【摘要】：目的探討缺血性小血管病(SVD)包括多發(fā)性腔隙性腦梗塞(MLI)和腦白質(zhì)病變(WML)與血管性癡呆(VD)的關(guān)系,為VD的預防、早期診斷和干預提供依據(jù)。 方法選取2010年4月至2011年4月寧夏自治區(qū)人民醫(yī)院神經(jīng)內(nèi)科住院及門診的腔隙性腦梗塞患者、腦白質(zhì)病患者及二者兼有的患者90例,所用病例診斷均符合全國第四屆腦血管疾病學術(shù)會議制定的診斷標準。確定患者是否存在高血壓、糖尿病、高脂血癥、吸煙、飲酒史,采用Hachinski缺血指數(shù)量表(HIS)、哈密爾頓抑郁量表(HAMD)等神經(jīng)心理學量表對患者進行評定。采用簡易精神量表(MMSE)和蒙特利爾認知評估量表(MoCA)對90例經(jīng)顱腦CT或顱腦MRI證實的SVD患者(單純MLI組35例、MLI+WML組31例、單純WML組24)和23例認知正常者進行檢測并分析比較。 結(jié)果(1)單純MLI組、MLI+WML組、單純WML組MoCA評分分別為(22.40±6.83)、(21.35±5.55)及(26.41±3.48),MMS評分分別為(24.20±6.07)、(24.11±4.95)及(26.91±3.02)。單純MLI組、MLI+WML組、單純WML組MoCA與MMSE總分均有正相關(guān)性(r=0.895,p=0.000；r=0.761,p=0.000；r=0.932,p=0.000)。 (2)MMSE評分顯示,與對照組比較,單純MLI組即刻記憶、短程記憶、物體命名、語言復述、閱讀理解、言語表達的分值均降低(均P0.05)：MLI+WML組時間定向、短程記憶、語言復述較對照組降低（均P＜0.05）；而單純WML組與對照組比較，各分值均無顯著差異（均P＞0.05）。單純MLI組與MLI+WML組比較，閱讀理解分值降低（P＜0.05）. （3）單純MLI組、MLI+WML組、單純WML組的MMSE評分在不同等級癡呆人數(shù)上有顯著差異（P＜0.05）。 （4）單純MLI組與MLI+WML組相比，各梗塞部位無顯著性差別（P＞0.05）。 （5）單純WML組與對照組logistic回歸顯示：高血壓病史（P=0.045，OR=5.158）糖尿病病史（P=0.032，OR=0.049）與腦白質(zhì)病變相關(guān)，其中高血壓病史對腦白質(zhì)病變影響大。結(jié)論單純MLI組、MLI+WML組、單純WML組三組患者MoCA與MMSE總分均呈正相關(guān)。三組患者中MLI+WML組最容易發(fā)生癡呆。缺血性小血管病變，，尤其單純MLI可引起認知損害，主要表現(xiàn)在時間定向、地點定向、即可記憶等亞項。單純WML者認知能力損害不明顯，但WML可能促使癡呆發(fā)生，其中高血壓對腦白質(zhì)病變影響最大。
[Abstract]:Objective to investigate the relationship between ischemic small vascular disease (SVD), including multiple lacunar infarction (MLI), white matter lesion (WML) and vascular dementia (VD), so as to provide evidence for the prevention, early diagnosis and intervention of VD. Methods from April 2010 to April 2011, 90 patients with lacunar cerebral infarction, patients with leukoencephalopathy and both were selected from Department of Neurology, Ningxia Autonomous region people's Hospital. The diagnosis of all the cases was in accordance with the diagnostic criteria set by the fourth National Conference on Cerebrovascular Diseases. To determine the existence of hypertension, diabetes, hyperlipidemia, smoking, drinking history, the Hachinski Ischemia Index (HIS), Hamilton Depression scale (HAMD) were used to evaluate the patients. (MMSE) and (MoCA) were used to detect and compare 90 patients with SVD confirmed by craniocerebral CT or craniocerebral MRI (35 patients with MLI alone, 31 with MLI WML and 24 with WML) and 23 patients with normal cognition. Results (1) MoCA scores in MLI group and WML group were (22.40 鹵6.83), (21.35 鹵5.55 and (26.41 鹵3.48), respectively (24.20 鹵6.07), (24.11 鹵4.95) and (26.91 鹵3.02), respectively. There was a positive correlation between the total score of MoCA and MMSE in the MLI WML group and WML group (r 0.895p 0.000 ~ 0.000) MMSE score showed that compared with the control group, the MLI group had immediate memory, short range memory, object naming, language repetition, reading comprehension. The scores of speech expression in the WML group were significantly lower than those in the control group (P < 0. 05), but there was no significant difference between the WML group and the control group (all P > 0. 05). Compared with MLI WML group, the score of reading comprehension in MLI group was significantly lower than that in MLI WML group (P < 0. 05). (3). The MMSE scores in MLI group and WML group were significantly different in the number of dementia of different grades (P < 0. 05). (4). The scores of MMSE in MLI group and MLI WML group were significantly lower than those in MLI WML group (P < 0. 05). There was no significant difference among the infarct sites (P > 0. 05). (5). The logistic regression analysis between the WML group and the control group showed that the history of hypertension (P0. 045) diabetes mellitus (P0. 032) was related to the white matter lesions, and the history of hypertension had a great influence on the white matter lesions. Conclusion there was a positive correlation between the total score of MoCA and MMSE in MLI group and WML group. Of the three groups, the MLI WML group was most likely to develop dementia. Ischemic small vascular lesions, especially MLI alone, can cause cognitive impairment, mainly manifested in time orientation, location orientation, memory and other subitems. Cognitive impairment was not obvious in patients with WML alone, but WML might promote dementia, and hypertension had the greatest effect on leukoencephalopathy.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R749.1

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