本文選題：腦微出血 + 腔隙性腦梗死　； 參考：《山東大學(xué)》2015年博士論文

【摘要】：背景隨著醫(yī)療技術(shù)水平的不斷提高,人們的壽命也在逐漸延長。伴隨而來的是認(rèn)知功能下降的人群也有逐漸增加的趨勢,這將嚴(yán)重影響患者本人及其家屬的生活質(zhì)量,給家庭和社會增加非常大的負(fù)擔(dān)。目前核磁共振技術(shù)已經(jīng)非常成熟,人們借助MRI對腦小血管病(small vessel disease, SVD)有了更深的認(rèn)識。近年來提出了SVD的概念,研究發(fā)現(xiàn)其對認(rèn)知功能障礙(cognitive impairment, CI)有著促進(jìn)的作用,這引起了人們的格外重視。眾所周知,患者一旦發(fā)展至癡呆狀態(tài),即使精心護(hù)理也只能減緩病情的發(fā)展,而病程卻是不可逆的。SVD多指腔隙性腦梗死(lacunar infarction, LI)、腦微出血 (cerebral microbleeds, CMBs)以及腦白質(zhì)疏松(leukoaraiosis, LA)。其中,CMBs是如何使得認(rèn)知功能減退的呢?有沒有提前防治的措施?具體的發(fā)病機(jī)制又是怎樣?以往文獻(xiàn)絕大部分都是橫斷面的研究,至于其發(fā)展如何研究的較少。本研究應(yīng)用前瞻性研究方法對此進(jìn)行分析了CMBs對認(rèn)知功能的影響。目的通過對患者分組進(jìn)行多點(diǎn)評估比較,研究CMBs對認(rèn)知功能的影響,查找CMBs的危險因素,對一些可控的危險因素提前干預(yù),從而盡可能減少認(rèn)知障礙的發(fā)生,旨在為臨床工作提供理論參考。方法病例組選取2013.1-2013.12月一年內(nèi)在神經(jīng)內(nèi)科門診及病房、體檢中心就診的患者。根據(jù)入選及排除的條件,最后進(jìn)入CMBs組參四次評估者為68人,作為A組,根據(jù)CMBs分布位置A組再分為下列三個亞組：A1組：病灶在腦葉區(qū)及腦葉下的白質(zhì)區(qū)；A2組：病灶在基底節(jié)區(qū)、丘腦、胼胝體區(qū)的白質(zhì)、內(nèi)囊、外囊、腦干或小腦等深部腦區(qū)；A3組：病灶在腦葉區(qū)及深部腦區(qū)均有分布。116名腦MRI檢查無病灶者作為對照組B組。入組時,所有患者進(jìn)行一般資料登記,然后分別在入組時、3個月、6個月、12個月時采集血壓、血常規(guī)、血糖、血脂、同型半胱氨酸等數(shù)據(jù)信息,其中,血脂包括甘油三酯、總膽固醇、低密度脂蛋白膽固醇。同時,登記頸部血管B超、心電圖、頭部CT、顱腦MRI+磁敏感加權(quán)成像(susceptibility-weighted imaging, SWI)等數(shù)據(jù),采用簡易精神狀態(tài)評價量表(mini mental state examination, MMSE)、巴氏指數(shù)表和格拉斯哥昏迷評分表進(jìn)行評分并記錄。數(shù)據(jù)采集完成后,應(yīng)用統(tǒng)計軟件SPSS17.0對結(jié)果進(jìn)行統(tǒng)計學(xué)分析。其中,以單因素方差分析、重復(fù)測量方差分析、非參數(shù)檢驗處理計量資料,以卡方檢驗處理計數(shù)資料,并運(yùn)用Pearson線性相關(guān)、Spearman線性相關(guān)、Logistic回歸做相關(guān)回歸分析,設(shè)P0.05有統(tǒng)計學(xué)意義。結(jié)果1. MMSE低分組文化程度平均水平低于MMSE正常組,年齡平均水平高于后者,高血壓病、腦卒中史的患病率高于MMSE正常組,MMSE低分組中腦MRI合并有WMH、CMBs的比率高于MMSE正常組(P0.05)。2.A組平均年齡、男性所占比例高于B組(P0.05)；伴有高血壓、糖尿病、腦卒中病史和抗血栓藥物史的患者比例也高于B組(P0.05)；A組中合并LI、嚴(yán)重WMH的比例高于B組(P0.05)。3.通過對兩組患者進(jìn)行四次組間比較,發(fā)現(xiàn)A組中的A2、A3亞組MMSE總分及單項分中的注意力、計算力得分平均水平四次均低于B組(P0.05)；A3組的畫圖能力與B組四次比較均有顯著差異(P0.05)；A1組在6個月時語言能力得分低于B組,12個月時評估A1的MMSE總分、注意力及計算力、語言能力、圖案構(gòu)畫能力均低于B組(P0.05)。4.組內(nèi)比較：6個月時,A2組、A3組的MMSE總分和計算力、注意力得分,以及A2組中的延遲回憶得分均低于入組時水平(P0.05)；12個月時比較A組的三個亞組及B組的MMSE,總分、注意力和計算力得分、延遲回憶得分均較入組時有顯著減退,A組三個亞組的畫圖能力得分也顯著下降(P0.05)。5. Logistic回歸分析結(jié)果顯示年齡、性別、高血壓病史、腦卒中史為發(fā)生CMBs的危險因素。6. CMBs的數(shù)目與MMSE總分存在負(fù)相關(guān)(P0.001)；CMBs的分布部位與MMSE,總分相關(guān)(P0.05)；由腦葉區(qū)CMBs組至深部腦區(qū)CMBs組再至彌散分布CMBs組的順序,使得MMSE,總分的平均水平呈下降趨勢。結(jié)論1.存在CMBs的患者,尤其是深部腦區(qū)CMBs患者和彌散分布CMBs患者認(rèn)知功能受損明顯,其中,注意力、計算能力、延遲記憶力以及動手畫圖能力下降明顯,腦葉區(qū)的CMBs患者語言表達(dá)及執(zhí)行力受損明顯。2.患者的認(rèn)知功能隨著時間推移而逐漸減退,最早體現(xiàn)在注意力、計算力和延遲回憶的減退,其次為畫圖能力減退。CMBs可對認(rèn)知功能可以造成損害。其中位于深部腦區(qū)的CMBs,以及腦葉區(qū)和深部腦區(qū)均有分布的CMBs,對認(rèn)知功能的損害速度要快于單純腦葉區(qū)的CMBs。3.患者年齡越大,發(fā)生CMBs的風(fēng)險越大；有高血壓病史、腦卒中史的患者發(fā)生CMBs的風(fēng)險較沒有者風(fēng)險更大；男性發(fā)生CMBs的風(fēng)險高。4. CMBs的病灶越多,認(rèn)知功能減退的程度越嚴(yán)重；CMBs分布彌散的患者認(rèn)知損害最重,其次為深部CMBs組,再次為腦葉CMBs。
[Abstract]:Background as the level of medical technology continues to improve, people's life is also increasing, with a gradual increase in cognitive decline, which will seriously affect the quality of life of the patients themselves and their families, and add a great burden to the family and society. Now MRI technology is very mature, People have a deeper understanding of small vessel disease (SVD) with the help of MRI. In recent years, the concept of SVD has been proposed. Research has found that it has a promoting effect on cognitive dysfunction (cognitive impairment, CI), which has aroused great attention. It is well known that once the patient develops to dementia, even careful nursing is also known. It can only slow down the development of the disease, but the course is irreversible.SVD lacunar infarction (LI), cerebral microbleeds, CMBs, and leukoaraiosis (leukoaraiosis, LA). How do CMBs make cognitive function decrease? Are there any measures to prevent and cure early? The specific pathogenesis is What? Most of the previous literature is a cross-sectional study and less research on how it is developed. This study uses a prospective study method to analyze the effect of CMBs on cognitive function. Objective to study the effect of CMBs on the recognition function by multiple evaluation and comparison of the patients, and to find the risk factors of CMBs. Some controlled risk factors were intervened in advance so as to minimize the occurrence of cognitive impairment and to provide a theoretical reference for clinical work. Method case group selected patients in the Department of neurology outpatient and ward in 2013.1-2013.12 month, and the patients in the medical center. According to the conditions of admission and exclusion, the final four assessors of group CMBs were 68. People, as group A, were divided into three subgroups according to the CMBs distribution position A group: group A1: the focus was in the lobar region and the white matter under the lobe of the brain; group A2: the focus was in the basal ganglia, the thalamus, the corpus callosum white matter, the inner capsule, the outer capsule, the brain stem or the cerebellum, and the A3 group: the lesion was distributed in the brain and deep brain regions with.116 name MRI examination. The patients without focus were used as the control group B. When the group was enrolled, all the patients were registered with general data, then the blood pressure, blood routine, blood sugar, blood lipid, homocysteine and other data were collected for 3 months, 6 months and 12 months, respectively, and the blood lipid included glycerol three ester, total cholesterol, low density lipoprotein cholesterol. Blood vessel B-ultrasound, electrocardiogram, head CT, brain MRI+ magnetic sensitivity weighted imaging (susceptibility-weighted imaging, SWI) and other data, using a simple mental state assessment scale (mini mental state examination, MMSE), the pasteurized index table and the Glasgow coma scale. After the data collection was completed, the statistical software SPSS17.0 was applied. The results were analyzed statistically. Among them, a single factor analysis of variance, repeated measurement of variance analysis, non parameter test processing measurement data, chi square test processing counting data, and using Pearson linear correlation, Spearman linear correlation, Logistic regression analysis, P0.05 have statistical significance. Results 1. MMSE low group culture The average level was lower than the normal MMSE group, the age average level was higher than that of the latter, the incidence of hypertension and stroke history was higher than that of the normal MMSE group, and the ratio of MRI in the middle MMSE group was higher than that of the MMSE normal group (P0.05).2.A group (P0.05), and the proportion of men was higher than the B group (P0.05), with hypertension, diabetes, and stroke history. The proportion of patients with antithrombotic drugs was also higher than that in group B (P0.05); group A was combined with LI, and the proportion of severe WMH was higher than that of group B (P0.05).3. through four groups of two groups, A2 in the A group, A3 sub group and the attention of the single score. The average level of calculating power score was four times lower than that of the group. There were significant differences in the four times compared with the group B (P0.05); in group A1, the score of language ability was lower than that of group B at 6 months, and the total score of MMSE in A1 was evaluated at 12 months, and the ability of attention and calculation, language ability and pattern construction were lower than that in group.4. (P0.05) in group B: 6 months, A2 group, A3 group, total MMSE total and computational power, attention score, and group of attention. The score of delayed recollection was lower than that of the entry group (P0.05). At 12 months, the scores of MMSE, total, attention and computing power in three subgroups and B groups in group A were significantly lower than those in the group, and the score of drawing ability in three subgroups of group A decreased significantly (P0.05).5. Logistic regression analysis showed age and sex, The history of hypertension, the history of cerebral apoplexy was a risk factor for the occurrence of CMBs, the number of.6. CMBs was negatively correlated with the total MMSE score (P0.001); the distribution of CMBs was related to MMSE, the total score was related (P0.05), and the average level of the total score decreased from the CMBs group to the CMBs group in the deep brain region to the CMBs group in the diffuse distribution. Conclusion 1. existed. The cognitive impairment of patients with CMBs, especially in patients with CMBs in deep brain and diffuse distribution of CMBs, was significantly impaired, in which attention, computational ability, delayed memory, and hands-on drawing ability decreased significantly. The cognitive function of patients with.2. in the patients with CMBs in the lobar area decreased gradually, and the earliest decline in cognitive function of the patients with.2. was the earliest. The impairment of attention, computational power and delayed recall, followed by the impairment of drawing ability.CMBs, can cause damage to cognitive function. The CMBs in the deep brain region, and the CMBs in the brain and deep brain regions, are faster than the CMBs.3. patients in the single lobar area, and the greater the age of CMBs. The greater the risk for the patients with a history of hypertension and stroke history, the risk of CMBs was greater than that of those who did not; the more the risk of CMBs was higher in men, the more the focus of.4. CMBs, the more the degree of cognitive impairment was, the most severe cognitive impairment in the scattered patients with CMBs, followed by the deep CMBs group, and again the CMBs. of the brain lobe CMBs..
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R749.13

【共引文獻(xiàn)】

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本文編號：2020288