本文選題：視神經(jīng)脊髓炎譜系疾病 + 多發(fā)性硬化　； 參考：《天津醫(yī)科大學(xué)》2015年博士論文

【摘要】：研究目的研究調(diào)查視神經(jīng)脊髓炎譜系疾病(neuromyelitis optica spectrum disorder,NMOSD)患者系統(tǒng)性癥狀:疲勞、睡眠障礙及認(rèn)知功能障礙。探討這些系統(tǒng)性癥狀相關(guān)因素,擴展對NMOSD患者癥狀的認(rèn)識,加深對NMO病理損壞的理解,從而為更好的管理NMOSD患者提供理論依據(jù)。研究內(nèi)容和方法2013年9月-2014年6月連續(xù)收集就診于天津醫(yī)科大學(xué)總醫(yī)院神經(jīng)內(nèi)科的臨床確診的NMOSD患者33例,健康對照20例。兩組的年齡、性別、受教育年限相匹配。記錄分析臨床影像資料;對患者進行系列量表測評:匹茲堡睡眠質(zhì)量指數(shù)量表(Pittsburgh Sleep Quality Index,PSQI)、艾普沃斯嗜睡量表(Epworth Sleepiness Scale,ESS)、疲勞量表(Fatigue Questionnaire,FQ)、Beck抑郁量表(Beck Depression Inventory,BDI)、日常生活能力量表(Activities of Daily Living Scale,ADL)、多發(fā)性硬化簡易認(rèn)知功能測評量表(The Minimal Assessment of Cognitive Function in Multiple Sclerosis,MACFIMS);24小時多導(dǎo)睡眠圖(polysomnography,PSG)監(jiān)測。采用SPSS17.0統(tǒng)計軟件包對數(shù)據(jù)進行統(tǒng)計分析。檢驗水準(zhǔn)取α=0.05,P0.05為有統(tǒng)計學(xué)意義。研究結(jié)果1.疲勞(1)疲勞發(fā)生的調(diào)查結(jié)果:NMOSD組的疲勞發(fā)生率高于正常對照組(64%vs 35%,P=0.043)。兩組的疲勞量表總分、軀體疲勞、腦力疲勞評分分別為6.4 vs 3.8(P=0.001),4.4 vs2.8(P=0.002),2.0 vs 1.1(P=0.007)。根據(jù)FQ量表評分,將病例組分為疲勞組(FQ≥4,n=21)和非疲勞組(FQ4,n=12)。疲勞患者日常生活能力明顯低于非疲勞組(ADL:31.9 vs 23.7,P=0.003),并且疲勞程度與ADL分值呈正相關(guān)(r=0.455,P=0.008)。(2)在nmosd患者中發(fā)生疲勞的相關(guān)因素分析結(jié)果:兩組在臨床特征上無差異。相對于非疲勞組,疲勞組bdi分值增高(16.6vs7.3,p=0.016);疲勞組平均、最低血氧濃度(meanspo2,nadirspo2)均降低(90%vs94%,p=0.004;87%vs93%,p=0.002)。疲勞組患者相對于非疲勞組患者,主觀夜間睡眠差,白天易嗜睡(psqi:9.2vs5.8,p=0.044;ess:7.3vs3.8,p=0.024);非快速眼動睡眠期n3期所占比例降低(6.7%vs11.6%,p=0.033),睡眠期轉(zhuǎn)換次數(shù)增高(131.3vs103.5,p=0.049)。相關(guān)分析顯示,疲勞程度與抑郁程度呈正相關(guān)(r=0.599,p0.001);與meanspo2,nadirspo2呈負(fù)相關(guān)(r=-0.457,p=0.007;r=-0.558,p=0.001);與psqi評分呈明顯正相關(guān)(r=0.453,p=0.008)。2.睡眠障礙nmosd患者psg睡眠特征:①睡眠效率(sleepefficiency,se)減低:與正常對照組相比,病例組se下降(78%vs86%,p=0.034);入睡后再清醒時間增加44分鐘(p0.0001)。②睡眠結(jié)構(gòu):與正常對照組相比,病例組在快速眼動期、非快速眼動期n1期分別增加4%(p=0.042)和6%(p=0.001),非快速眼動期n3期減少12%(p0.0001),覺醒指數(shù)較正常對照組降低(6vs12,p=0.014)。③呼吸事件:病例組中,呼吸睡眠暫停的患者比例高于正常對照組(18%vs5%,p=0.007),meanspo2、nadirspo2均低于正常對照組(94%vs96%,p=0.011;89%vs92%,p=0.039)。④周期性肢體運動:病例組的周期性肢體運動次數(shù)明顯高于正常對照組(20vs2,p=0.020)。有腦干和小腦病變的患者周期性肢體運動次數(shù)明顯高于非幕下病變組(41vs3,p=0.001)。3.認(rèn)知功能(1)nmosd患者比健康對照組mmse和moca得分顯著降低(27.2vs28.3,p=0.014;24.2vs27.1,p=0.000)。nmosd患者認(rèn)知功能障礙的發(fā)生率為39.4%。nmosd患者在以下認(rèn)知功能方面顯著受損:步伐聽覺連續(xù)加法測試(pasat,p=0.002),符號數(shù)字轉(zhuǎn)換測試(sdmt,p=0.000),california詞語學(xué)習(xí)測驗(totallearningofcvlt-ii,p=0.000),短延遲暗示回憶(sdcr,p=0.006),長延遲自由回憶(ldfr,p=0.005),長延遲暗示回憶(ldcr,p=0.010),簡易視空間記憶測驗(bvmt-r,p0.05),語義口語流暢性測驗(p=0.000)。最常見認(rèn)知障礙類型是記憶。(2)存在認(rèn)知功能障礙的NMOSD患者與認(rèn)知功能保留的NMOSD患者比較,年齡更大、教育水平更低(年齡:54.5±1.9 vs 42.5±3.0,P=0.002;受教育程度:8.4±1.1 vs 11.2±0.7,P=0.028)。結(jié)論1.NMOSD患者的疲勞發(fā)生率明顯增高,既有軀體疲勞,又有腦力疲勞;存在疲勞的NMOSD患者日常生活能力下降;NMOSD患者的疲勞程度與抑郁程度、主觀睡眠質(zhì)量、SpO2相關(guān)。2.NMOSD患者的SE下降、WASO增加、REM及NREM-N1所占比例增加、NREM-N3所占比例減少、睡眠呼吸紊亂明顯、SpO2降低、周期性肢體運動明顯增多。存在幕下病變的NMOSD患者周期性肢體運動明顯。3.NMOSD患者存在認(rèn)知功能障礙,主要表現(xiàn)在短時、長時記憶功能,視覺及聽覺信息處理速度等方面。NMOSD患者年齡越大、受教育越低,發(fā)生認(rèn)知功能障礙的可能性越大。
[Abstract]:Objective to investigate the investigation of neuromyelitisoptica spectrum disorder (neuromyelitis optica spectrum disorder, NMOSD) in patients with systemic symptoms: fatigue, sleep disorders and cognitive impairment. To explore the factors related to the systemic symptoms, and learn more about the symptoms of patients with NMOSD, to deepen the understanding of NMO pathology damage, so as to provide a theoretical basis for better management of NMOSD 33 patients with clinically diagnosed NMOSD patients. The research contents and methods in September 2013 -2014 year in June were collected in General Hospital Affiliated to Tianjin Medical University from the Department of Neurology, 20 cases of healthy control. The two groups in age, gender, education matched records. Clinical analysis of image data; with series scale: Pittsburgh sleep quality index scale (Pittsburgh Sleep Quality Index, PSQI), EPPs Voss sleepiness scale (Epworth Sleepiness Scale, ESS), fatigue scale (Fatigue Quest Ionnaire, FQ), Beck Depression Scale (Beck Depression Inventory, BDI), ADL (Activities of Daily Living Scale, ADL), multiple sclerosis, simple cognitive function assessment scale (The Minimal Assessment of Cognitive Function in Multiple Sclerosis, MACFIMS); polysomnography (Figure polysomnography 24 hours PSG), packet monitoring. The data were analyzed with SPSS17.0 statistical software. Take a =0.05 level test, P0.05 had statistical significance. The research results of the 1. fatigue (1) survey results: fatigue fatigue occurred in NMOSD group was higher than that in the normal control group (64%vs 35%, P=0.043). The two group fatigue scale the total score, physical fatigue, mental fatigue scores were 6.4 vs 3.8 (P=0.001), 4.4 vs2.8 (P=0.002), 2 vs (1.1 P=0.007). According to the FQ score, the patients were divided into fatigue group (FQ = 4, n=21) and non fatigue group (FQ4, n=12) in patients with fatigue. The ability of daily life was significantly lower than the non fatigue group (ADL:31.9 vs 23.7, P=0.003), and the degree of fatigue was positively correlated with ADL scores (r=0.455, P=0.008). (2) in patients with nmosd related factors of fatigue analysis results: the two groups in clinical characteristics. No difference compared with non fatigue group, fatigue group BDI score increased (16.6vs7.3, p=0.016); fatigue group average, minimum oxygen concentration (meanspo2, nadirspo2) were decreased (90%vs94%, p=0.004; 87%vs93%, p=0.002). The fatigue group compared with non fatigue group, subjective sleep, sleepiness (psqi:9.2vs5.8, white Tianyi p=0.044; ess:7.3vs3.8, p=0.024); non REM N3 the proportion of lower (6.7%vs11.6%, p=0.033), the sleep period conversion times increased (131.3vs103.5, p=0.049). Correlation analysis showed that the fatigue degree and the degree of depression was positively correlated (r=0.599, p0.001); and meanspo2, nadirspo2 were negatively correlated (r=-0.457 P=0.007, r=-0.558, p=0.001);; there was a significant positive correlation with PSQI score (r=0.453, p=0.008) nmosd.2. PSG features of sleep disorders in patients with sleep: sleep efficiency (sleepefficiency, Se) decreased compared with normal control group, Se group were decreased (78%vs86%, p=0.034); then awake time increased 44 minutes after falling asleep (P0.0001). The sleep structure: compared with normal control group, patients in REM sleep, non REM stage N1 were increased by 4% (p=0.042) and 6% (p=0.001), non REM N3 phase decreased 12% (P0.0001), arousal index is lower than normal control group (6vs12, p=0.014) 3. Respiratory events: in the case group, the proportion of patients with sleep apnea is higher than the normal control group (18%vs5%, p=0.007), meanspo2, nadirspo2 were lower than the normal control group (94%vs96%, p=0.011; 89%vs92%, p=0.039). The periodic limb movement: periodic limb movement the number of cases was significantly higher than that of The normal control group (20vs2, p=0.020). The number of patients with periodic limb movement brainstem and cerebellar lesions were significantly higher than those in non subtentorial lesions group (41vs3, p=0.001).3. cognitive function (1) nmosd patients than in healthy control group MMSE and MOCA scores were significantly lower (27.2vs28.3, p=0.014; 24.2vs27.1, p=0.000).Nmosd patients with cognitive dysfunction the incidence of 39.4%.nmosd in patients with significantly impaired cognitive function in the following aspects: the pace of PASAT (PASAT, p=0.002), digital symbol conversion test (SDMT, p=0.000), California Verbal Learning Test (totallearningofcvlt-ii, p=0.000), short delay memory (sdcr, p=0.006) suggested that, long delayed free recall (ldfr, p=0.005), long delay memory (LdCr, p=0.010) suggests, simple visual spatial memory test (bvmt-r, P0.05), oral semantic fluency test (p=0.000). The most common type of cognitive impairment and memory. (2) cognitive function barrier Because of the comparison of NMOSD and cognitive function in patients with preserved NMOSD patients, older age, lower education levels (age: 54.5 + 1.9 vs 42.5 + 3, P=0.002; education level: 8.4 + 1.1 vs 11.2 + 0.7, P=0.028). Conclusion fatigue in patients with 1.NMOSD were significantly increased, both the body fatigue. And mental fatigue; there is a decrease of daily life ability of NMOSD patients with fatigue; fatigue degree in patients with NMOSD and depression, subjective sleep quality, SpO2 with.2.NMOSD SE decreased, WASO increased, REM and NREM-N1 increase in the proportion of NREM-N3, reduce the proportion of sleep disordered breathing, decreased SpO2, periodic limb the movement increased significantly. There are infratentorial lesions of NMOSD patients with periodic limb movement was.3.NMOSD patients have cognitive dysfunction, mainly in the short term, long memory, visual and auditory information processing speed with.NMOSD years The greater the age, the lower the education, the greater the possibility of cognitive impairment.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R744.52

【共引文獻】

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