【摘要】：目的：探討腦血管病危險(xiǎn)因素血脂管理對VCI患者認(rèn)知功能的影響。 方法：選擇2013年4月~2014年1月在吉林大學(xué)第三臨床醫(yī)學(xué)院神經(jīng)內(nèi)一科門診及住院治療的60~70歲腦血管病患者136例，回顧性分析記錄既往10年吸煙史、飲酒史、家族史、血壓、血糖、血脂、腦血管病史以及其他影響血管性認(rèn)知障礙發(fā)生的可能情況，重點(diǎn)詢問十年內(nèi)患者血脂水平及管理狀況，，根據(jù)血脂管理情況結(jié)合目前血脂水平將患者分為血脂正常組（對照組）、血脂管理良好組、血脂管理不良組。三組患者均進(jìn)行蒙特利爾認(rèn)知評估量表（MoCA）評估。比較各組認(rèn)知障礙差別及認(rèn)知域損傷特征。檢測患者的血脂水平，包括空腹總膽固醇（TC）、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)和甘油三酯(TG)。對血脂管理不良組患者的血脂與損傷的認(rèn)知域進(jìn)行關(guān)聯(lián)性分析。 結(jié)果：血脂正常組、管理良好組和管理不良組三組之間年齡沒有統(tǒng)計(jì)學(xué)差異（P=0.658）；三組之間性別比較沒有統(tǒng)計(jì)學(xué)差異（P=0.248）；三組之間受教育年限也沒有統(tǒng)計(jì)學(xué)差異（P=0.220）。三組之間MoCA總分（P=0.013）、視空間與執(zhí)行得分（P=0.046）、注意力得分（P=0.020）和定向力得分（P=0.015）是有統(tǒng)計(jì)學(xué)差異的；三組之間命名得分（P=0.247）、復(fù)述得分（P=0.685）、語言流暢性（P=0.057）、抽象得分（P=0.457）和延遲回憶得分（P=0.256）是沒有統(tǒng)計(jì)學(xué)差異的。在管理不良組中，甘油三脂與MoCA總分之間存在負(fù)相關(guān)關(guān)系（P0.001）；甘油三脂與視空間與執(zhí)行得分之間存在負(fù)相關(guān)關(guān)系（P=0.006）；總膽固醇與MoCA總分之間存在負(fù)相關(guān)關(guān)系（P=0.010）；總膽固醇與注意力得分之間存在負(fù)相關(guān)關(guān)系（P=0.002）；低密度脂蛋白與MoCA總分之間存在負(fù)相關(guān)關(guān)系（P=0.005）；高密度脂蛋白與MoCA總分之間存在正相關(guān)關(guān)系（P=0.020）。 結(jié)論：1.長期血脂管理不良可影響患者認(rèn)知功能。2.血脂管理不良尤其對視空間、執(zhí)行能力、注意力及定向力影響明顯。3.甘油三脂越高，視空間障礙與執(zhí)行障礙越明顯；總膽固醇越高注意力障礙越明顯。4.早期干預(yù)腦血管病危險(xiǎn)因素是預(yù)防VCI的基本措施。
[Abstract]:Objective: to investigate the effect of lipid management on cognitive function of patients with VCI. Methods: from April 2013 to January 2014, 136 patients with cerebrovascular diseases aged 6070 years were enrolled in the Department of Neurology, Jilin University third School of Clinical Medicine from April 2013 to January 2014. The past 10 years of smoking, drinking, family history and blood pressure were retrospectively analyzed and recorded. Blood sugar, blood lipids, history of cerebrovascular disease and other possible conditions affecting vascular cognitive impairment were asked to focus on blood lipid levels and management status within 10 years. Patients were divided into normal group (control group), good blood lipid management group and poor blood lipid management group according to blood lipid management and current blood lipid level. Three groups of patients were assessed with Montreal Cognitive Assessment scale (MoCA). The difference of cognitive impairment and the characteristics of cognitive domain injury were compared. Blood lipid levels, including fasting total cholesterol, (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglyceride (TG)., were measured. The relationship between lipid and cognitive domain of patients with poor blood lipid management was analyzed. Results: there was no significant difference in age (P0. 658) among the three groups (P0. 658), but there was no statistical difference between the three groups (P0. 248). There was no significant difference in the number of years of schooling between the three groups (P0. 220). The total score of MoCA (P0. 013), the score of visual space and execution (P0. 046), the score of attention (P0. 020) and the score of orientation (P0. 015) were significantly different among the three groups. There were no statistical differences among the three groups in naming score (P0. 247), retelling score (P0. 685), language fluency (P0. 057), abstract score (P0. 457) and delayed recall score (P0. 256). In the poorly managed group, there was a negative correlation between triglyceride and total MoCA score (P0. 001), a negative correlation between triglyceride and visual space and executive score (P0. 006). There was a negative correlation between total cholesterol and total MoCA score (P0. 010), total cholesterol and attention score (P0. 002), low density lipoprotein (LDL-C) and total MoCA score (P0. 005). There was a positive correlation between high density lipoprotein and total score of MoCA (P0. 020). Conclusion 1. Long-term poor blood lipid management can affect the cognitive function of patients. 2. 2. Poor blood lipid management, especially on the visual space, executive ability, attention and orientation. 3. The higher the triglyceride, the more obvious the visual space disorder and the executive disorder, and the higher the total cholesterol, the more obvious the attention disorder. 4. Early intervention in risk factors of cerebrovascular disease is the basic measure to prevent VCI.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R749.13

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