本文選題：無癡呆型血管性認(rèn)知障礙 + 蒙特利爾評(píng)估量表　； 參考：《蘇州大學(xué)》2013年碩士論文

【摘要】：背景血管性認(rèn)知障礙（vascular cognitive impairment, VCI）涵蓋了由腦血管病或腦血管病危險(xiǎn)因素引起的從輕度認(rèn)知障礙到癡呆的一大類綜合征，包括無癡呆型血管性認(rèn)知障礙（vascular cognitive impairment no dementia, VCIND）、血管性癡呆（vasculardementia, VD）和混合性癡呆。加拿大健康與衰老研究對(duì)10263名社區(qū)居民和住院患者為期5年的隨訪研究結(jié)果顯示，VCIND患者有46％進(jìn)展為癡呆，52％死亡，而且某些VCIND患者的癥狀可自動(dòng)改善，提示VCIND并非肯定會(huì)進(jìn)展為VD。VCIND是癡呆的臨床前期階段，早期識(shí)別和干預(yù)對(duì)癡呆的防治有著極為重要的意義。 目的研究VCIND的認(rèn)知損害特征，探討蒙特利爾認(rèn)知評(píng)估量表中文版（MontrealCognitive Assessment, MoCA）在蘇州地區(qū)VCIND人群中篩查的應(yīng)用價(jià)值，并與簡(jiǎn)易精神狀態(tài)量表（Mini-Mental State Examination, MMSE）進(jìn)行比較。 方法對(duì)92例蘇州地區(qū)的受試者進(jìn)行成套神經(jīng)心理學(xué)測(cè)試，包括視空間執(zhí)行功能、記憶力、命名、注意力等內(nèi)容，研究VCIND的認(rèn)知功能特點(diǎn)，并進(jìn)行MoCA和MMSE量表的比較。應(yīng)用受試者工作特征曲線（ROC）分析MoCA量表識(shí)別VCIND的最佳靈敏度和特異度，確定其最佳分界值。 結(jié)果VCIND組MoCA總平均分為（20.80±2.66）分，MMSE總平均分為（25.88±2.51）分，兩者呈高度相關(guān)，相關(guān)系數(shù)r為=0.711。受教育程度對(duì)MoCA得分有顯著影響，受教育年限≤9年者：MoCA評(píng)分除注意力和語言流暢性外，其余各分項(xiàng)在兩組間差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。受教育程度＞9年者：MoCA評(píng)分除注意力、計(jì)算力、定向力及語言流暢性外，其余各分項(xiàng)在兩組間差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。受教育程度≤9年者：MoCA的篩查最佳分界值為24/25分，此時(shí)篩查VCIND的敏感度為87.5%，特異度100%，MMSE篩查最佳分界值為26/27分，此時(shí)篩查VCIND的敏感度為68.8%，特異度100%；受教育程度＞9年者：MoCA的篩查最佳分界值為26/27分，此時(shí)篩查VCIND的敏感度為94.4%，特異度為70%，，MMSE的篩查最佳分界值為28/29分，此時(shí)篩查VCIND的敏感度為66.7%，特異度為80%。 結(jié)論 1．VCIND患者存在包括視空間執(zhí)行功能、記憶力、抽象思維、計(jì)算力等多個(gè)領(lǐng)域認(rèn)知功能的損害。 2．MoCA是篩查VCIND的一個(gè)簡(jiǎn)便、有效的工具，MoCA用于VCIND的篩查優(yōu)于MMSE。 目的研究無癡呆型血管性認(rèn)知障礙（VCIND）患者外周血炎性標(biāo)志物CD64指數(shù)、白介素-6（Interleukin-6, IL-6）、C反應(yīng)蛋白（C-reactive protein, CRP）等的變化特征，探討其與認(rèn)知障礙的關(guān)系，明確VCIND的血炎性標(biāo)志物。 方法共有92例受試者入選，其中無癡呆型血管性認(rèn)知障礙組（VCIND）50例，男性30例，女性20例，年齡（66.68±8.75）歲，受教育年限（9.52±2.87）年。認(rèn)知功能正常組（normal control, NC）42例，男性21例，女性21例，年齡（67.86±6.48）歲，受教育年限（11.00±2.91）年。對(duì)所有入選者采用流式細(xì)胞儀、免疫濁度法及血液分析儀分別測(cè)定其CD64指數(shù)和IL-6、CRP及白細(xì)胞計(jì)數(shù)和中性粒細(xì)胞比率，比較兩組之間各炎性指標(biāo)的差異，進(jìn)而對(duì)炎性指標(biāo)和認(rèn)知障礙的關(guān)系行Spearman相關(guān)分析。 結(jié)果與對(duì)照組相比，VCIND組CD64指數(shù)、IL-6、CRP、白細(xì)胞計(jì)數(shù)及中性粒細(xì)胞比率明顯增高，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05），VCIND組與NC組炎性指標(biāo)情況如下：CD64指數(shù)（0.30±0.77與0.23±0.71, P=0.000）；IL-6（3.84±1.17與2.24±0.76,P=0.000）；CRP（5.22±0.25與5.04±0.35, P=0.007）；白細(xì)胞計(jì)數(shù)（6.48±1.92與5.39±1.11,P=0.001）；中性粒細(xì)胞比率（70.24±8.17與58.16±7.38, P=0.000）。對(duì)炎性指標(biāo)和認(rèn)知障礙的關(guān)系行Spearman相關(guān)分析后發(fā)現(xiàn)，CD64指數(shù)、IL-6分別與MoCA評(píng)分呈顯著負(fù)相關(guān)（r=-0.803, P=0.000）、（r=-0.828, P=0.000），差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。 結(jié)論 炎癥反應(yīng)參與VCIND的病理過程，CD64指數(shù)及IL-6可能是VCIND的早期生物學(xué)標(biāo)志物。
[Abstract]:Vascular cognitive impairment (VCI) covers a large class of syndromes from the risk factors of cerebrovascular disease or cerebrovascular disease from mild cognitive impairment to dementia, including non dementia vascular cognitive impairment (vascular cognitive impairment no dementia, VCIND), vascular dementia (vasculardementia,) VD) and mixed dementia. The results of a 5 year follow-up study of 10263 community and hospitalized patients in the Canadian health and aging study showed that 46% of VCIND patients progressed to dementia, 52% died, and the symptoms of some VCIND patients could be improved automatically, suggesting that VCIND would not advance to VD.VCIND as a preclinical stage of dementia, Early identification and intervention are of great importance to the prevention and treatment of dementia.
Objective to study the cognitive impairment characteristics of VCIND, and to explore the application value of the Chinese version of the Montreal cognitive assessment scale (MontrealCognitive Assessment, MoCA) in the VCIND population of Suzhou, and to compare it with the simple mental state scale (Mini-Mental State Examination, MMSE).
Methods a complete set of neuropsychological tests were conducted in 92 Suzhou subjects, including visual spatial execution, memory, naming, attention and so on. The cognitive functions of VCIND were studied and compared with the MoCA and MMSE scales. The optimal sensitivity and specificity of the MoCA scale for the identification of VCIND were analyzed by using the subject work feature curve (ROC). Degree, determine its best dividing value.
Results the total average of MoCA in group VCIND was (20.80 + 2.66), and the total average of MMSE was (25.88 + 2.51). The correlation coefficient r was =0.711., the education degree had a significant influence on the score of MoCA, and the number of years of education was less than 9 years. The difference of the other sub items in the MoCA score was statistically significant in the two groups, except for attention and language flow. P < 0.05). The degree of education for more than 9 years: MoCA score, except attention, calculation, orientation and language fluency, was statistically significant between the two groups (P < 0.05). The best demarcation value of MoCA was 24/25, and the sensitivity of screening VCIND was 87.5%, specificity 100%, and MMSE screening most. The best demarcation value was 26/27 points, at this time the sensitivity of screening VCIND was 68.8%, and the specificity was 100%; the best demarcation value of MoCA was 26/27 score for 9 years of education. At this time, the sensitivity of screening VCIND was 94.4%, the specificity was 70%, and the best dividing line for MMSE was 28/29 points, and the sensitivity of VCIND screening was 66.7% and the specificity was 80%.
conclusion
1.VCIND patients suffer from cognitive impairment in many areas including visual spatial executive function, memory, abstract thinking and computational power.
2.MoCA is a simple and effective tool for screening VCIND. MoCA for VCIND screening is better than MMSE..
Objective to study the changes in the CD64 index of peripheral blood inflammatory markers, -6 (Interleukin-6, IL-6), C reactive protein (C-reactive protein, CRP) in patients with dementia free vascular cognitive impairment (VCIND), and to explore the relationship between them and cognitive impairment, and to clarify the inflammatory markers of VCIND.
Methods a total of 92 subjects were selected, of which there were 50 cases of dementia vascular cognitive impairment (VCIND), 30 men, 20 women, age (66.68 + 8.75) years, years of Education (9.52 + 2.87) years. The cognitive function normal group (normal control, NC) 42 cases, 21 men, 21 cases, age (67.86 + 6.48) years, years of education years. The CD64 index, IL-6, CRP, white blood cell count and neutrophil ratio were measured by flow cytometry, immunoturbidimetry and blood analyzer, and the differences of inflammatory indices between the two groups were compared, and the relationship between the inflammatory index and cognitive impairment was analyzed by Spearman correlation.
Results compared with the control group, the CD64 index, IL-6, CRP, white blood cell count and neutrophil ratio in the VCIND group were significantly higher, and the difference was statistically significant (P < 0.05). The inflammatory indices in group VCIND and NC were as follows: CD64 index (0.30 + 0.77 and 0.23 + 0.71, P=0.000); IL-6 (3.84 + 1.17 and 2.24 + 0.76, P=0.000); CRP (5.22 + 0.25 and 5.04 + 0.35,) P=0.007); leukocyte count (6.48 + 1.92 and 5.39 + 1.11, P=0.001); neutrophils ratio (70.24 + 8.17 and 58.16 + 7.38, P=0.000). After Spearman correlation analysis on the relationship between inflammatory indices and cognitive impairment, the CD64 index and IL-6 were significantly negatively correlated with MoCA score (r=-0.803, P=0.000), (r=-0.828, P=0.000), and the difference was statistically significant Learning significance (P < 0.05).
conclusion
Inflammatory reaction is involved in the pathological process of VCIND. CD64 index and IL-6 may be early biomarkers of VCIND.

【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】：2013
【分類號(hào)】：R749.16

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