【摘要】：目的：近年來隨著神經(jīng)影像的進步，尤其是磁共振成像的普及，腦白質(zhì)病變（White matter lesion, WML）已成為中老年人群中頭核磁診斷報告中頻繁出現(xiàn)的一個診斷。其在影像學(xué)上主要表現(xiàn)為：腦室周圍或皮層下T2W（IT2-weighted imaging）高信號。腦白質(zhì)病最顯著的臨床表現(xiàn)是精神狀態(tài)和認(rèn)知功能的改變，即在沒有失語的情況下出現(xiàn)注意力、記憶力、視覺空間技能、執(zhí)行功能和情感狀態(tài)等其中一項或幾項缺陷。嚴(yán)重病例還可出現(xiàn)癡呆、癱瘓、視力喪失、昏迷甚至死亡。腦白質(zhì)�。↙eukoencephalopathy）最主要的特征為中樞神經(jīng)細(xì)胞的髓鞘損害，多發(fā)性硬化屬于腦白質(zhì)病的一個特殊類型。內(nèi)向整流性鉀離子通道蛋白-4.1（Inwardlyrectifying potassium channel4.1, Kir4.1），最近分別被確定為多發(fā)性硬化和視神經(jīng)脊髓炎自身抗體應(yīng)答的靶分子。為了探討臨床常見的腦白質(zhì)病變與Kir4.1蛋白是否也存在相關(guān)性，我們進一步分析了血中Kir4.1蛋白濃度與臨床常見的腦白質(zhì)病變的關(guān)系，此也為探索血Kir4.1蛋白作為腦白質(zhì)病變臨床診斷和治療的神經(jīng)生物標(biāo)志物提供了理論基礎(chǔ)。 方法：2013年3月~8月期間，通過對因頭暈、認(rèn)知或情感功能障礙就診于大連醫(yī)科大學(xué)附屬第一、第二醫(yī)院神經(jīng)內(nèi)科并使用1.5-T MR進行頭顱掃描的核磁掃描結(jié)果進行圖像判別，，選擇性收集腦白質(zhì)病變按照“the Rotterdam Study”的圖像判讀協(xié)議評級提示為重度損害的患者的作為病例組，共14例，其中腦室周圍白質(zhì)病變?yōu)?例，皮層下白質(zhì)病變6例；選擇性收集腦白質(zhì)病變按上述評級標(biāo)準(zhǔn)提示為無或輕微損害的患者作為對照組，共10例。整理所有患者的詳細(xì)臨床資料，并留取血液標(biāo)本，通過酶聯(lián)免疫吸附測定法（Enzyme-linked immunosorbent assay,ELISA）測定標(biāo)本中Kir4.1蛋白的濃度。通過軟件分析血中Kir4.1濃度與腦白質(zhì)病變的相關(guān)性。 結(jié)果：1、對病例特點進行分析，病例組和對照組的年齡、人數(shù)、體重指數(shù)對比無顯著性差異，病例組和對照組的中高血壓患病率、血脂異常、糖尿病患病率對比均無顯著性差異。 2、對相關(guān)危險因素的分析，病例組和對照組的收縮壓、舒張壓、空腹血糖、心率、收縮壓、高密度脂蛋白（HDL-c）、膽固醇、低密度脂蛋白（LDL-c）、同型半胱氨酸（HCY）無顯著性差異；病例組和對照組的血甘油三酯水平存在顯著性差異（P0.05），在單變量的Logistic回歸分析中，甘油三酯（OR,1.05;95%CI,0.958-1.151; P=0.297），說明甘油三酯是腦白質(zhì)病變的危險因素。 3、對血K4.1蛋白的分析，病例組與對照組進行血Kir4.1蛋白濃度對比存在顯著性差異（P0.05），說明腦白質(zhì)病變和血Kir4.1蛋白濃度存在一定的相關(guān)性；病例組被分為腦室周圍白質(zhì)病變組和皮層下白質(zhì)病變組，兩兩對比，皮層下腦白質(zhì)病變組與對照組進行血Kir4.1蛋白濃度對比存在顯著性差異（P0.05），說明血Kir4.1蛋白濃度和皮層下腦白質(zhì)病變存在一定的相關(guān)性；其余兩組對比無顯著性差異。 結(jié)論：1、血甘油三酯水平升高可能是腦白質(zhì)病變的一個危險因素。 2、腦白質(zhì)病變患者的血Kir4.1蛋白濃度升高，尤以皮層下腦白質(zhì)病變患者明顯。
[Abstract]:Objective : In recent years , with the progress of neuroimaging , especially the popularization of magnetic resonance imaging , white matter lesion ( WML ) has become a frequently occurring diagnosis in the middle - aged and elderly population . The most significant clinical manifestation of leukoencephalopathy is the change of mental state and cognitive function .

Methods : From March to August 2013 , 14 cases of patients with severe impairment were classified according to the image interpretation protocol of " the brain study " by using 1.5 - T MR imaging in the first and second hospitals of Dalian Medical University .
Selective collection of leukoencephalopathy was presented as a control group for patients with no or mild impairment according to the above - mentioned rating criteria . Detailed clinical data were collected from all patients and blood samples were collected . The concentration of Kir4.1 protein in the specimen was determined by enzyme - linked immunosorbent assay ( ELISA ) . The correlation between Kir4.1 concentration in blood and leukoencephalopathy was analyzed by software .

Results : 1 . There was no significant difference in the age , number and body mass index between the case group and the control group . There was no significant difference in the prevalence of hypertension , blood lipid and diabetes in the case group and the control group .

2 . Analysis of relevant risk factors , systolic blood pressure , diastolic pressure , fasting blood glucose , heart rate , systolic blood pressure , high density lipoprotein ( HDL - c ) , cholesterol , low density lipoprotein ( LDL - c ) and homocysteine ( HCY ) were not significantly different between the case group and the control group .
There was a significant difference in serum triglyceride levels between the case group and the control group ( P0.05 ) . In the logistic regression analysis of the single variable , the triglycerides ( OR , 1.05 ; 95 % CI , 0.958 - 1.151 ; P = 0.297 ) were found to be a risk factor for the brain white matter lesions .

3 . There was a significant difference in the concentration of Kir4.1 protein in the case group and the control group ( P0.05 ) , which showed that there was a certain correlation between the brain white matter and the blood Kir4.1 protein concentration .
Compared with the control group , there was a significant difference between the concentration of Kir4.1 protein and the plasma Kir4.1 protein concentration ( P0.05 ) .
There was no significant difference between the two groups .

Conclusion : 1 . The elevated level of triglyceride may be a risk factor for leukoencephalopathy .

2 . The plasma Kir4.1 protein concentration in the patients with leukoencephalopathy increased , especially in the patients with cerebral white matter lesions .
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R742

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相關(guān)期刊論文 前1條

1 陸彤;蔣彬;;內(nèi)向整流性鉀離子通道家族[J];中國心臟起搏與心電生理雜志;2009年03期

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