本文關(guān)鍵詞：缺血性腦白質(zhì)病變與認(rèn)知功能、血漿熱休克蛋白70水平、步態(tài)的相關(guān)分析　出處：《安徽醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 缺血性腦白質(zhì)病變 認(rèn)知功能 熱休克蛋白70 步態(tài)

【摘要】：目的：探討不同程度缺血性腦白質(zhì)病變(WMIL)對認(rèn)知功能的影響及其與血漿熱休克蛋白70(HSP70)的相關(guān)性,同時,通過對不同程度WMIL者在單項任務(wù)和雙項任務(wù)下的步態(tài)參數(shù)的評估,探討WMIL、認(rèn)知功能與步態(tài)障礙的相關(guān)性。方法：根據(jù)頭顱MRI檢查結(jié)果,選取WMIL患者75例,根據(jù)Fazekas分級量表評分將WMIL患者分為輕度組、中度組和重度組。納入同期正常對照者40名作為對照組。應(yīng)用蒙特利爾認(rèn)知功能評估(MoCA)量表對研究對象進行認(rèn)知功能評估；通過足印法對研究對象在單、雙項任務(wù)下進行10m行走測試以評估步態(tài)變化；采用酶聯(lián)免疫吸附試驗(ELISA)測定研究對象血漿熱休克蛋白70 (HSP70)水平。結(jié)果：輕、中、重度WMIL患者的MoCA總分,視空間與執(zhí)行功能和延遲回憶評分明顯低于對照組(P0.05),而重度WMIL患者的計算力和注意力評分亦均低于對照組(P0.05); WMIL的Fazekas評分與MoCA評分呈負相關(guān)關(guān)系(r=-0.884,P0.05)。輕、中、重度WMIL患者的血漿HSP70濃度明顯高于對照組,差異具有統(tǒng)計學(xué)意義(P0.05); WMIL的Fazekas評分與血漿HSP70水平呈正相關(guān)關(guān)系(P0.05)。與對照組相比：單項任務(wù)下,中、重度WMIL者的步長縮短,步速減慢,步長的變異性和步寬的變異性明顯增大,差異均有統(tǒng)計學(xué)意義(P0.05),重度WMIL者步寬明顯增大,差異有統(tǒng)計學(xué)意義(P0.05)；雙項任務(wù)下,輕、中、重度WMIL者的步長明顯縮短、步速明顯減慢,步長的變異性和步寬的變異性明顯增大,差異均有統(tǒng)計學(xué)意義(P0.05)；中、重WMIL者步寬明顯增大,差異有統(tǒng)計學(xué)意義(P0.05)。與單任務(wù)相比,雙項任務(wù)下,輕、中、重度WMIL者的步長明顯縮短,步速明顯減慢,步寬、步長的變異性和步寬的變異性明顯增大,差異均有統(tǒng)計學(xué)意義(P＜0.05)。單、雙項任務(wù)下,WMIL者的步長、步速與WMIL的Fazekas評分呈負相關(guān)關(guān)系(P＜0.05),與MoCA評分呈正相關(guān)關(guān)系(P＜0.05)；步寬、步長的變異性和步寬的變異性與WMIL的Fazekas評分呈正相關(guān)關(guān)系(P＜0.05),與MoCA評分呈負相關(guān)關(guān)系(P＜0.05)。結(jié)論：WMIL患者存在認(rèn)知功能和步態(tài)障礙,且隨WMIL程度的增加,認(rèn)知功能損害及步態(tài)改變越明顯；雙項任務(wù)下10米行走測試有助于早期發(fā)現(xiàn)WMIL者的步態(tài)障礙與其認(rèn)知功能損害；WMIL者血漿HSP70水平增高,提示血漿HSP70可能在WMIL的發(fā)病中起一定作用。
[Abstract]:Objective: to investigate the effect of WMIL on cognitive function and its correlation with plasma heat shock protein 70 (HSP70). Through the evaluation of gait parameters of WMIL patients with different degrees under single task and double task, the correlation between cognitive function and gait dysfunction was discussed. Methods: according to the results of cranial MRI examination. 75 patients with WMIL were selected and divided into mild group according to Fazekas rating scale. In the moderate and severe groups, 40 normal controls were included as the control group. The subjects were assessed with the Montreal Cognitive function Assessment (MoCA) scale. The gait changes of the subjects were evaluated by walking test of 10 m under single and double tasks by the footmark method. The plasma levels of heat shock protein 70 (HSP70) were measured by Elisa. Results: the total score of MoCA in patients with mild, moderate and severe WMIL was measured. The scores of visual space, executive function and delayed recall were significantly lower than those of the control group (P 0.05), while the scores of computational power and attention in the patients with severe WMIL were lower than those in the control group (P 0.05). There was a negative correlation between Fazekas score and MoCA score in WMIL. The plasma HSP70 concentration in patients with severe WMIL was significantly higher than that in the control group (P 0.05). There was a positive correlation between the Fazekas score of WMIL and the level of plasma HSP70. Compared with the control group, the step length of the patients with moderate and severe WMIL was shorter than that of the control group. The variation of step length and step width increased obviously with the decrease of step speed, and the difference was statistically significant (P 0.05). In severe WMIL, the step width increased significantly, and the difference was statistically significant (P 0.05). Under two tasks, the step length of the patients with mild, moderate and severe WMIL was significantly shorter, the step speed was significantly slower, the variability of step length and step width were significantly increased, and the differences were statistically significant (P 0.05). Compared with the single task, the step length of the patients with moderate, moderate and severe WMIL was significantly shorter and the step speed was significantly slower than that of the single task. The variability of step width, step length and step width increased significantly (P < 0.05). There was a negative correlation between walking speed and Fazekas score of WMIL (P < 0.05) and a positive correlation with MoCA score (P < 0.05). The variability of step width, step length and step width was positively correlated with the Fazekas score of WMIL (P < 0.05). There was a negative correlation with MoCA score (P < 0.05). Conclusion there are cognitive dysfunction and gait dysfunction in patients with WMIL, and the more obvious changes of cognitive function and gait are with the increase of WMIL degree. The 10-meter walking test under two tasks was helpful for the early detection of gait disorders and cognitive impairment in patients with WMIL. The increase of plasma HSP70 level in patients with WMIL suggests that plasma HSP70 may play a role in the pathogenesis of WMIL.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R743.3

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