本文選題：膽堿能通路　切入點：腦白質(zhì)高信號　出處：《中國人民解放軍醫(yī)學(xué)院》2012年碩士論文

【摘要】：研究背景和目的： 膽堿能系統(tǒng)是癡呆和正常老化的認知功能相關(guān)的主要的神經(jīng)遞質(zhì)系統(tǒng),該系統(tǒng)功能異常在認知功能障礙中起著重要作用。膽堿能系統(tǒng)功能障礙目前已確定為阿爾茨海默病(Alzheimer's disease, AD)的病理生理改變之一。 膽堿能通路高信號量表(Cholinergic Pathways Hyperintensities Scale, CHIPS)考慮了磁共振成像T2白質(zhì)高信號(white matter hyperintensities, WMH)與從基底前腦膽堿能系統(tǒng)的Mynert基底核發(fā)出的膽堿能通路投射的空間相關(guān)性,評價了膽堿能通路WMH的程度。 因此,為探討膽堿能通路上白質(zhì)損傷對認知障礙及正常老年人認知功能的影響,本課題對膽堿能通路白質(zhì)損傷的患病情況,膽堿能通路白質(zhì)損傷與認知功能的關(guān)系及相關(guān)危險因素進行了研究。 材料和方法：選取我院查體病人216人,按照認知功能分為對照組182例,輕度認知功能損傷(mild cognitive impairment, MCI)組23例,AD組11例,按照年齡分為70歲、70-80歲與80歲組。采用CHIPS評分對膽堿能通路WMH進行評分,根據(jù)CHIPS總分分為正常(0分)、輕度異常(1-7分)及明顯異常(≥8分)。同時采用Fazekas及ARWMC評分評估WMH。采用MoCA量表評價認知功能。收集臨床患病及用藥情況。 結(jié)果： 1、CHIPS反映的膽堿能通路WMH的患病率為78.7%,其中輕度異常占31.9%,明顯異常占46.8%。70歲、70-80歲與80歲三組CHIPS總分分別為5.14±6.68、11.79±12.63、13.61±10.21分,CHIPS輕度以上異常的比例分別為64.2%、80.3%、96.6%,差異均具有統(tǒng)計學(xué)意義(p=0.000)。 2、CHIPS正常、輕度異常及明顯異常組間認知損傷(MCI+AD)患病率分別為2.2%、8.7%、26.7%(X2=24.319,p=0.000)；Logistic回歸顯示,CHIPS損傷程度加重一級,認知損傷患病風險增加2.858倍(X2=46.438,p=0.000),MCI患病風險增加6.112倍(X2=32.614,p=0.000)。 CHIPS正常、輕度異常及明顯異常組間僅MoCA語言項差異具有統(tǒng)計學(xué)意義(p=0.003),但調(diào)整年齡、文化因素的影響后,MoCA各項得分均不受CHIPS總分的影響(p0.05)。 3、CHIPS評分與Fazekas評分的腦室旁白質(zhì)(ps=0.544,p=0.000)及深部白質(zhì)(ps=0.729,p=0.000)的得分具有相關(guān)性。CHIPS評分與ARWMC評分具有相關(guān)性(r=0.819,p=0.000)。 4、CHIPS影響因素的分析顯示,CHIPS明顯損傷組中,高血壓患病率為74.3%,服用ARB及CCB患者的比例明顯增高(p0.05)。納入MCI及AD組后,年齡(p=0.002)、認知(p=0.027)及高血壓(p=0.025)是影響CHIPS評分的獨立危險因素。而去除MCI與AD組后,年齡仍影響CHIPS總分(p=0.001),但高血壓不再具有顯著性意義(p=0.068)。 結(jié)論： 1、CHIPS所反映的膽堿能通路白質(zhì)損傷在老年人中較為常見,隨年齡的增加而加重。 2、膽堿能通路白質(zhì)損傷增加MCI、AD患病的危險性。 3、膽堿能通路白質(zhì)損傷的危險因素包括年齡、高血壓,其評分與Fazekas及ARWMC評分相關(guān),考慮與其他WML具有相似的病理生理機制。
[Abstract]:Background and objectives of the study:. Cholinergic system is the main neurotransmitter system associated with cognitive function of dementia and normal aging. The abnormal function of the system plays an important role in cognitive dysfunction. Cholinergic dysfunction has been identified as one of the pathophysiological changes of Alzheimer's disease (ADD). The Cholinergic Pathways Hyperintensities scale (CHIPS) considered the spatial correlation between Mr T 2white matter hyperintensions (WMHs) and the projection of cholinergic pathway from the Mynert basal nucleus of the basal forebrain cholinergic system. The degree of cholinergic pathway WMH was evaluated. Therefore, in order to investigate the effects of white matter injury on cognitive impairment and cognitive function in the elderly, the present study was designed to investigate the prevalence of white matter injury in cholinergic pathway. The relationship between white matter damage and cognitive function of cholinergic pathway and related risk factors were studied. Materials and methods: two hundred and sixteen patients in our hospital were divided into control group (n = 182) and mild cognitive impairment group (n = 23) according to their cognitive function. According to the age, the patients were divided into 70 and 80 years old and 80 years old groups. The WMH of cholinergic pathway was scored by CHIPS score. According to the total score of CHIPS, it was divided into normal (0 points, mild abnormal 1-7 points) and obvious abnormal (鈮，

本文編號：1654941