本文選題：視神經(jīng)脊髓炎 + NMO疾病譜��； 參考：《福建醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：了解視神經(jīng)脊髓炎（NMO）及其疾病譜(NMOSD)患者認(rèn)知功能損害的特點(diǎn)及其影響因素；對(duì)視神經(jīng)脊髓炎及其譜系疾病的尿酸水平進(jìn)行分析。 方法：對(duì)2012.9.1～2014.3.31期間于福建醫(yī)科大學(xué)附屬第一醫(yī)院神經(jīng)內(nèi)科入院確診為視神經(jīng)脊髓炎及其疾病譜的44例患者的臨床資料進(jìn)行回顧性分析。其中30例病例組和相應(yīng)的對(duì)照組采用重復(fù)性成套神經(jīng)心理狀態(tài)測(cè)驗(yàn)（RBANS）量表進(jìn)行認(rèn)知功能評(píng)估，采用擴(kuò)展殘疾狀態(tài)量表（EDSS）評(píng)估殘疾狀態(tài)、予漢密爾頓抑郁量表(HAMD)和漢密爾頓焦慮量表(HAMA)進(jìn)行評(píng)估焦慮抑郁狀態(tài)評(píng)估,進(jìn)行橫斷面分析。采用雙側(cè)T檢驗(yàn)進(jìn)行參數(shù)檢驗(yàn),卡方精確概率法進(jìn)行非參數(shù)檢驗(yàn),采用logistic回歸分析的方法，探討NMO及NMOSD患者認(rèn)知障礙評(píng)分與EDSS評(píng)分、臨床特點(diǎn)以及情緒等因素的相關(guān)性。采用Spearman相關(guān)分析血清AQP4抗體水平與EDSS評(píng)分、脊髓受累節(jié)段數(shù)、復(fù)發(fā)次數(shù)、年齡、顱內(nèi)病灶的相關(guān)性。使用T檢驗(yàn)進(jìn)行病例組與對(duì)照組、性別、EDSS評(píng)分組間的尿酸水平的差異比較。 結(jié)果：⑴病程中出現(xiàn)單眼或雙眼視神經(jīng)炎占86%,長(zhǎng)節(jié)段橫貫性脊髓炎占69.2%,主要發(fā)生在頸髓和胸髓。接受AQP4檢驗(yàn)的患者中陽性者占64.3%。AQP4抗體滴度水平與復(fù)發(fā)次數(shù)、病程有著明顯的正相關(guān)的關(guān)系，但與發(fā)病年齡、損害脊髓節(jié)段長(zhǎng)度、EDSS評(píng)分無明顯相關(guān)性。不同部位的顱內(nèi)病灶A(yù)QP4抗體滴度不同，在延髓者AQP4滴度較高，病灶在丘腦部位者滴度最低。⑵病例組與對(duì)照組比較，RBANS評(píng)分明顯降低（分別為72.00±16.609和89.40±19.253），，差別具有統(tǒng)計(jì)學(xué)意義（P0.001）；RBANS五項(xiàng)認(rèn)知評(píng)分中有三個(gè)項(xiàng)目的評(píng)分下降具有統(tǒng)計(jì)學(xué)意義，分別為視覺廣度(P0.001)、注意(P0.001)、延遲記憶(P值=0.017)。NMO認(rèn)知損害的嚴(yán)重程度與NMOSD比較，兩組之間差異無統(tǒng)計(jì)學(xué)意義（P=0.825）。RBANS評(píng)分與HAMA、HAMD評(píng)分及受教育程度具有相關(guān)性（Pearson相關(guān)系數(shù)分別為：-0.541，-0.510，1.563；P值分別為0.01，0.01，p=0.0390.05），而與性別、年齡、病程、復(fù)發(fā)次數(shù)以及是否存在顱腦病灶之間無明顯相關(guān)性。⑶NMO及NMO疾病譜患者尿酸水平低于對(duì)照組。 結(jié)論：1、NMO及其疾病譜患者中認(rèn)知損害和情緒障礙較常見；2、認(rèn)知障礙嚴(yán)重程度與教育程度、情緒異常存在相關(guān)性，與病程、軀體殘障程度、年齡、臨床類型、腦部可見病灶無關(guān)；3、NMO及NMO疾病譜患者尿酸水平降低。
[Abstract]:Objective: to investigate the characteristics and influencing factors of cognitive impairment in patients with optic neuromyelitis (NMO) and its disease spectrum (NMOSD), and to analyze the level of uric acid in optic neuromyelitis and its lineage diseases. Methods: the clinical data of 44 patients with optic neuromyelitis and its disease spectrum who were admitted to the Department of Neurology of the first affiliated Hospital of Fujian Medical University on March 31, 2012.1,2014.were retrospectively analyzed. The cognitive function of 30 cases and corresponding control group were evaluated by repetitive neuropsychological state test (RBANS), and the disability status was evaluated by extended disability status scale (EDSS). Hamilton Depression scale (Hamd) and Hamilton anxiety scale (Hama) were used to evaluate anxiety and depression status. Bilateral T test was used for parameter test, chi-square accurate probability method for non-parametric test, and logistic regression analysis method to investigate the correlation between cognitive impairment score and EDSs score, clinical characteristics and emotion in NMO-NMOSD patients. Spearman correlation was used to analyze the correlation between serum AQP4 antibody level and EDSS score, number of spinal cord involvement, recurrence times, age and intracranial lesions. T-test was used to compare the uric acid levels between the patients and the control group and the gender EDSS score group. Results the incidence of monocular or binocular optic neuritis was 86% in the disease course and 69.2% in the long segment transverse myelitis which mainly occurred in the cervical spinal cord and thoracic spinal cord. There was a positive correlation between the antibody titer of 64.3. AQP4 and the number of relapse and the course of disease, but there was no significant correlation with the age of onset and the length of spinal cord injury and EDSS score. The titer of AQP4 antibody in the medulla oblongata was higher than that in the control group (72.00 鹵16.609 vs 89.40 鹵19.253, P 0.001). In the group with the lowest titer of the lesion in the thalamus, the score of AQP4 antibody was significantly lower than that in the control group (72.00 鹵16.609 and 89.40 鹵19.253, respectively). The scores of three of the five cognitive scores of RBANS were significantly lower than those of NMOSD, which were visual span (P 0.001), attention (P 0.001), delayed memory (P < 0.017) and NMO (P = 0.017). There was no significant difference between the two groups (P < 0. 825). RBANS score was correlated with Hamad score and education level. Pearson's correlation coefficient was 0. 01% -0. 541% -0. 510 0. 563 (P = 0. 01 0. 01), but 0. 039 0. 05% with sex, age, course of disease. There was no significant correlation between recurrence times and brain lesions. 3 the uric acid levels in patients with NMO and NMO disease spectrum were lower than those in the control group. Conclusion Cognitive impairment and emotional disorder are more common in patients with NMO and its disease spectrum. The severity of cognitive impairment is correlated with education level, emotional abnormality, and course of disease, physical disability, age, clinical type. The level of uric acid was decreased in patients with NMO and NMO disease spectrum.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R744.52

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