本文選題：腦白質(zhì)病變 + 糖化血紅蛋白�。� 參考：《山西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:探討糖尿病(Diabetes Mellitus DM)對(duì)腦白質(zhì)病變(white matter lesions WML)的嚴(yán)重程度有無影響,糖尿病與其他腦血管病危險(xiǎn)因素在致腦白質(zhì)病變上有無協(xié)同作用,應(yīng)用認(rèn)知功能評(píng)價(jià)腦白病變的嚴(yán)重程度是否準(zhǔn)確。方法:選取2014年4月至2015年2月就診于山西醫(yī)科大學(xué)第二臨床醫(yī)學(xué)院神經(jīng)內(nèi)二科經(jīng)顱腦MR檢查明確有腦白質(zhì)病變的住院患者150例,入選病例年齡均在55歲以上,65歲以下,均檢驗(yàn)糖化血紅蛋白,并收集一般病史資料,采用Fazekas影像評(píng)價(jià)量表進(jìn)行影像學(xué)評(píng)分,蒙特利爾認(rèn)知評(píng)估量表(Montreal Cognitive Assessment,Mo CA)進(jìn)行認(rèn)知評(píng)分。第一步,將所有患者進(jìn)行影像學(xué)評(píng)分及認(rèn)知功能評(píng)分,分別以A、B、C三組及A’、B’、C’三組代表輕、中、重度,分析兩種評(píng)分系統(tǒng)間有無相關(guān)性。第二步,應(yīng)用秩和檢驗(yàn),分析A、B、C三個(gè)不同層次的組間糖化血紅蛋白、糖尿病年限有無差異。第三步,以影像學(xué)評(píng)分等級(jí)為應(yīng)變量,以各種可能的危險(xiǎn)因素作為自變量,進(jìn)行多值有序的多重logistic回歸分析,明確糖尿病是否為腦白質(zhì)病變的危險(xiǎn)因素。第四步,分析其他危險(xiǎn)因素與糖尿病在對(duì)腦白間病變的影響上有無協(xié)同作用。結(jié)果:腦白質(zhì)病變患者影像評(píng)分與認(rèn)知評(píng)分有相關(guān)性(P0.05),但相關(guān)系數(shù)并不高(r=0.022809);經(jīng)秩和檢驗(yàn),糖化血紅蛋白與腦白質(zhì)病變影像評(píng)分嚴(yán)重程度有相關(guān)性(P0.001),糖尿病年限與腦白質(zhì)病變影像評(píng)分嚴(yán)重程度有相關(guān)性(P0.05);經(jīng)多值有序的多重logistic回歸分析,糖尿病使腦白質(zhì)病變的危險(xiǎn)增高3.728倍;合并糖尿病的腦白質(zhì)病變患者組中高血壓病致腦白質(zhì)病變的危險(xiǎn)系數(shù)為4.569,高于單純腦白質(zhì)病變組的2.671;合并糖尿病的腦白質(zhì)病變患者組中高脂血癥病致腦白質(zhì)病變的危險(xiǎn)系數(shù)為6.451,高于單純腦白質(zhì)病變組的5.500;合并糖尿病的腦白質(zhì)病變患者組中高同型半胱氨酸血癥致腦白質(zhì)病變的危險(xiǎn)系數(shù)為6.705,高于單純腦白質(zhì)病變組的5.124。結(jié)論:認(rèn)知功能雖與腦白質(zhì)病變的嚴(yán)重程度有相關(guān)性,但關(guān)系并不密切。糖尿病是腦白質(zhì)病變的一個(gè)獨(dú)立危險(xiǎn)因素,在對(duì)腦白間病變的影響上,糖尿病與高血壓病、高脂血癥及高同型半胱氨酸血癥有協(xié)同作用。
[Abstract]:Objective: to investigate whether diabetes mellitus (DM) has an effect on the severity of white matter lesions WML) in white matter lesions, and whether diabetes and other risk factors of cerebrovascular disease have synergistic effects on white matter lesions. Cognitive function was used to evaluate the severity of brain white lesions. Methods: from April 2014 to February 2015, 150 inpatients with white matter lesions were selected from the second Department of Neurology, second College of Clinical Medicine, Shanxi Medical University, who were diagnosed by craniocerebral Mr examination. The age of the patients were above 55 years old or below 65 years old. All patients were tested for glycosylated hemoglobin (HbA1c), and general medical history data were collected. The imaging scores were evaluated with the Fazekas image evaluation scale and the cognitive score with the Montreal Cognitive Assessment scale (Montreal Cognitive Assessment). In the first step, all the patients were scored by imaging and cognitive function. The patients were divided into three groups: group C and group C, which represented mild, moderate and severe, respectively. The correlation between the two scoring systems was analyzed. In the second step, the rank sum test was used to analyze the difference of glycosylated hemoglobin (HbA1c) in three different levels of AHBC and the duration of diabetes mellitus. In the third step, multiple logistic regression analysis was performed to determine whether diabetes was a risk factor for leukoencephalopathy, taking imaging score as dependent variable and various possible risk factors as independent variables. The fourth step is to analyze the synergistic effect of other risk factors and diabetes mellitus on the brain white-interleukopathy. Results: there was a correlation between image score and cognitive score in patients with leukoencephalopathy (P 0.05), but the correlation coefficient was not high (r = 0.022 2809). Glycosylated hemoglobin was correlated with the severity of white matter lesions (P 0.001), and the age of diabetes was correlated with the severity of white matter lesions (P 0.05). Diabetes increased the risk of white matter lesions by 3.728 times. The risk coefficient of white matter lesions caused by hypertension in patients with diabetes mellitus was 4.569, which was higher than that in patients with simple white matter disease 2.671, and that caused by hyperlipidemia in patients with diabetes mellitus was 4.569. The risk coefficient of hyperhomocysteinemia was 6.705, which was higher than that of pure white matter disease group (5.124%), and the risk coefficient of hyperhomocysteinemia group was 6.705, which was higher than that of pure white matter disease group (5.500%), and the risk coefficient of hyperhomocysteinemia group was 6.705 (P < 0.05). Conclusion: although cognitive function is correlated with the severity of leukoencephalopathy, it is not closely related. Diabetes is an independent risk factor for leukoencephalopathy. Diabetes has synergistic effects with hypertension, hyperlipidemia and hyperhomocysteinemia.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.1;R741

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相關(guān)期刊論文 前1條

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本文編號(hào)：1910430