本文選題：癡呆 + 屏氣指數(shù)��； 參考：《南華大學》2013年碩士論文

【摘要】：目的：（1）探討阿爾茨海默病(Alzheimer Disease, AD)和血管性癡呆(Vas-cular dementia, VaD)患者屏氣指數(shù)及事件相關(guān)性血流的變化。（2）探討AD與V-aD患者膽堿酯酶抑制劑療效的腦血流動力學評價指標。 方法：收集2011年8月至2012年12月我院神經(jīng)內(nèi)科住院部及認知障礙門診診斷的癡呆患者72例，其中阿爾茨海默�。ˋD）組32例，血管性癡呆（VaD）組40例，同時選取同時期年齡匹配的健康體檢者42例作為對照組（normal cont-rols，NC）；采用經(jīng)顱多普勒儀（Transcranial Doppler, TCD）檢測三組受試者雙側(cè)大腦中動脈（Middle C-erebral Artery, MCA）平均血流速度（Mean blood flo-w velocity, MFV）、搏動指數(shù)（Pulsatility Index, PI），并通過屏氣實驗計算三組受試者雙側(cè)MCA屏氣指數(shù)(B-reath holding index, BHI)；記錄三組受試者默讀前后雙側(cè)MCA MFV，計算事件相關(guān)性血流變化百分率（Percent change of blood fl-ow velocity, pCBFV）。給予癡呆患者服用膽堿酯酶抑制劑（安理申）進行治療12周后再次以簡易精神狀態(tài)量表（Mini-Mental State Examination, MMSE）行神經(jīng)心理學評分并采集TCD血流參數(shù)資料作為統(tǒng)計分析指標。 結(jié)果：1、AD組和VaD組合并高血壓病、糖尿病及腦卒中的比例高于NC組（P0.05），而在吸煙史、飲酒史、冠心病及高脂血癥的比例上三組差異無統(tǒng)計學意義（P＞0.05）。 2、服藥前三組受試者神經(jīng)心理學評分比較：AD組及VaD組MMSE分值均低于NC組，差異具有統(tǒng)計學意義（P＜0.05），AD組及VaD組間MMSE分值差異無統(tǒng)計學意義（P＞0.05）。 3、服藥前三組受試者TCD血流參數(shù)比較：AD組及VaD組MFV、BHI值均低于NC組，差異具有統(tǒng)計學意義（P＜0.05），而AD組與VaD組比較MFV及BHI值無明顯差異（P＞0.05）；AD組及VaD組PI值高于NC組，差異具有統(tǒng)計學意義（P＜0.05），且VaD組PI值高于AD組，差異有統(tǒng)計學意義（P＜0.05）。AD組、VaD組平均pCBFV均低于NC組（P＜0.05），且AD組平均pCBFV亦低于VaD組（P＜0.05）；NC組左右兩側(cè)pCBFV比較差異有統(tǒng)計學意義（P＜0.05），右側(cè)低于左側(cè)；VaD組左右兩側(cè)pCBFV比較差異有統(tǒng)計學意義（P＜0.05），左側(cè)低于右側(cè)；AD組左右兩側(cè)pCBFV差異無統(tǒng)計學意義。 4、二組患者服藥后神經(jīng)心理學評分變化：與服藥前相比較，VaD組患者服藥后MMSE分值較服藥前有顯著性提高（P＜0.05），而AD組患者MMSE分值雖有所提高，但差異無統(tǒng)計學意義（P＞0.05）。 5、二組患者服藥后TCD血流參數(shù)變化：與服藥前相比較，二組患者服藥后MFV值及BHI值較服藥前均有顯著性提高（P＜0.05）。與服藥前同側(cè)相比，AD組服藥后左側(cè)及右側(cè)pCBFV值均較服藥前提高，差異有統(tǒng)計學意義（P＜0.05），而VaD組服藥后左側(cè)及右側(cè)pCBFV值雖有所提高，，但差異無統(tǒng)計學意義（P＞0.05）。 6、認知功能改善組及認知功能惡化組TCD血流參數(shù)比較：與認知功能惡化組比較，認知功能改善組BHI值及pCBFV值較高，差異有統(tǒng)計學意義（P＜0.05），而MFV值及PI值兩組間無差異（P＜0.05）。 7、相關(guān)性分析：△BHI、△pCBFV值與△MMSE分值呈正相關(guān)（P＜0.01），而△MFV、△PI值與△MMSE分值無明顯相關(guān)性（P＞0.05）。 結(jié)論：1、AD和VaD患者事件相關(guān)性血流的偏側(cè)化現(xiàn)象受損； 2、pCBFV、BHI可考慮列為評價膽堿酯酶抑制劑療效的重要參考指標。
[Abstract]:Objective: (1) to explore the changes of breath holding index and event related blood flow in patients with Alzheimer Disease (AD) and Vas-cular dementia (VaD). (2) to explore the cerebral hemodynamic evaluation index of the efficacy of cholinesterase inhibitors in AD and V-aD patients.
Methods: from August 2011 to December 2012, 72 patients with dementia diagnosed in the inpatient department of Neurology and the cognitive disorder clinic were collected, including 32 cases of Alzheimer's disease (AD), 40 cases of vascular dementia (VaD), and 42 cases of normal cont-rols (NC) as the control group. Transcranial Doppler (TCD) was used to detect the mean blood flow velocity (Mean blood flo-w velocity, MFV) and pulsatile index of the bilateral middle cerebral arteries (Mean blood flo-w, MCA) in three groups of subjects, and the three groups of subjects were calculated by the breath holding experiment, and the three groups were recorded. Before and after reading the bilateral MCA MFV, the participants calculated the percentage of event related blood flow (Percent change of blood fl-ow velocity, pCBFV). After 12 weeks of treatment for the dementia patients taking cholinesterase inhibitor (An Lishen), the neuropsychological score was followed by a simple mental state scale (Mini-Mental State Examination). The data of TCD blood flow parameters were used as the statistical analysis index.
Results: 1, the proportion of group AD and VaD combined with hypertension, diabetes and stroke was higher than that of group NC (P0.05), but there was no significant difference in the proportion of smoking history, drinking history, coronary heart disease and hyperlipidemia (P > 0.05).
2, the neuropsychological scores of the three groups before taking the medicine were compared: the MMSE scores in group AD and VaD were all lower than those in group NC (P < 0.05), and there was no statistical difference between AD and VaD groups (P > 0.05).
3, the TCD blood flow parameters in the three groups were compared: MFV and BHI in group AD and VaD were lower than those in group NC (P < 0.05), but there was no significant difference in MFV and BHI (P > 0.05) in AD and VaD groups (P > 0.05). The average pCBFV in group VaD (P < 0.05) was lower than that in group NC (P < 0.05), and the average pCBFV in group AD was also lower than that in group VaD (P < 0.05). The difference between the two sides of the NC group was statistically significant (0.05), and the right side was lower than that in the left side. The left and right side of the group had a statistically significant difference (0.05) and left side lower than the right side. There was no statistically significant difference between the two sides of pCBFV.
4, two groups of patients after taking medicine neuropsychological score changes: compared with the before taking medicine, the MMSE score of group VaD patients was significantly higher than before taking medicine (P < 0.05), while the MMSE score of group AD increased, but the difference was not statistically significant (P > 0.05).
5, two groups of patients after taking the TCD blood flow parameters changes: compared with the pre medication, the MFV value and BHI value of the two groups were significantly higher than before taking the medicine (P < 0.05). Compared with the ipsilateral before taking the medicine, the left and right pCBFV values of the AD group were higher than those before taking the medicine (P < 0.05), and the left and right after the VaD group took the medicine. Although the side pCBFV value increased, the difference was not statistically significant (P > 0.05).
6, the comparison of TCD blood flow parameters in the cognitive functional improvement group and the cognitive function deterioration group: compared with the cognitive function deterioration group, the BHI value and the pCBFV value of the cognitive functional improvement group were higher (P < 0.05), but there was no difference between the two groups of MFV and PI values (P < 0.05).
7, correlation analysis: Delta BHI, Delta pCBFV value is positively correlated with delta MMSE score (P < 0.01), while Delta MFV, Delta PI value has no significant correlation with delta MMSE score (P > 0.05).
Conclusion: 1, the lateralization of event related blood flow in AD and VaD patients is impaired.
2, pCBFV and BHI can be considered as important reference indicators for evaluating the efficacy of cholinesterase inhibitors.

【學位授予單位】：南華大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R749.13

【共引文獻】

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