān)系。 結(jié)果：隨著OSAHS嚴(yán)重程度的加重，患者認(rèn)知評(píng)分尤其是MoCA評(píng)分在組間呈下降趨勢(shì)，海馬體積萎縮程度及PVH均呈升高趨勢(shì)。與單純鼾癥組比較，，重度OSAHS組海馬體積萎縮評(píng)分升高（[1.5±1.2）比（2.4±1.2）分，P=0.007]，PVH評(píng)分升高（[1.6±1.8）比(3.6±1.0)分，P=0.000]，MoCA和MMSE評(píng)分降低[（28.0±1.9）比（24.5±2.7）分，P=0.000和（28.7±1.3）比（27.5±1.4）分，P=0.013]，認(rèn)知功能受損主要表現(xiàn)在視空間與執(zhí)行力、延遲記憶力等方面。海馬體積萎縮、PVH評(píng)分與MoCA評(píng)分負(fù)相關(guān)（r=－0.30、－0.30，P=0.010、0.006）。多元線性回歸分析提示，決定MoCA量表評(píng)分的主要危險(xiǎn)因素為AHI和海馬體積萎縮程度（標(biāo)準(zhǔn)化回歸系數(shù)為：－0.386、－0.247，P=0.000、0.020）。OSAHS患者海馬體積萎縮、PVH嚴(yán)重程度評(píng)分與AHI、氧減指數(shù)（ODI）、呼吸相關(guān)微覺(jué)醒指數(shù)（RI）正相關(guān)，與最低脈氧飽和度（LSaO2）、平均脈氧飽和度（MSaO2）負(fù)相關(guān)（均P＜0.05）。而各組間患者的血脂四項(xiàng)、紅細(xì)胞壓積、D-二聚體及纖維蛋白元凝血指標(biāo)無(wú)統(tǒng)計(jì)學(xué)差異，且海馬體積萎縮、PVH評(píng)分與上述血清指標(biāo)亦無(wú)相關(guān)性（均P＞0.05）。 結(jié)論：OSAHS可引起患者海馬體積萎縮和腦白質(zhì)病變，出現(xiàn)不同程度的認(rèn)知功能障礙；認(rèn)知功能障礙與海馬體積萎縮和腦白質(zhì)病變相關(guān)；顱腦MRI技術(shù)可為診斷OSAHS患者的認(rèn)知功能障礙提供客觀影像學(xué)依據(jù)。
[Abstract]:Objective: To investigate the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) patients with brain magnetic resonance (MRI) and volume changes in the white matter of the brain imaging and cognitive function of Naka Haima, analysis the score of cognitive function and hippocampal volume, the correlation between the brain white matter changes and clinical value of brain MRI in the evaluation of cognitive dysfunction in OSAHS patients in.
Methods: from March 2012 to August 2013 due to snoring in the sleep center of The Second Hospital Affiliated to Suzhou University underwent polysomnography (PSG) monitoring in patients in the 81 cases of patients with discharge standards, according to apnea hypopnea index (AHI) were divided into mild OSAHS group (23 cases), moderate OSAHS group (18 cases), severe OSAHS group (23 cases) and primary snoring group (17 cases). The brain MRI attenuated inversion recovery sequence and conventional liquid perpendicular to the bilateral hippocampus (FIAIR) image sequence, and according to the standards of Scheltens and Fukudas respectively on hippocampal atrophy, around the lateral ventricle of cerebral white matter lesions is high signal intensity (PVH) severity score, analysis of the influence of different severity of OSAHS on brain related structure. The application of Montreal cognitive assessment (MoCA) scale, Mini Mental State Scale (MMSE) assessment of cognitive function in patients with OSAHS Then we analyzed the correlation between cognitive function score and hippocampus, white matter structure and PSG parameters. We detected the changes of fasting blood lipids, coagulation function and hematocrit in some OSAHS patients, and analyzed the relationship between serum indexes and brain structure changes.
Results: with the increase of the severity of OSAHS patients, especially the cognitive score MoCA score decreased in group, hippocampal atrophy and PVH increased. Compared with simple snoring group, severe OSAHS group hippocampal volume atrophy score increased ([1.5 + 1.2) than (2.4 + 1.2), P=0.007]. The PVH score increased ([1.6 + 1.8) than (3.6 + 1), P=0.000], MoCA and MMSE scores decreased [(28 + 1.9) than (24.5 + 2.7), and P=0.000 (28.7 + 1.3) than (27.5 + 1.4), P=0.013], impaired cognitive function is mainly manifested in the visual space and executive force, delayed memory and so on. Hippocampal atrophy, PVH score and MoCA score in negative correlation (R=0.30, 0.30, P=0.010,0.006). Multiple linear regression analysis showed that the main risk decision MoCA scale factor AHI and hippocampal atrophy (standardized regression coefficient: 0.386, 0.247, P=0.000,0.020).OSAHS Patients with hippocampal volume atrophy, PVH severity score and AHI, oxygen desaturation index (ODI), respiratory related microarousal index (RI) was positively correlated with the lowest pulse oxygen saturation (LSaO2), mean pulse oxygen saturation (MSaO2) negative correlation (P < 0.05). Groups of four blood lipids. Hematocrit, no significant difference between the two D- dimer and fibrinogen clotting index, and hippocampal volume shrinking, there is no correlation between PVH score and the serum index (P > 0.05).
Conclusion: OSAHS patients can cause hippocampal volume atrophy and cerebral white matter lesions appear different levels of cognitive impairment; cognitive dysfunction associated with hippocampal atrophy and white matter lesions; brain MRI technology can provide objective imaging for cognitive dysfunction in the diagnosis of patients with OSAHS basis.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R766;R445.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 吳士文;王賀波;劉若卓;靳瑋;齊亞超;于生元;;腔隙性腦梗死病灶數(shù)量和部位與皮質(zhì)下血管性認(rèn)知功能損害的相關(guān)性研究[J];中國(guó)全科醫(yī)學(xué);2010年11期

2 黃紹光,李慶云;上海市區(qū)30歲以上居民鼾癥流行病學(xué)初步調(diào)查[J];診斷學(xué)理論與實(shí)踐;2003年01期

3 中華醫(yī)學(xué)會(huì)呼吸病學(xué)分會(huì)睡眠呼吸疾病學(xué)組;阻塞性睡眠呼吸暫停低通氣綜合征診治指南(草案)[J];中華結(jié)核和呼吸雜志;2002年04期

4 謝崢;黃麗娜;連立飛;杜敢琴;騰丹陽(yáng);白永杰;白亞輝;;急性腔隙性腦梗死認(rèn)知功能障礙與病變的相關(guān)性[J];中華腦血管病雜志(電子版);2009年04期

5 殷玲,王玉明;腦梗死復(fù)發(fā)因素探討[J];卒中與神經(jīng)疾病;2003年02期

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