缺血性腦白質(zhì)病變情感淡漠發(fā)生情況及與認知障礙研究
發(fā)布時間：2019-05-29 21:45
【摘要】：目的:探討缺血性腦白質(zhì)病變患者血清同型半胱氨酸和特定炎性細胞因子(IL-6、CRP、TNF-α)水平的表達,并分析缺血性腦白質(zhì)病變患者情感淡漠發(fā)生情況及與認知障礙關(guān)系。方法:1、選取西南醫(yī)科大學附屬醫(yī)院神經(jīng)內(nèi)科以頭昏頭痛為主訴并通過影像學證實存在缺血性腦白質(zhì)病變(white matter lesions,WMLs)的患者44例為觀察組,同期住院病人中頭顱影像學未見明顯異常者44例為對照組,兩組性別、飲酒、吸煙、心臟病、受教育程度、腦血管病危險因素(年齡、高血壓病、糖尿病、血脂水平等)資料比較無差異。2、所有病例根據(jù)修訂版情感淡漠評定量表(modified apathy evaluation scale,MAES)進行評分,比較WMLs組與對照組情感淡漠發(fā)生率,并以此將WMLs患者分為情感淡漠組和非情感淡漠組(MAES評分大于14分定義為情感淡漠)。3、入院次日所有入組病例抽取空腹肘正中靜脈血測定并比較WMLs組與對照組及WMLs伴情感淡漠與不伴情感淡漠組間血清炎性細胞因子(IL-6、TNF-α、CRP)及血清同型半胱氨酸(total Homocysteine,tHcy)水平差異。4、采用簡易精神狀態(tài)檢查表(mini mental state examination,MMSE)及蒙特利爾認知量表(Montreal Cognitive Assessment,MoCA)評價WMLs伴情感淡漠及不伴情感淡漠組患者總體認知功能,選用連線測驗及Stroop色詞實驗對其執(zhí)行功能進行進一步測試。最后整理、統(tǒng)計、分析所有收集資料。結(jié)果:1、WMLs患者情感淡漠發(fā)生率(36.4%)明顯高于正常對照組(15.9%),中/重度WMLs患者情感淡漠發(fā)生率(54.5%)明顯高于輕度WMLs患者(18.2%),差異具有統(tǒng)計學意義。2、wmls患者血清thcy(11.82±3.17μmol/l)、il-6(99.92±18.43ng/ml)和tnf-α(233.99±84.35ng/ml)水平高于對照組thcy(8.46±1.52μmol/l)、il-6(37.87±6.40ng/ml)和tnf-α(34.51±6.33ng/ml)水平,差異均有統(tǒng)計學意義;中重度wmls患者血清thcy(13.48±2.73μmol/l)及il-6(111.90±11.13ng/ml)水平顯著高于輕度wmls患者thcy(10.16±2.78μmol/l)及il-6(95.86±20.36ng/ml)水平,差異均有統(tǒng)計學意義。3、wmls伴情感淡漠患者血清il-6(106.34±11.68ng/ml)、crp(5.13±4.29mg/l)和thcy(13.77±3.18μmol/ml)水平高于不伴情感淡漠患者il-6(76.63±34.08ng/ml)、crp(1.68±2.47mg/l)和thcy(10.51±2.58μmol/ml)水平,差異具有統(tǒng)計學意義。多元線性回歸分析提示il-6(標準化偏回歸系數(shù)b’=0.638,p=0.000)與crp(標準化偏回歸系數(shù)b’=0.341,p=0.004)可顯著影響maes評分,il-6、crp水平越高,情感淡漠越重。4、wmls伴情感淡漠患者mmse得分(18.00±7.16)低于不伴情感淡漠患者(25.75±4.24),wmls伴情感淡漠患者moca得分(13.00±5.89)低于不伴情感淡漠患者(18.80±4.74),差異具有統(tǒng)計學意義。pearson相關(guān)分析提示mmse與moca得分與maes評分呈負相關(guān)。5、wmls伴情感淡漠患者stroop測驗任務c反應時、stroop干擾效應、連線測驗a和b完成時、連線測驗干擾量均大于不伴情感淡漠者,wmls伴情感淡漠患者連線測驗a錯誤數(shù)多于不伴情感淡漠者,上述差異均具有統(tǒng)計學意義。pearson相關(guān)分析提示stroop干擾效應反應時、連線測驗干擾量均與maes評分呈正相關(guān),即情感淡漠愈重,執(zhí)行功能障礙愈明顯。結(jié)論:1、情感淡漠是缺血性腦白質(zhì)病變患者的常見伴發(fā)癥狀,且白質(zhì)病變程度越重情感淡漠發(fā)生率越高;2、血清tHcy、IL-6、TNF-α水平與缺血性腦白質(zhì)病變的發(fā)生密切相關(guān),其中tHcy、IL-6水平越高,腦白質(zhì)病變程度越重;3、IL-6、CRP、tHcy水平與缺血性腦白質(zhì)病變伴發(fā)情感淡漠相關(guān),其中IL-6和CRP與情感淡漠嚴重程度呈正相關(guān),IL-6、CRP水平越高,情感淡漠越重;4、腦白質(zhì)病變伴情感淡漠患者較非情感淡漠患者有著更為嚴重的認知功能障礙及執(zhí)行功能損害。
[Abstract]:Objective: To study the expression of serum homocysteine and specific inflammatory cytokines (IL-6, CRP, TNF-1) in patients with ischemic white matter lesions, and to analyze the relationship between the occurrence and the cognitive disorder of the patients with ischemic white matter lesions. Methods:1. The neurology department of the Affiliated Hospital of Southwest Medical University was selected as the main body of head and head, and 44 cases of patients with ischemic white matter disease (WMLs) were confirmed by imaging. There was no difference between the two groups of sex, drinking, smoking, heart disease, the degree of education, the risk factors of cerebrovascular disease (age, hypertension, diabetes, blood lipid level, etc.). The incidence of the emotion of WMLs group and the control group was compared, and the patients with WMLs were divided into two groups:1. The levels of serum inflammatory cytokines (IL-6, TNF-1, CRP) and serum homocysteine (tHcy) were measured in all enrolled cases on the following day of admission and compared with the control group and the control group and the WMLs, and the levels of serum inflammatory cytokines (IL-6, TNF-1, CRP) and serum homocysteine (tHcy) were different. The general cognitive function of WMLs with the condition of mild state examination (MMSE) and the Montreal Cognitive Scale (MoCA) was used to evaluate the overall cognitive function of WMLs with the indifferent and indifferent group. The function of the executive function of WMLs was further tested by using the connection test and the Stroop color word experiment. And finally, arranging, counting and analyzing all the collected data. Results:1. The incidence of affective apathy (36.4%) in the patients with WMLs was significantly higher than that in the normal control group (15.9%), and the incidence of the moderate/ severe WMLs (54.5%) was significantly higher than that of the patients with mild WMLs (18.2%). The level of il-6 (99.92-18.43 ng/ ml) and tnf-1 (233.99-84.35 ng/ ml) was higher than that of control group thcy (8.46-1.52. mu.mol/ l), il-6 (37.87-6.40 ng/ ml) and tnf-1 (34.51-6.33 ng/ ml). The serum thcy (13.48-2.73. mu.mol/ l) and il-6 (11.90-11.13 ng/ ml) in patients with moderate to severe wmls were significantly higher than those in mild wmls (10.16-2.78. mu.mol/ l) and il-6 (95.86-20.36 ng/ ml). The levels of crp (5.13-4.29 mg/ l) and thcy (13.77-3.18. mu.mol/ ml) were higher than those in the non-affective apathy patients (76.63-34.08 ng/ ml), crp (1.68-2.47 mg/ l) and thcy (10.51-2.58. mu.mol/ ml). The multivariate linear regression analysis suggested that il-6 (normalized partial regression coefficient b '= 0.638, p = 0.000) and crp (normalized partial regression coefficient b' = 0.341, p = 0.004) could significantly affect the maes score, il-6, the higher the crp level, the more severe the feeling. The mse score (18.00-7.16) in wmls with the apathy patients was lower than that of the non-affective patients (25.75-4.24), and the mcoa score (13.00-5.89) in wmls with the apathy patients was lower than that of the non-affective patients (18.80-4.74), and the difference was of statistical significance. The correlation analysis showed that the mse and moca scores were negatively correlated with the maes score. The above-mentioned difference is of statistical significance in wmls with the number of connected test a and the number of connected test a. The correlation analysis of pearson suggested that the amount of the interference in the connection test was positively correlated with the maes score, i. e. the less the feeling and the more obvious the performance of the dysfunction. Conclusion:1. The higher the incidence of the common concomitant symptoms in the patients with ischemic and white matter lesions, the higher the incidence of the degree of the white matter lesions, the higher the level of the serum tHcy, IL-6, and TNF-1, and the higher the level of tHcy and IL-6. The higher the degree of white matter lesions, the higher the level of IL-6, CRP and tHcy was associated with the apathy of the ischemic white matter lesions, where IL-6 and CRP were positively related to the severity of the mood, the higher the level of IL-6 and CRP, the more severe the feeling of emotion, and 4, The patients with the white matter lesion and the apathy have more serious cognitive impairment and functional damage than the non-affective patients.
【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743
本文編號：2488248
[Abstract]:Objective: To study the expression of serum homocysteine and specific inflammatory cytokines (IL-6, CRP, TNF-1) in patients with ischemic white matter lesions, and to analyze the relationship between the occurrence and the cognitive disorder of the patients with ischemic white matter lesions. Methods:1. The neurology department of the Affiliated Hospital of Southwest Medical University was selected as the main body of head and head, and 44 cases of patients with ischemic white matter disease (WMLs) were confirmed by imaging. There was no difference between the two groups of sex, drinking, smoking, heart disease, the degree of education, the risk factors of cerebrovascular disease (age, hypertension, diabetes, blood lipid level, etc.). The incidence of the emotion of WMLs group and the control group was compared, and the patients with WMLs were divided into two groups:1. The levels of serum inflammatory cytokines (IL-6, TNF-1, CRP) and serum homocysteine (tHcy) were measured in all enrolled cases on the following day of admission and compared with the control group and the control group and the WMLs, and the levels of serum inflammatory cytokines (IL-6, TNF-1, CRP) and serum homocysteine (tHcy) were different. The general cognitive function of WMLs with the condition of mild state examination (MMSE) and the Montreal Cognitive Scale (MoCA) was used to evaluate the overall cognitive function of WMLs with the indifferent and indifferent group. The function of the executive function of WMLs was further tested by using the connection test and the Stroop color word experiment. And finally, arranging, counting and analyzing all the collected data. Results:1. The incidence of affective apathy (36.4%) in the patients with WMLs was significantly higher than that in the normal control group (15.9%), and the incidence of the moderate/ severe WMLs (54.5%) was significantly higher than that of the patients with mild WMLs (18.2%). The level of il-6 (99.92-18.43 ng/ ml) and tnf-1 (233.99-84.35 ng/ ml) was higher than that of control group thcy (8.46-1.52. mu.mol/ l), il-6 (37.87-6.40 ng/ ml) and tnf-1 (34.51-6.33 ng/ ml). The serum thcy (13.48-2.73. mu.mol/ l) and il-6 (11.90-11.13 ng/ ml) in patients with moderate to severe wmls were significantly higher than those in mild wmls (10.16-2.78. mu.mol/ l) and il-6 (95.86-20.36 ng/ ml). The levels of crp (5.13-4.29 mg/ l) and thcy (13.77-3.18. mu.mol/ ml) were higher than those in the non-affective apathy patients (76.63-34.08 ng/ ml), crp (1.68-2.47 mg/ l) and thcy (10.51-2.58. mu.mol/ ml). The multivariate linear regression analysis suggested that il-6 (normalized partial regression coefficient b '= 0.638, p = 0.000) and crp (normalized partial regression coefficient b' = 0.341, p = 0.004) could significantly affect the maes score, il-6, the higher the crp level, the more severe the feeling. The mse score (18.00-7.16) in wmls with the apathy patients was lower than that of the non-affective patients (25.75-4.24), and the mcoa score (13.00-5.89) in wmls with the apathy patients was lower than that of the non-affective patients (18.80-4.74), and the difference was of statistical significance. The correlation analysis showed that the mse and moca scores were negatively correlated with the maes score. The above-mentioned difference is of statistical significance in wmls with the number of connected test a and the number of connected test a. The correlation analysis of pearson suggested that the amount of the interference in the connection test was positively correlated with the maes score, i. e. the less the feeling and the more obvious the performance of the dysfunction. Conclusion:1. The higher the incidence of the common concomitant symptoms in the patients with ischemic and white matter lesions, the higher the incidence of the degree of the white matter lesions, the higher the level of the serum tHcy, IL-6, and TNF-1, and the higher the level of tHcy and IL-6. The higher the degree of white matter lesions, the higher the level of IL-6, CRP and tHcy was associated with the apathy of the ischemic white matter lesions, where IL-6 and CRP were positively related to the severity of the mood, the higher the level of IL-6 and CRP, the more severe the feeling of emotion, and 4, The patients with the white matter lesion and the apathy have more serious cognitive impairment and functional damage than the non-affective patients.
【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743
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