【摘要】：【背景與目的】 淡漠是卒中后常見精神癥狀之一，然而，卒中后出現(xiàn)淡漠的危險(xiǎn)因素及結(jié)構(gòu)基礎(chǔ)尚不明確。本研究目的在于探究缺血性腦卒中后淡漠的危險(xiǎn)因素及可能的結(jié)構(gòu)基礎(chǔ)。 【對象與方法】 （1）連續(xù)入組于2012年12月至2013年6月期間在廣州市第一人民醫(yī)院神經(jīng)內(nèi)科住院的缺血性腦卒中患者85例（起病2周以內(nèi)），按照淡漠的臨床評定標(biāo)準(zhǔn)將上述患者分為淡漠組及非淡漠組。登記患者的基本人口資料，包括年齡、性別、受教育年限，記錄患者是否存在高血壓病、II型糖尿病、腦血管病等基礎(chǔ)病史，是否存在吸煙、飲酒史，記錄入院時(shí)患者的血壓、血糖、血脂水平及NIHSS神經(jīng)功能缺損評分；根據(jù)磁共振掃描T2和Flair序列上的顯示，登記病灶位置；并在起病1月內(nèi)采用MMSE、MOCA、HAMD量表對其認(rèn)知功能、抑郁程度進(jìn)行評價(jià)。應(yīng)用組間比較對各因素進(jìn)行單因素分析，并采用二元多因素Logistic回歸模型查找獨(dú)立危險(xiǎn)因素。（2）85例患者中共有56例完成DTI檢查，我們采用DTI纖維束追蹤術(shù)構(gòu)建腦白質(zhì)結(jié)構(gòu)網(wǎng)絡(luò)，并應(yīng)用圖論分析來研究該網(wǎng)絡(luò)的拓?fù)鋵傩�。根�?jù)節(jié)點(diǎn)分析結(jié)果，構(gòu)建淡漠相關(guān)及淡漠非相關(guān)子網(wǎng)絡(luò)，分析各子網(wǎng)絡(luò)與淡漠的關(guān)系；應(yīng)用二元多因素Logistic回歸分析，分析各部分網(wǎng)絡(luò)與淡漠之間的關(guān)系。 【結(jié)果】 （1）85例入組患者中，28例（32.9%）被評定為患有淡漠。年齡、受教育年限、腦血管病史、認(rèn)知功能、抑郁及額葉、基底節(jié)位置病灶與淡漠有關(guān)，而MMSE評分降低（OR：0.76,95%CI：0.65-0.88，P0.01)及有腦血管病史（OR：10.27,95%CI：2.61-40.44，P0.01）可作為卒中后出現(xiàn)淡漠的獨(dú)立危險(xiǎn)因素。（2）全腦網(wǎng)絡(luò)局部效率（r=-0.39, P0.01）及全局效率（r=-0.44, P0.01）與AES-C評分顯著相關(guān)，且全局效率在淡漠組降低（P=0.04）。共發(fā)現(xiàn)34個(gè)節(jié)點(diǎn)的效率在淡漠組降低或與AES-C評分相關(guān)，其中額葉節(jié)點(diǎn)20個(gè)，包括雙側(cè)中央前回、雙側(cè)背外側(cè)額上回、雙側(cè)額中回、雙側(cè)島蓋部額下回、雙側(cè)三角部額下回、雙側(cè)眼眶部額下回、雙側(cè)補(bǔ)充活動(dòng)區(qū)、雙側(cè)內(nèi)側(cè)額上回及右側(cè)眶部額上回、右側(cè)眶部額中回、右側(cè)羅蘭多殼蓋、左側(cè)內(nèi)側(cè)眶部額上回；島葉區(qū)節(jié)點(diǎn)兩個(gè)，即雙側(cè)島葉；頂葉節(jié)點(diǎn)6個(gè)，，包括雙側(cè)中央后回、雙側(cè)緣上回、雙側(cè)旁中央小葉；基底節(jié)區(qū)節(jié)點(diǎn)2個(gè)，為雙側(cè)尾狀核；顳葉節(jié)點(diǎn)6個(gè)，包括雙側(cè)顳上極及雙側(cè)海馬。此34個(gè)節(jié)點(diǎn)組成淡漠相關(guān)網(wǎng)絡(luò)的局部效率（P=0.05）及全局效率（P0.01）在淡漠組降低，且該局部效率（r=-0.28，P=0.04）與全局效率（r=-0.59，P0.01）均與AES-C評分相關(guān)，而淡漠非相關(guān)網(wǎng)絡(luò)與淡漠無關(guān)。此外，二者之間纖維連接強(qiáng)度在淡漠組降低（P0.01），且與AES-C評分相關(guān)（r=-0.52，P0.01）。多因素分析中，淡漠相關(guān)網(wǎng)絡(luò)全局效率的降低（OR：0.00，95%CI：0.00-0.07，P=0.01）及既往有腦血管病史（OR：6.41，95%CI：1.32-31.15，P=0.02）在本研究中成為卒中后淡漠的獨(dú)立危險(xiǎn)因素。 【結(jié)論】 （1）卒中后淡漠與年齡、受教育年限、腦血管病史、認(rèn)知功能、抑郁、及額葉、基底節(jié)位置病灶有關(guān)，MMSE評分的下降及既往有腦血管病史可作為卒中后淡漠的獨(dú)立危險(xiǎn)因素。（2）淡漠是一種與白質(zhì)結(jié)構(gòu)完整性破壞有關(guān)的癥狀，其發(fā)生的結(jié)構(gòu)基礎(chǔ)復(fù)雜，可能與額葉-皮質(zhì)下環(huán)路內(nèi)及部分頂葉、邊緣系統(tǒng)之間纖維連接的破壞有關(guān)。我們所發(fā)現(xiàn)的淡漠相關(guān)網(wǎng)絡(luò)可作為卒中后淡漠的獨(dú)立危險(xiǎn)因素。
[Abstract]:[Background and Purpose] The light desert is one of the common mental symptoms of the stroke. However, the risk factors and the structural foundation of the apathy after stroke are not clear. The purpose of this study is to explore the risk factors and possible structural groups of the apathy after the ischemic stroke. A.[Object [Methods] (1) In the period from December 2012 to June 2013,85 patients (within 2 weeks of onset) of the ischemic stroke in the Department of Neurology of the First People's Hospital of Guangzhou were divided into a mild group and a non-indifferent group. The basic population data of the patients, including age, sex and age of education, recorded whether the patient had the basic medical history of hypertension, type II diabetes, cerebrovascular disease and other basic medical history, whether there was a smoking or drinking history, and recorded the blood pressure, blood sugar, blood lipid level and NIHSS nerve function defect score of the patient at the time of admission; according to the display of the magnetic resonance scan T2 and the Flair sequence, the position of the lesion was registered; and the cognitive function and the degree of depression were evaluated by means of MMSE, MOCA and HAMD in the first month of the disease. To set up the risk factors. (2) In the total of 85 patients,56 cases of DTI were completed. We used the DTI fiber bundle tracing technique to construct the network of the white matter structure, and the graph theory analysis was applied to study the topological properties of the network. According to the results of the node analysis, the relationship between the subnetworks and the apathy was analyzed according to the results of the node analysis, the relation between the subnetworks and the apathy was analyzed, and the network and the apathy of each part were analyzed by using the multi-factor logistic regression analysis. off-to-point The results] (1) Among the 85 enrolled patients,28 (32.9%) were assessed as having a mild condition. The age, age of education, history of cerebrovascular disease, cognitive function, depression and frontal and basal ganglia were related to the apathy, while the MMSE score decreased (OR: 0.76,95% CI: 0.65-0.88, P0.01) and the history of cerebrovascular disease (OR: 10.27,95% CI: 2.61-40.44, P0.01). The local efficiency of the whole brain network (r =-0.39, P0.01) and global efficiency (r =-0.44, P0.01) were significantly correlated with the AES-C score, and the global efficiency decreased in the indifferent group (P = 0.04). The efficiency of 34 nodes was found to be lower in the indifferent group or related to the AES-C score. Among them,20 of the frontal nodes, including the bilateral central frontal gyrus, the bilateral dorsolateral frontal gyrus, the bilateral frontal gyrus, the bilateral complementary active region, the lower back of the bilateral triangular part, the lower back of the two-sided orbital part, the double-sided supplementary active region, the upper back of the bilateral medial frontal and the right orbital part, the bilateral island lobe, the top leaf node,6, including the bilateral central back, the back of the bilateral margin, the double-side central leaflets; 52, P0.01). In the multi-factor analysis, the decrease in global efficiency of the indifferent network (OR: 0.00,95% CI: 0.00-0.07, P = 0.01) and the history of prior cerebrovascular disease (OR: 6.41,95% CI: 1.32-31.15, P = 0.02) became a stroke in this study. The only one in the desert. Risky factors.[Conclusion] (1) The age, duration of education, history of cerebrovascular disease, cognitive function, depression, and frontal and basal ganglia are related to the history of stroke, cognitive function, depression, and frontal and basal ganglia, and the decline of MMSE score and the history of previous cerebrovascular diseases An independent risk factor for the apathy in the post-stroke. (2) The apathy is a symptom associated with the destruction of the structural integrity of the white matter, the complex structure of which may be related to the destruction of the fiber connection between the frontal-subcortical loop and some of the parietal and limbic systems. The apathy-related network we have found may
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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