本文關(guān)鍵詞：血管狹窄對(duì)腦白質(zhì)疏松患者認(rèn)知功能的影響　出處：《安徽醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

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【摘要】：背景與目的隨著人口的不斷老齡化和影像學(xué)技術(shù)的發(fā)展,腦白質(zhì)疏松(LA)逐漸受到人們的關(guān)注。目前認(rèn)為L(zhǎng)A不僅與認(rèn)知功能損害密切相關(guān),同時(shí)也是腦卒中的獨(dú)立危險(xiǎn)因素。LA一直被認(rèn)為是小血管病變所致,但近年來(lái)越來(lái)越多的研究認(rèn)為L(zhǎng)A與大血管病變也密切相關(guān)。LA患者多存在以執(zhí)行和注意功能受損為主的多領(lǐng)域認(rèn)知功能損害,但對(duì)于這種高級(jí)功能的損害與大血管狹窄之間的關(guān)系鮮有報(bào)道。本文擬通過(guò)對(duì)LA患者的白質(zhì)疏松等級(jí)及血管狹窄程度進(jìn)行評(píng)價(jià),探討LA患者血管狹窄與認(rèn)知功能之間的關(guān)系。材料與方法選擇2013年9月至2014年6月于安徽醫(yī)科大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科門(mén)診和住院的LA患者101例,按照認(rèn)知功能損害不同分為皮質(zhì)下血管性認(rèn)知功能損害(SVCI)組(n=54)及認(rèn)知功能正常(NC)組(n=47),采用包括簡(jiǎn)易智能精神狀態(tài)量表(MMSE)、劍橋老年認(rèn)知功能評(píng)估量表-中文版(CAMCOG-C)以及蒙特利爾量表(Mo CA)等多項(xiàng)認(rèn)知功能量表評(píng)價(jià)認(rèn)知功能,使用3.0T頭顱MRI掃描并按照Fazekas的評(píng)分標(biāo)準(zhǔn)將白質(zhì)疏松嚴(yán)重程度分為3級(jí)(1級(jí)、2級(jí)、3級(jí)),應(yīng)用頭顱CT血管造影(CTA)或頭顱磁共振血管成像(MRA)對(duì)LA患者腦血管狹窄程度進(jìn)行評(píng)價(jià)。結(jié)果SVCI組LA等級(jí)及血管狹窄程度(2.0±0.8、2.6分±1.0分)均顯著高于NC組(1.1±0.6、2.0分±1.0分)(P=0.020,P=0.003);將LA患者按照白質(zhì)等級(jí)進(jìn)行分組后發(fā)現(xiàn),LA等級(jí)越高者,其血管狹窄程度越嚴(yán)重,認(rèn)知評(píng)分逐漸降低,且三組間MMSE(25分±4分、24分±6分、22分±4分)及CAMCOG-C(83分±14分、80分±14分、73分±14分)評(píng)分差異具有統(tǒng)計(jì)學(xué)意義(P=0.012,P=0.014)。同時(shí)為了進(jìn)一步探討LA等級(jí)、血管狹窄程度和認(rèn)知功能三者之間的關(guān)系,我們將LA患者M(jìn)MSE評(píng)分與各相關(guān)因素進(jìn)行相關(guān)分析,結(jié)果發(fā)現(xiàn)LA患者認(rèn)知功能與LA等級(jí)(r=-0.317,P=0.001)及血管狹窄程度(r=-0.284,P=0.004)均成顯著負(fù)相關(guān)。為進(jìn)一步探討LA患者認(rèn)知功能損害的相關(guān)危險(xiǎn)因素,我們進(jìn)行多元邏輯回歸分析后發(fā)現(xiàn),在控制性別、年齡、文化程度、高血壓、糖尿病及吸煙、飲酒等各項(xiàng)因素后LA等級(jí)(OR=2.025,95%CI=1.037~3.954)及血管狹窄程度(OR=1.812,95%CI=1.129~2.908)仍是LA患者認(rèn)知功能損害的危險(xiǎn)因素。結(jié)論血管狹窄和白質(zhì)疏松病變均與患者的認(rèn)知功能密切相關(guān),血管狹窄在與其他因素共同作用導(dǎo)致白質(zhì)病變的同時(shí),其本身也可能導(dǎo)致患者認(rèn)知功能下降。早期發(fā)現(xiàn)血管狹窄患者并進(jìn)行神經(jīng)介入等處理,不僅可減輕腦白質(zhì)病變,而且對(duì)改善患者認(rèn)知損害可能也具有較好遠(yuǎn)期作用,本研究結(jié)果也為防治血管性癡呆的發(fā)生提供了新的途徑。
[Abstract]:Background and objective with the aging of population and the development of imaging technology, leukoaraiosis (LAA) has attracted more and more attention. It is believed that LA is not only closely related to cognitive impairment. It is also an independent risk factor for stroke. La has been considered to be the result of small vascular disease. However, in recent years, more and more studies believe that LA is also closely related to macrovascular disease. LA patients have multi-domain cognitive impairment, which is mainly caused by impairment of executive and attention function. However, there are few reports on the relationship between the damage of advanced function and the stenosis of large vessels. This article intends to evaluate the grade of leukoaraiosis and the degree of vascular stenosis in patients with LA. To explore the relationship between vascular stenosis and cognitive function in LA patients. Materials and methods LA patients were selected from September 2013 to June 2014 in Department of Neurology, Department of Neurology, first affiliated Hospital of Anhui Medical University. 101 cases. Patients with subcortical vascular cognitive impairment were divided into subcortical vascular cognitive impairment (SVCI) group (n = 54) and normal cognitive function group (n = 47) according to cognitive impairment. MMSE was used to measure mental state including simple mental state. The Chinese version of the Cambridge scale for the Assessment of Cognitive function for the elderly (CAMCOG-C) and the Montreal scale (MOCA) were used to evaluate the cognitive function. The severity of leukoaraiosis was divided into 3 grades (grade 1, grade 1, grade 2, grade 3) by MRI scan of 3.0T head and according to the standard of Fazekas. The degree of cerebral vascular stenosis in patients with LA was evaluated by using CT angiography (CTAA) or magnetic resonance angiography (MRAA). Results the grade of LA and the degree of stenosis were evaluated in SVCI group (P < 0.05). 2.0 鹵0.8. The scores of 2.6 鹵1.0) were significantly higher than those of NC group (1.1 鹵0.6 鹵2.0 鹵1.0). The patients with LA were classified according to the white matter grade. The higher the grade of LA, the more severe the stenosis and the lower the cognitive score, and the MMSE was (25 鹵4, 24 鹵6) between the three groups. The scores of 22 鹵4), CAMCOG-C(83 鹵14, 80 鹵14 and 73 鹵14) were significantly different (P < 0.012). In order to further study the relationship among LA grade, vascular stenosis and cognitive function, we analyzed the correlation between the MMSE score of LA patients and the relevant factors. The results showed that the cognitive function of the patients with LA was related to the grade of LA (r = 0.317P = 0.001), and the degree of stenosis was r = -0.284. In order to further study the risk factors of cognitive impairment in LA patients, we conducted multivariate logistic regression analysis and found that control gender, age, and education level. After hypertension, diabetes, smoking and drinking, the LA grade was 2.025 ~ 95 CI 1.037 ~ 3.954) and the degree of stenosis was 1.812. Conclusion Vascular stenosis and leukoaraiosis are closely related to cognitive function in patients with LA. Vascular stenosis, together with other factors, may lead to white matter lesions, but also may lead to cognitive decline in patients. Early detection of vascular stenosis patients and nerve intervention and other treatment. Not only can reduce the white matter lesions, but also improve the cognitive impairment of patients may have a good long-term effect, this study also provides a new way to prevent and treat vascular dementia.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R743.3

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相關(guān)期刊論文 前1條

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本文編號(hào)：1414812