本文選題：阿爾茨海默病 + 輕度認(rèn)知功能損害　； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:認(rèn)知功能障礙是指多個認(rèn)知域發(fā)生的障礙,認(rèn)知域包括定向力、記憶力、計(jì)算力、執(zhí)行力、理解判斷力等。癡呆是其中一種損害范圍廣泛、臨床癥狀較重的認(rèn)知功能障礙類型,其高發(fā)病率和高致殘率越來越引起人們的重視。阿爾茨海默病(Alzheimer's disease,AD)是最常見的一種癡呆類型,早期僅表現(xiàn)為記憶力的下降,后期才會出現(xiàn)全面性的認(rèn)知功能損害。由于中晚期AD已嚴(yán)重影響患者的生存質(zhì)量,而目前對中晚期AD又缺乏有效的治療措施,因此,對AD的早期發(fā)現(xiàn)及干預(yù)成為醫(yī)學(xué)界研究的焦點(diǎn)。既往關(guān)于AD的研究發(fā)現(xiàn),AD患者在表現(xiàn)為臨床癡呆前已經(jīng)出現(xiàn)一定程度的病理改變,在此前提下,人們提出輕度認(rèn)知功能損害(mild cognitive impairment,MCI)的概念。MCI以記憶力減退為主要臨床癥狀,但未達(dá)到癡呆的診斷標(biāo)準(zhǔn),是介于AD與正常人之間的過渡狀態(tài),海馬是其病理改變早期常累及的部位,當(dāng)海馬結(jié)構(gòu)(hippocampal formation,HPF)損害到一定程度時,則會出現(xiàn)海馬體積(hippocampal volume,HV)的變化。研究表明,海馬與記憶密切相關(guān),尤其是對近記憶力影響顯著,因此,HV測量在認(rèn)知功能損害中的診斷價值引起人們的高度關(guān)注。本研究通過3.0T磁共振成像(magnetic resonance imaging,MRI)測量HV,分析AD、MCI患者與正常人HV的區(qū)別以及其與臨床指標(biāo)的相關(guān)關(guān)系等,探討HV在認(rèn)知功能損害中的臨床應(yīng)用價值。方法:選擇2013年3月至2014年12月在我院神經(jīng)內(nèi)科門診就診及住院的認(rèn)知功能障礙患者及正常老年人作為研究對象,根據(jù)患者臨床查體及神經(jīng)心理學(xué)量表篩選出AD組、MCI組和正常對照組(normal control,NC),共90例,均為右利手。其中,男性48名,女性42名,年齡位于65-80歲之間,平均年齡為72.34±3.95歲。AD組符合美國神經(jīng)病學(xué)、語言障礙和卒中-老年性癡呆和相關(guān)疾病學(xué)會(NINCDS-ADRDA)診斷標(biāo)準(zhǔn),MCI組符合Petersen等1999年制定的標(biāo)準(zhǔn)。收集所有受試者癡呆的危險因素,在無禁忌的情況下,行常規(guī)3.0T MRI(包括T1W1、T2W1、FLAIR和DWI),除外顱內(nèi)腫瘤、腦積水及多發(fā)梗塞等疾病,對符合條件者行海馬斜冠狀位掃描。海馬邊界參考Watson等的定界方法,完成掃描后,在重建的圖像上手動勾畫海馬邊界、計(jì)算HV,并對所測得的HV進(jìn)行標(biāo)準(zhǔn)化處理。為確保結(jié)果的準(zhǔn)確性,每位患者HV均由同1位影像科技師測量完成。通過綜合分析AD組、MCI組和NC組HV及臨床一般資料(簡易精神狀態(tài)量表評分(mini-mental state examination,MMSE)、血脂、血糖、同型半胱氨酸(homocysteine,Hcy)等),評價HV測量在認(rèn)知功能損害中的應(yīng)用價值。應(yīng)用SPSS13.0統(tǒng)計(jì)軟件對所有數(shù)據(jù)行統(tǒng)計(jì)學(xué)分析,計(jì)量資料比較采用方差分析和非參數(shù)檢驗(yàn),各指標(biāo)間相關(guān)分析采用Spearman相關(guān)分析。結(jié)果:1一般資料90例受試者中,AD組、MCI組和NC組各30例,3組年齡、性別、受教育年限的分布差異,經(jīng)統(tǒng)計(jì)學(xué)分析均無統(tǒng)計(jì)學(xué)意義(P0.05)。2 MMSE評分AD組、MCI組和NC組3組MMSE評分分別為19.97±4.27分、27.30±2.32分、29.10±1.12分。3組MMSE評分兩兩比較,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。3標(biāo)準(zhǔn)化后HV AD組左右兩側(cè)及總HV分別為3.005±0.417cm3、3.135±0.376cm3、6.141±0.791cm3;MCI組左右兩側(cè)及總HV分別為3.202±0.193cm3、3.313±0.203cm3、6.515±0.394cm3;NC組左右兩側(cè)及總HV分別為:3.377±0.302cm3、3.477±0.318cm3、6.854±0.619cm3。AD組、MCI組和NC組3組兩兩比較,左右兩側(cè)及總HV均具有統(tǒng)計(jì)學(xué)差異(P0.05)。4標(biāo)準(zhǔn)化后HV與MMSE評分相關(guān)關(guān)系所有受試者左右兩側(cè)和總HV分別與MMSE評分進(jìn)行相關(guān)分析,三者均呈正相關(guān)關(guān)系(r=0.520,P0.05;r=0.510,P0.05;r=0.519,P0.05)。5生化指標(biāo)AD組、MCI組和NC組3組血脂、血糖及其他生化指標(biāo)經(jīng)統(tǒng)計(jì)學(xué)分析均無統(tǒng)計(jì)學(xué)差異(P0.05)。3組Hcy水平兩兩比較,均具有統(tǒng)計(jì)學(xué)差異(P0.05)。標(biāo)準(zhǔn)化后HV與Hcy水平之間相關(guān)關(guān)系所有受試者左右兩側(cè)和總HV與Hcy水平均不具有相關(guān)關(guān)系。所有受試者M(jìn)MSE評分與Hcy水平呈負(fù)相關(guān)關(guān)系(r=-0.438,P0.05)。結(jié)論:1 MRI作為無創(chuàng)性診斷技術(shù),是HV測量的最佳工具之一。2 HV的變化可早期體現(xiàn)患者認(rèn)知功能狀態(tài),同時可作為評估患者認(rèn)知功能損害程度的重要依據(jù)。3 HV測量聯(lián)合MMSE評分,可更準(zhǔn)確的為MCI、AD患者早期診斷和治療提供客觀依據(jù)。4 Hcy可能為認(rèn)知功能損害的危險因素之一。
[Abstract]:Objective: cognitive dysfunction refers to the obstacles in multiple cognitive domains. Cognitive domains include orienteering, memory, computational power, execution, and understanding judgment. Dementia is one of the types of cognitive impairment which has a wide range of impairment and severe clinical symptoms, and its high incidence and high disability rate have attracted more and more attention. Alzheimer's disease (AD) is the most common type of dementia. Early memory only shows a decline in memory, and comprehensive cognitive impairment appears in the later period. Since intermediate and late AD has seriously affected the patient's quality of life, and at present, there is no effective treatment for middle and late AD. Therefore, early detection and intervention of AD has become a result. The focus of medical research. A previous study of AD found that AD patients showed a certain degree of pathological changes before clinical dementia. On this premise, people proposed that the concept of mild cognitive impairment (mild cognitive impairment, MCI).MCI was the main clinical symptom in memory reduction, but did not reach the diagnostic criteria for dementia. It is a transitional state between the AD and the normal people. The hippocampus is an early part of its pathological changes. When the hippocampal formation (HPF) is damaged to a certain extent, the hippocampal volume (hippocampal volume, HV) changes. The study shows that the hippocampus is closely related to memory, especially to memory. Therefore, the diagnostic value of HV measurement in cognitive impairment causes people's attention. This study uses the 3.0T magnetic resonance imaging (magnetic resonance imaging, MRI) to measure HV, analyzes the difference between AD, MCI patients and normal HV, and its correlation with clinical indicators, and discusses the clinical value of HV in cognitive impairment. Methods: the subjects were selected from March 2013 to December 2014 in the outpatient department of Neurology Department of Department of Neurology and hospitalized cognitive impairment patients and normal elderly people. According to the patients' clinical examination and neuropsychological scale, AD group, MCI group and normal control group (normal control, NC) were selected, all 90 cases were right hand. Among them, 48 men, women 42, between the age of 65-80 years, and the average age of 72.34 + 3.95 years old, group.AD conforms to American neurology, language disorders and stroke - Alzheimer's and related disease association (NINCDS-ADRDA) diagnostic criteria, and the MCI group conforms to the standards established in 1999, such as Petersen. Rules 3.0T MRI (including T1W1, T2W1, FLAIR and DWI), except intracranial tumor, hydrocephalus and multiple infarction, and other diseases such as intracranial tumor, cerebral hydrocephalus and multiple infarction. The boundary of hippocampal oblique coronal scan, hippocampal boundary reference Watson and so on were performed. After completing the scan, the sea horse boundary was manually outlined on the reconstructed image, HV was calculated, and the measured HV was standardized. To ensure the accuracy of the results, each patient's HV was measured by the same 1 image technicians. Through the comprehensive analysis of group AD, group MCI and NC, HV and clinical general data (simple mental state scale score (Mini-Mental State Examination, MMSE), blood lipids, blood sugar, homocysteine (homocysteine, Hcy), etc.), to evaluate the cognitive impairment in HV measurement. SPSS13.0 statistical software was applied to statistical analysis of all data. The measurement data were compared with variance analysis and non parametric test, and the correlation analysis between each index was analyzed by Spearman correlation analysis. Results: 1 general data of 90 subjects, group AD, group MCI and NC group were 30 cases, 3 groups of age, sex, and the distribution of years of education. The difference was not statistically significant (P0.05).2 MMSE score AD group. The 3 groups of MMSE scores in group MCI and NC group were 19.97 + 4.27, 27.30 + 2.32, 29.10 + 1.12,.3 group MMSE score 22, the difference was statistically significant (P0.05).3 after the standardization of the two sides of HV .141 + 0.791cm3; the left and right sides of group MCI and total HV were 3.202 + 0.193cm3,3.313 + 0.203cm3,6.515 + 0.394cm3 respectively. The left and right sides of the NC group and the total HV were 3.377 + 0.302cm3,3.477 + 0.318cm3,6.854 + 0.619cm3.AD groups respectively. The correlation analysis between the left and right sides and the total HV of all subjects and the total HV were analyzed with the MMSE score respectively. All the three were positive correlation (r=0.520, P0.05; r=0.510, P0.05; r=0.519, P0.05).5 biochemical index AD group, MCI group and NC group 3 groups of blood lipids, blood sugar and other biochemical indexes were not statistically different (22). There was statistical difference (P0.05). The correlation between HV and Hcy level after standardization was not related to all subjects on both sides and the total HV and Hcy level. The MMSE score of all subjects was negatively correlated with the Hcy level (r=-0.438, P0.05). Conclusion: 1 MRI as a non-invasive diagnostic technique, is one of the best tools for HV measurement.2 The changes can early reflect the state of cognitive function of patients, and can be used as an important basis for assessing the degree of cognitive impairment of patients with.3 HV measurement of combined MMSE score, which can provide an objective basis for the early diagnosis and treatment of MCI and AD patients with an objective basis for the possible risk factors of cognitive impairment by.4 Hcy.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R749.1

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