【摘要】：目的：輕度認知障功能障礙(mild cognitive impairment, MCI)是指多種原因導致的認知功能輕微受損,達不到癡呆水平,總體認知水平和日常生活能力基本正常的一種綜合征。常見的類型為遺忘型輕度認知障礙(amnestic mild cognitive impairment,aMCI)、非癡呆血管性認知損害(vascular cognitive impairment-no dementia, VCIND)。目前由于癡呆尚無有效的治療方法, MCI被認為是可識別可干預的癡呆早期階段,故成為研究的熱點。腦血管反應性(cerebrovascular reactivity,CVR)是腦微小血管自身通過血管舒張或收縮維持腦血流量穩(wěn)定的代償能力。有研究表明CVR損害與癡呆有關。屏氣指數(shù)(breath-holding index,BHI)是反映腦血管反應性(cerebrovascular reactivity,CVR)的重要指標。本研究試圖為TCD屏氣試驗測算BHI是否可能用于MCI的研究和aMCI與VCIND的鑒別提供參考依據(jù)。 方法：研究對象來源于自2011年3月至2011年12月常德市第一人民醫(yī)院神經(jīng)內科、老干科門診和住院病人及體檢中心。采用簡易精神狀態(tài)檢測(MMSE)和蒙特利爾認知評定(MoCA)量表聯(lián)合篩查MCI患者,分別按2010年中華醫(yī)學會制定的“輕度認知障礙的診斷和治療”指南及中國血管性認知功能損害專家共識標準診斷的aMCI和VCIND患者中,選取aMCI組30例、VCIND組30例。正常對照組30例,按年齡、性別及文化程度與病例組相匹配。對三組均進行TCD屏氣試驗。通過TCD監(jiān)測屏氣試驗前后雙側大腦中動脈的平均血流速度(mean blood flow velocity,MBFV),記錄流速趨勢圖及屏氣時間,計算相應屏氣時間的BHI。比較三組間MBFV、BHI、血管危險因素的特點,分析CVR與認知功能的關系。 結果：1、與正常對照組比較,aMCI組和VCIND組的BHI下降,差異有統(tǒng)計學意義(P0.001),而VCIND組與aMCI組比較,差異無統(tǒng)計學意義(P0.05)；aMCI組及VCIND組MBFV較正常對照組低,但各組組間比較,差異無統(tǒng)計學意義。2、BHI與MMSE、 MoCA呈正相關,MMSE、MoCA越高,BHI越高,有統(tǒng)計學意義(P0.001)。3、aMCI組及VCIND組的收縮壓、空腹血糖、總膽固醇、高密度脂蛋白、低密度脂蛋白、甘油三酯高于正常對照組,糖尿病多于正常對照組,差異有統(tǒng)計學意義(P0.05)。但aMCI組與VCIND組間比較差異無統(tǒng)計學意義(P0.05)。 結論：1、腦血管反應性受損可能與輕度認知障礙有關；2.TCD屏氣試驗不能鑒別(?)MCI和VCIND;3、TCD檢測BHI評價CVR對MCI患者的腦微小血管病變的早期發(fā)現(xiàn)有重要意義。
[Abstract]:Objective: mild cognitive impairment (mild cognitive impairment, MCI) is a kind of syndrome with mild impairment of cognitive function due to various causes, which can not reach the level of dementia, and the overall cognitive level and daily living ability are basically normal. The common type of amnesia was (amnestic mild cognitive impairmenta MCI, and (vascular cognitive impairment-no dementia with vascular cognitive impairment (VCIND). Because there is no effective treatment for dementia, MCI is considered to be a recognizable and interventional early stage of dementia, so it has become a hot research topic. Cerebrovascular reactivity is the compensatory ability of small cerebral vessels to maintain the stability of cerebral blood flow through vasodilation or contraction. Studies have shown that CVR damage is associated with dementia. Breath-holding index (BHI) is an important index to reflect cerebrovascular reactivity. This study is intended to provide a reference for the TCD breath-holding test to estimate whether BHI can be used in the study of MCI and the identification of aMCI and VCIND. Methods: the subjects of the study were from the Department of Neurology Department of the first people's Hospital of Changde City from March 2011 to December 2011. MCI patients were screened by MMSE and the Montreal Cognitive Assessment (MoCA) scale. According to the guidelines of "diagnosis and treatment of mild cognitive impairment" formulated by the Chinese Medical Association in 2010 and the Chinese expert consensus criteria for Vascular Cognitive impairment, 30 patients with AMCI and 30 patients with VCIND were selected. 30 cases of normal control group were matched with the case group according to age, sex and education level. TCD breath-holding test was performed in all three groups. The mean blood flow velocity of bilateral middle cerebral artery (mean blood flow velocity-MBFV) was monitored by (mean blood flow before and after breath-holding test, and the trend of flow velocity and breath-holding time were recorded, and the corresponding breath-holding time was calculated. The relationship between CVR and cognitive function was analyzed by comparing the characteristics of vascular risk factors between three groups. Results compared with the normal control group, the BHI of the two groups decreased significantly (P0.001), but there was no significant difference between the VCIND group and the aMCI group (P0.05), but the MBFV of the VCIND group and the VCIND group was lower than that of the normal control group, but there was no significant difference between the VCIND group and the VCIND group, but there was no significant difference between the VCIND group and the control group (P0.05), but there was no significant difference between the two groups. There was no significant difference between MMSE and MMSE, and there was a positive correlation between MMSE and MoCA. The higher the MoCA was, the higher the BHI was. The systolic blood pressure, fasting blood glucose, total cholesterol, high density lipoprotein, low density lipoprotein and triglyceride in VCIND group and VCIND group were higher than those in normal control group. Diabetes mellitus was more than normal control group, the difference was statistically significant (P0.05). However, there was no significant difference between aMCI group and VCIND group (P0.05). Conclusion: 1. Cerebral vascular reactivity impairment may be related to mild cognitive impairment. 2. TCD breath-holding test can not distinguish MCI from VCIND3TCD to evaluate CVR in the early detection of cerebral microvascular lesions in patients with MCI.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R749.1

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