腦血管病患者腦微出血危險(xiǎn)因素分析及與認(rèn)知功能的關(guān)系
發(fā)布時(shí)間：2018-09-02 05:28
【摘要】：第一部分腦血管病患者腦微出血危險(xiǎn)因素分析目的:探討腦血管病患者腦微出血(cerebral microbleeds,CMBs)的相關(guān)危險(xiǎn)因素,為CMBs的防治提供理論依據(jù)。方法:連續(xù)收集2015年1月至2017年1月于河北醫(yī)科大學(xué)第二醫(yī)院神經(jīng)內(nèi)科住院的腦血管病患者。記錄入組患者一般人口學(xué)資料、個(gè)人史、既往史、檢查結(jié)果等信息。對(duì)所有患者行頭顱MRI檢查(包括:T1WI、T2WI、FLAIR、DWI、MRA、SWI)并依據(jù)MARS量表記錄CMBs的部位及數(shù)目,依據(jù)Fazekas評(píng)分評(píng)估腦白質(zhì)稀疏的嚴(yán)重程度。根據(jù)SWI是否檢出CMBs將入組患者分為陽(yáng)性組和陰性組,分析CMBs的危險(xiǎn)因素、CMBs的數(shù)目分別與Fazekas評(píng)分及腔隙性腦梗死數(shù)目間的關(guān)系。依據(jù)CMBs的發(fā)生部位將陽(yáng)性組患者分為單純腦葉CMBs組、腦深部及幕下CMBs組及混合CMBs組,分析不同部位CMBs危險(xiǎn)因素的差異。結(jié)果:1基本資料:共納入164例腦血管病患者,CMBs陽(yáng)性組98例(59.8%),CMBs陰性組66例(40.2%)。CMBs在非急性腦血管病、急性腦梗死、急性腦出血、急性腦梗死出血性轉(zhuǎn)化患者中的檢出率分別為43.3%、63.9%、85.7%、100%。CMBs在腦葉、腦深部、幕下的發(fā)生率分別為46.3%、38.4%、15.3%。2 CMBs危險(xiǎn)因素分析:年齡(OR=1.069,95%CI:1.008-1.133)、高血壓(OR=3.472,95%CI:1.243-9.696)、腦白質(zhì)稀疏(OR=2.235,95%CI:1.345-3.715)、腔隙性腦梗死(OR=1.589,95%CI:1.01-2.499)為CMBs獨(dú)立的危險(xiǎn)因素。3 CMBs分別與腦白質(zhì)稀疏及腔隙性腦梗死的相關(guān)性分析:CMBs的數(shù)目與腦白質(zhì)稀疏的嚴(yán)重程度(r=0.564,P0.001)及腔隙性梗死灶的數(shù)目(r=0.762,P0.001)均成正相關(guān)關(guān)系。4不同部位CMBs危險(xiǎn)因素的差異:單純腦葉CMBs組患者的年齡最大,腔隙性腦梗死灶數(shù)目最多;腦深部及幕下CMBs組患者高血壓史比例最高;混合CMBs組Fazekas評(píng)分最大。結(jié)論:高齡、高血壓、腦白質(zhì)疏松及腔隙性腦梗死為CMBs獨(dú)立的危險(xiǎn)因素,CMBs的嚴(yán)重程度與腦白質(zhì)稀疏及腔隙性腦梗死的嚴(yán)重程度均呈正相關(guān)關(guān)系。第二部分腦血管病患者腦微出血與認(rèn)知功能的關(guān)系目的:探討腦血管病患者CMBs對(duì)認(rèn)知功能的影響。方法:從第一部分腦血管病患者中選取基線資料(年齡、性別、受教育程度、腦白質(zhì)稀疏嚴(yán)重程度、腔隙性腦梗死數(shù)目等)相匹配的患者為研究對(duì)象。采用簡(jiǎn)易精神狀態(tài)檢查表(Mini-Mental State Examination,MMSE)及蒙特利爾認(rèn)知評(píng)估量表(Montreal Cognitive Assessment,Mo CA)對(duì)所有入組患者進(jìn)行認(rèn)知功能評(píng)估。對(duì)比CMBs陰性組與CMBs陽(yáng)性組總體認(rèn)知功能評(píng)分、各領(lǐng)域認(rèn)知功能評(píng)分及癡呆比例的差異;分析不同部位CMBs對(duì)總體認(rèn)知功能及各領(lǐng)域認(rèn)知功能的影響。結(jié)果:1基線資料:共納入96例基線資料匹配的腦血管病患者,CMBs陽(yáng)性組51例(53.1%),CMBs陰性組45例(46.9%)。2 CMBs與認(rèn)知功能的關(guān)系:CMBs陽(yáng)性組Mo CA評(píng)分及在視空間及執(zhí)行功能、注意、延遲回憶3個(gè)認(rèn)知領(lǐng)域的評(píng)分均低于CMBs陰性組,癡呆比例高于CMBs陰性組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。3不同部位CMBs對(duì)認(rèn)知功能的影響:單純腦葉CMBs組Mo CA評(píng)分及在各認(rèn)知領(lǐng)域的評(píng)分均低于非單純腦葉CMBs組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。而深部及幕下CMBs組Mo CA評(píng)分及在各認(rèn)知領(lǐng)域的評(píng)分與對(duì)照組的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:在腦血管病患者中,CMBs(尤其是單純腦葉CMBs)會(huì)導(dǎo)致全面認(rèn)知功能下降甚至癡呆,且與視空間及執(zhí)行功能、注意、延遲回憶3個(gè)領(lǐng)域的認(rèn)知功能關(guān)系最密切。
[Abstract]:Objective: To explore the risk factors of cerebral microbleeds (CMBs) in patients with cerebrovascular diseases, and to provide theoretical basis for the prevention and treatment of CMBs. Patients. General demographic data, personal history, past history, examination results, etc. were recorded. All patients were examined with cranial MRI (including T1WI, T2WI, FLAIR, DWI, MRA, SWI) and the location and number of CMBs were recorded according to the MARS scale. The severity of leukoaraiosis was assessed according to Fazekas score. The patients were divided into positive group and negative group, the risk factors of CMBs were analyzed, and the relationship between the number of CMBs and Fazekas score and lacunar infarction was analyzed. Data: A total of 164 patients with cerebrovascular diseases were enrolled in this study, 98 (59.8%) were CMBs positive and 66 (40.2%) were CMBs negative. The detection rates of CMBs in patients with non-acute cerebrovascular diseases, acute cerebral infarction, acute cerebral hemorrhage and hemorrhagic transformation of acute cerebral infarction were 43.3%, 63.9%, 85.7% and 100%, respectively. Risk factors for CMBs: age (OR = 1.069, 95% CI: 1.008-1.133), hypertension (OR = 3.472, 95% CI: 1.243-9.696), leukoaraiosis (OR = 2.235, 95% CI: 1.345-3.715), lacunar infarction (OR = 1.589, 95% CI: 1.01-2.499) were independent risk factors for CMBs. 3 CMBs were associated with leukoaraiosis and lacunar infarction, respectively. The number of S was positively correlated with the severity of leukoaraiosis (r = 0.564, P 0.001) and the number of lacunar infarcts (r = 0.762, P 0.001). Conclusion: Age, hypertension, leukoaraiosis and lacunar infarction are independent risk factors for CMBs. The severity of CMBs is positively correlated with the severity of leukoaraiosis and lacunar infarction. Part II The relationship between cerebral microhemorrhage and cognitive function in patients with cerebrovascular disease. Methods: The baseline data (age, sex, education, degree of leukoaraiosis, number of lacunar infarctions, etc.) matched patients with cerebrovascular disease were selected from the first part of the study. Mini-Mental State Examination (MMSE) and Mini-Mental State Examination (MMSE) were used. The Montreal Cognitive Assessment (Mo CA) was used to assess the cognitive function of all the patients. The differences of the overall cognitive function score, cognitive function score and dementia ratio between CMBs negative group and CMBs positive group were compared. The effects of different parts of CMBs on the overall cognitive function and cognitive function in different fields were analyzed. Results: 1 Baseline data: A total of 96 patients with cerebrovascular disease matched with baseline data were included, 51 patients (53.1%) were CMBs positive group, 45 patients (46.9%) were CMBs negative group. 2 Relationship between CMBs and cognitive function: The scores of Mo CA and visual space and executive function, attention and delayed recall in CMBs positive group were lower than those in CMBs negative group. In the CMBs negative group, the difference was statistically significant (P Conclusion: In patients with cerebrovascular diseases, CMBs (especially simple lobe CMBs) can lead to the decline of overall cognitive function, even dementia, and are most closely related to visual space and executive function, attention and delayed recall.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
本文編號(hào)：2218383
[Abstract]:Objective: To explore the risk factors of cerebral microbleeds (CMBs) in patients with cerebrovascular diseases, and to provide theoretical basis for the prevention and treatment of CMBs. Patients. General demographic data, personal history, past history, examination results, etc. were recorded. All patients were examined with cranial MRI (including T1WI, T2WI, FLAIR, DWI, MRA, SWI) and the location and number of CMBs were recorded according to the MARS scale. The severity of leukoaraiosis was assessed according to Fazekas score. The patients were divided into positive group and negative group, the risk factors of CMBs were analyzed, and the relationship between the number of CMBs and Fazekas score and lacunar infarction was analyzed. Data: A total of 164 patients with cerebrovascular diseases were enrolled in this study, 98 (59.8%) were CMBs positive and 66 (40.2%) were CMBs negative. The detection rates of CMBs in patients with non-acute cerebrovascular diseases, acute cerebral infarction, acute cerebral hemorrhage and hemorrhagic transformation of acute cerebral infarction were 43.3%, 63.9%, 85.7% and 100%, respectively. Risk factors for CMBs: age (OR = 1.069, 95% CI: 1.008-1.133), hypertension (OR = 3.472, 95% CI: 1.243-9.696), leukoaraiosis (OR = 2.235, 95% CI: 1.345-3.715), lacunar infarction (OR = 1.589, 95% CI: 1.01-2.499) were independent risk factors for CMBs. 3 CMBs were associated with leukoaraiosis and lacunar infarction, respectively. The number of S was positively correlated with the severity of leukoaraiosis (r = 0.564, P 0.001) and the number of lacunar infarcts (r = 0.762, P 0.001). Conclusion: Age, hypertension, leukoaraiosis and lacunar infarction are independent risk factors for CMBs. The severity of CMBs is positively correlated with the severity of leukoaraiosis and lacunar infarction. Part II The relationship between cerebral microhemorrhage and cognitive function in patients with cerebrovascular disease. Methods: The baseline data (age, sex, education, degree of leukoaraiosis, number of lacunar infarctions, etc.) matched patients with cerebrovascular disease were selected from the first part of the study. Mini-Mental State Examination (MMSE) and Mini-Mental State Examination (MMSE) were used. The Montreal Cognitive Assessment (Mo CA) was used to assess the cognitive function of all the patients. The differences of the overall cognitive function score, cognitive function score and dementia ratio between CMBs negative group and CMBs positive group were compared. The effects of different parts of CMBs on the overall cognitive function and cognitive function in different fields were analyzed. Results: 1 Baseline data: A total of 96 patients with cerebrovascular disease matched with baseline data were included, 51 patients (53.1%) were CMBs positive group, 45 patients (46.9%) were CMBs negative group. 2 Relationship between CMBs and cognitive function: The scores of Mo CA and visual space and executive function, attention and delayed recall in CMBs positive group were lower than those in CMBs negative group. In the CMBs negative group, the difference was statistically significant (P Conclusion: In patients with cerebrovascular diseases, CMBs (especially simple lobe CMBs) can lead to the decline of overall cognitive function, even dementia, and are most closely related to visual space and executive function, attention and delayed recall.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
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