發(fā)布時(shí)間：2018-03-20 21:32

  本文選題：血管性癡呆　切入點(diǎn)：病因類型　出處：《大連醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：隨著社會(huì)經(jīng)濟(jì)、文化及醫(yī)療條件等各方面的進(jìn)步，我國(guó)社會(huì)人口老齡化的趨勢(shì)越來越明顯，而腦血管病又是中老年人群的高發(fā)和常見疾病，血管性因素引起的癡呆，其發(fā)病率更是逐年增高。血管性癡呆（Vascular Dementia，VaD）在癡呆中占有相當(dāng)大的比例，是目前唯一可以防治的癡呆，具有一定的可逆性。這嚴(yán)重影響到了患者及其家庭的生活質(zhì)量，，給國(guó)家和家庭帶來了沉重的負(fù)荷。因此，越來越多的學(xué)者開始將目光投向這一領(lǐng)域。關(guān)注VaD的危險(xiǎn)因素，及時(shí)延緩病情的發(fā)展，具有十分重要的意義。 研究目的:本研究旨在研究VaD的常見臨床類型及其相關(guān)的危險(xiǎn)因素。 研究方法:2011年2月至2013年2月在大連市中心醫(yī)院神經(jīng)內(nèi)科住院治療的VaD患者82例，無認(rèn)知功能障礙的患者52例。按照規(guī)定的入組條件，符合標(biāo)準(zhǔn)條件的患者簽署知情同意書后進(jìn)行入組。 1.對(duì)所有患者的一般資料、神經(jīng)系統(tǒng)檢查、既往史、個(gè)人史、家族史及其用藥情況進(jìn)行詳細(xì)詢問并進(jìn)行記錄。 2.對(duì)所有患者依次進(jìn)行HAMD、MMSE、MOCA、CDR、ADL和HIS量表得分評(píng)定，篩選出VaD組患者82例，正常對(duì)照組患者52例。 3.把VaD組患者按分類標(biāo)準(zhǔn)進(jìn)行細(xì)化分組，找出VaD的臨床常見類型及各種類型在VaD中所占的百分比。 4.對(duì)所有入組患者進(jìn)行實(shí)驗(yàn)室檢查，內(nèi)容包括：血常規(guī)、尿常規(guī)、生化（血脂、血糖、血尿酸、血同型半胱氨酸、超敏C反應(yīng)蛋白）及血纖維蛋白原。影像學(xué)檢查：心電圖、顱腦核磁及頸動(dòng)脈超聲檢查。 5.統(tǒng)計(jì)學(xué)處理： 采用SPSS17.0統(tǒng)計(jì)學(xué)軟件對(duì)資料進(jìn)行統(tǒng)計(jì)分析，計(jì)數(shù)資料用頻數(shù)（百分比）或平均數(shù)±標(biāo)準(zhǔn)差（x±S）表示，參數(shù)分析采用配對(duì)t檢驗(yàn)，對(duì)于分類資料采用X2檢驗(yàn)。規(guī)定p㩳0.05有統(tǒng)計(jì)學(xué)意義。 研究結(jié)果： 1.在本研究中，缺血性小血管性癡呆組共計(jì)有50人，占所有入組的血管性癡呆患者的60.98%。 2.血管性癡呆組與正常對(duì)照組在年齡、卒中次數(shù)、高血壓、糖尿病、高脂血癥、同型半胱氨酸（HCY）、纖維蛋白原（FIB）、頸動(dòng)脈斑塊形成、高尿酸血癥、超敏C反應(yīng)蛋白（Hs-crp）和吸煙之間差異有顯著性意義（p＜0.05），而兩組在性別、文化程度及房顫之間差異均無顯著性意義（p＞0.05）。 3.缺血性小血管性癡呆組與正常對(duì)照組在年齡、卒中史、高血壓、糖尿病、血脂、纖維蛋白原（FIB）、同型半胱氨酸（HCY）、吸煙和頸動(dòng)脈斑塊之間差異有顯著性意義（p＜0.05），而兩組在性別、受教育程度、超敏C反應(yīng)蛋白（Hs-crp）、高尿酸血癥（Hyperuricemia）以及房顫之間差異均無顯著性意義（p＞0.05）。 結(jié)論： 1.缺血性小血管性癡呆、缺血性大血管性癡呆及出血性癡呆是血管性癡呆常見的三種臨床類型。 2.年齡、卒中次數(shù)、高血壓、糖尿病、高脂血癥、高纖維蛋白原血癥、頸動(dòng)脈斑塊形成、高尿酸血癥、超敏C反應(yīng)蛋白以及吸煙是血管性癡呆的危險(xiǎn)因素，而性別、高同型半胱氨酸血癥、文化程度及房顫可能非其獨(dú)立危險(xiǎn)因素。 3.年齡、卒中次數(shù)、高血壓、糖尿病、高脂血癥、高同型半胱氨酸血癥、高纖維蛋白原血癥、頸動(dòng)脈斑塊形成及吸煙是缺血性小血管性癡呆的危險(xiǎn)因素，而性別、高尿酸血癥、超敏C反應(yīng)蛋白、文化程度及房顫可能非其獨(dú)立危險(xiǎn)因素。
[Abstract]:Along with the social economy, the culture and medical conditions such as progress, the trend of our country ageing is more and more obvious, and cerebrovascular disease in the elderly population is a high incidence of common diseases and disease, vascular factors, its incidence is increasing year by year. Vascular dementia (Vascular Dementia, VaD) occupies a large proportion in dementia, dementia is currently the only can be prevented and is reversible. It seriously affects the quality of life of patients and their families, and brought a heavy burden to the country and family. Therefore, more and more scholars began to pay attention to this field. VaD the development of risk factors, timely delay the disease, it has very important significance.
Objective: the purpose of this study was to investigate the common clinical types of VaD and its related risk factors.
Research methods: from February 2011 to February 2013, 82 patients with VaD were enrolled in the Department of Neurology, Dalian Central Hospital, 52 patients without cognitive impairment. According to the prescribed entry conditions, the patients who met the criteria were informed of the informed consent.
1. the general information of all patients, neurological examination, previous history, personal history, family history and drug use were inquired and recorded in detail.
2. for all patients, the scores of HAMD, MMSE, MOCA, CDR, ADL and HIS were evaluated in turn, and 82 patients in group VaD and 52 in normal control group were selected.
3. groups of patients in group VaD were grouped according to the classification criteria to find out the common clinical types of VaD and the percentage of various types in VaD.
4. all the patients in the laboratory were examined, including blood routine, urine routine, biochemical (blood fat, blood sugar, blood uric acid, homocysteine, hypersensitive C reactive protein) and fibrinogen. Image examination: electrocardiogram, craniocerebral magnetic resonance and carotid artery ultrasonography.
5. statistical treatment:
The data were statistically analyzed by SPSS17.0 statistical software. The counting data were expressed by frequency (percentage) or mean + standard deviation (x + S). The paired t test was used for parameter analysis, and X2 test was used for categorical data. P 0.05 was statistically significant.
The results of the study:
1. in this study, there were 50 patients with ischemic small vascular dementia, which accounted for 60.98%. in all patients with vascular dementia.
2. vascular dementia group and normal control group in age, hypertension, diabetes, stroke frequency, hyperlipidemia, homocysteine (HCY), fibrinogen (FIB), carotid artery plaque formation, hyperuricemia, high sensitive C reactive protein (Hs-crp) had significant difference between smoking and smoking (P < 0.05), and differences between the two groups in gender, culture degree and atrial fibrillation was not significant (P > 0.05).
3. small ischemic vascular dementia group and normal control group in age, history of stroke, hypertension, diabetes mellitus, blood lipid, fibrinogen (FIB), homocysteine (HCY), there was a significant difference between smoking and carotid plaque (P < 0.05), while the two groups in gender, level of education. High sensitivity C reactive protein (Hs-crp), hyperuricemia (Hyperuricemia) and the difference between atrial fibrillation was not significant (P > 0.05).
Conclusion:
1. ischemic small vascular dementia, ischemic large vascular dementia and hemorrhagic dementia are the three common clinical types of vascular dementia.
2. age, stroke frequency, hypertension, hyperlipidemia, diabetes, high fibrinogen, carotid plaque formation, hyperuricemia, high sensitive C reactive protein and risk factors of vascular dementia is smoking, gender, hyperhomocysteinemia, cultural degree and non atrial fibrillation may be the independent risk factors.
3. age, stroke frequency, hypertension, hyperlipidemia, diabetes, high homocysteine, fibrinogen, carotid artery plaque formation and cigarette smoking is a risk factor for ischemic vascular dementia, small sex, hyperuricemia, high sensitive C reactive protein, the degree of atrial fibrillation and may be the independent risk factor.

【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】：2013
【分類號(hào)】：R749.13

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