本文關鍵詞：非癡呆型血管性認知障礙患者MMSE與MoCA評分比較及其與C-反應蛋白、葉酸、維生素B12的相關性研究，由筆耕文化傳播整理發(fā)布。

        背景血管性認知障礙(vascular cognitive impairment, VCI)是指由腦血管病或腦血管病的危險因素引起的從輕度認知障礙到癡呆的一大類綜合征，包括無癡呆型血管性認知障礙(vascular cognitive impairment no dementia, VCIND)、血管性癡呆(vasculardementia，VD)和混合性癡呆(mixed dementia，MD)。VCI是老年人慢性進展性認知損害最常見的類型，VCI中未達到癡呆診斷標準者被定義為VCIND。VCIND患者的認知功能損害是局灶性的或記憶相對保留，不足以引起嚴重的功能障礙，隨時間推移和病情發(fā)展，大多數(shù)VCIND將發(fā)展為血管性癡呆(VD)。由于在VCIND階段，有多種可干預的危險因素存在，，早期發(fā)現(xiàn)并在日常生活受到影響前進行干預，可避免發(fā)展到不可逆的VD晚期階段。簡易精神狀態(tài)量表（Mini-menta1State Examination，MMSE)是一種被臨床醫(yī)生使用最廣泛的認知功能障礙篩查量表，但很多已達到VCI診斷標準的患者，其MMSE得分仍在正常范圍。MMSE敏感性較差，漏診率高。目前MoCA在國內(nèi)多是用于篩查、評估有輕度認知功能障礙(MCI)的患者，有較高的敏感性，但MoCA在VCIND患者中的應用研究較少。本研究主要探討兩種評估量表的差別及優(yōu)缺點，以選擇敏感度和特異度更高的神經(jīng)心理學評估量表作為快速篩查有非癡呆型血管性認知功能障礙患者的工具。目前認為，VCI發(fā)病可能是在多種機制的共同作用下引起的，炎性因素在其中扮演著重要的角色。一些炎性因子在腦脊液和血液中的水平變化與VCI可能有一定的相關性。C-反應蛋白(CRP)為炎癥時的急性時相蛋白，是臨床最顯著的炎癥標記物。因此，檢測相關炎性標志物并進一步了解其在認知損害中的作用，有助于VCI患者的早期防治。近年來的研究發(fā)現(xiàn)葉酸、Vitamin B12與血管性認知障礙有關。葉酸及Vitamin B12與VCI的關系及其作用國內(nèi)外文獻報道較少，而且結(jié)果、結(jié)論不一致。本文旨在探討CRP、葉酸及Vitamin B12與無癡呆型血管性認知障礙的相關性。目的探討MOCA與MMSE的特點，選擇敏感度和特異度更高的量表作為篩查VCIND的工具；探討CRP、葉酸及Vitamin B12與VCIND的相關性。方法2011年12月至2012年12月在蘇州大學附屬第二醫(yī)院神經(jīng)內(nèi)科住院及門診患者80例，其中VCIND患者41例和性別、年齡和文化程度相匹配的正常對照39例(normal control, NC)完成一系列神經(jīng)心理學測驗，包括總體認知水平、記憶力、注意力、命名、視覺空間能力、執(zhí)行功能等各個認知領域，比較兩組認知功能的差異。神經(jīng)心理學測驗包括簡易精神狀態(tài)量表（Mini-menta1State Examination，MMSE)和蒙特利爾認知量表(Montreal cognitive assessment，MoCA)。兩組患者均于晨時抽取空腹血標本送我院檢驗科檢測患者C-反應蛋白，血清葉酸和Vitamin B12水平。所有入選對象對試驗方案均知情同意，并且通過倫理委員會批準。結(jié)果1. MMSE、MoCA總分在VCIND組和NC組都呈高度相關性，VCIND組r=0.897p<0.01； NC組r=0.883p<0.01； VCIND組MMSE評定總分低于NC組(22.57±4.21vs27.32±3.66)，MoCA評定總分也低于NC組(20.12±4.17vs25.08±4.41)；MoCA各項目得分中，VCIND組在視空間與執(zhí)行功能、注意、延遲記憶、定向四個方面低于NC組(p>0.05)。2. NCIND組患者C-反應蛋白較NC組高，血清葉酸和VtimaniB12水平較NC組低。結(jié)論：1.MOCA量表中文版較MMSE量表用于篩查VCIND患者具有較高的特異度和敏感度，是篩查VCIND患者的較好的評估量表。2.血清C-反應蛋白濃度升高，血清葉酸、維生素B12缺乏與VCIND具有相關性，對VCIND患者的輔助診斷具有參考價值。

    Background Vascular cognitive impairment(VCI) include all levels of cognitivedecline resulting from cerebrovascular disease (CVD) or risk factors for CVD, rangingfrom mild deficits in one or more cognitive domains to a broad dementia-likesyndrome.Three broad clinical subtypes are included: vascular cognitive impairment nodementia(VCIND), vascular dementia (VD) and mixed dementia (MD). VCI cases that donot meet the criteria for dementia can also be labeled as vascular cognitive impairment nodementia(VCIND). With the time and progression of disease,the most patients of VCINDmay develop to vascular dementia (VD).In the stage of VCIND there are many risk factorswhich can be intervened, so to early discover cognitive impairment before daily life iseffected and to interfere in it may avoid the late stage of VD.MMSE (Mini-menta1State Examination, MMSE) is the most widely used screeningscale of cognitive function disorder for clinician. A lot of patients have reached theVCI,but the MMSE score is in the normal range. The sensitivity of MMSE is low, the rateof misdiagnosis is high.MoCA have high sensitivity for screening and assessing patientswith mild cognitive impairment (MCI), but MOCA used for patients with VCIND is less.This study investigates the differences, advantages and disadvantages of the two scales, toselect a higher degree of sensitivity and specificity of neuropsychological assessment scaleas a rapid screening tool of vascular cognitive impairment no dementia(VCIND).Currently,VCI disease may be caused by the combined effect of a variety ofmechanism, and the inflammatory factor play an important role. Some inflammatoryfactors may have some relevance in the cerebrospinal fluid and blood levels with VCI.C-reactive protein (CRP) is the acute phase proteins of inflammation，and it is the mostsignificant clinical markers of inflammation.Therefor,detecting the inflammatory markers and learning more about its role in the cognitive impairment, contribute to prevent andtreat the patients with VCI early. The recent studies have found that folic acid, VitaminB12have relation with VCI. The relations and role of folic acid and Vitamin B12with VCIreported in the literature is less,the results and conclusions is inconsistent. This article aimsto explore the relevance of the CRP, folic acid and Vitamin B12with VCI.Objective To investigate the characteristics of MOCA and MMSE, select the highersensitivity and specificity scale as a screening tool for VCIND; to explore the relevance ofCRP, folic acid and Vitamin B12with VCIND.Method December2011to December2012, the Second Affiliated Hospital ofSoochow University Department of Neurology, inpatient and outpatient patients with80cases, including39cases of patients with VCIND41cases and gender, age andeducation-matched normal control (NC) completed a series of neuropsychological tests,including the overall level of cognitive, memory, attention, naming, differences invisual-spatial ability, executive function and other cognitive domains were comparedcognitive function.Neuropsychological tests, including the Mini-Mental State Examination(MMSE) and Montreal Cognitive Assessment (MoCA).Patients in both groups fastingblood samples in the morning were sent to our hospital clinical laboratory testing inpatients with C-reactive protein, serum folate and vitamin B12level. All selected objectson the pilot program, informed consent, and approved by the Ethics Committee.Results (1)Totle scores of MoCA were correlated with that of MMSE,(VCINDgroup r=0.897，p<0.01;NC group r=0.883, p<0.01); The scores of MoCA’s subitems werecorrelated with totle scores of MoCA; The totle scores of MMSE in VCIND group werelower than the NC group,(22.57±4.21vs27.32±3.66);The totle scores of MoCA inVCIND group were lower than the NC group (20.12±4.17vs25.08±4.41);Some sub-itemscore of MoCA in VCIND group were lower than the NC group.In VCIND group,the scoreof Visuospatial/Executive,Abstraction subitem,Delayed recall and Orientation were lowerthan the NC group.(p<0.05)(2) Compared with NC group,C-reactive protein of NCIND group increased,folateand vitamin B12reduced.Conclusion1.The sensitivity and Specificity of MOCA is higher than MMSE forscreening patients with VCIND, it can be used as a good scale for screening patients withVCIND. 2.C-reactive protein, folic acid and vitamin B12have a correlation with the VCIND,ithas a reference value for the diagnosis of patients with VCIND.

非癡呆型血管性認知障礙患者MMSE與MoCA評分比較及其與C-反應蛋白、葉酸、維生素B12的相關性研究

中文摘要4-6Abstract6-8引言10-13    參考文獻12-13資料與方法13-16結(jié)果16-20討論20-27參考文獻27-31結(jié)論31-32附錄32-35綜述35-45    參考文獻42-45研究生期間發(fā)表的論文45-46致謝46-47

  本文關鍵詞：非癡呆型血管性認知障礙患者MMSE與MoCA評分比較及其與C-反應蛋白、葉酸、維生素B12的相關性研究，由筆耕文化傳播整理發(fā)布。