腦小血管病中腦微出血與認(rèn)知功能障礙關(guān)系的研究
發(fā)布時間：2019-07-04 09:34
【摘要】：目的:本研究旨在探討腦小血管病人群中CMBs與認(rèn)知功能障礙的關(guān)系,查找CMBs的相關(guān)危險因素。腦小血管病在老年人群中很常見,按有無癥狀來分,可以分為癥狀性腦小血管病和非癥狀性腦小血管病。腦小血管病的影像學(xué)診斷包括腔隙性梗死與腔隙灶、腦白質(zhì)疏松、腦微出血及腦萎縮腦,它們很少引起神經(jīng)系統(tǒng)功能障礙,所以臨床醫(yī)生對此關(guān)注較少,而認(rèn)知功能障礙,早期更是難以發(fā)現(xiàn),診斷率很低,導(dǎo)致后期治療效果差,嚴(yán)重影響患者的生活質(zhì)量,為家庭以及社會帶來沉重負(fù)擔(dān)。隨著磁敏感加權(quán)成像序列的廣泛使用,腦微出血的檢出率越來越頻繁,引發(fā)了神經(jīng)內(nèi)科醫(yī)師的高度重視,CMBs與知功能障礙之間的關(guān)系更是成為目前的研究熱點(diǎn)。本文通過探討腦微出血的相關(guān)危險因素及其對認(rèn)知功能的影響,能盡早對其危險因素進(jìn)行有效的干預(yù)和防治,有著十分重大的臨床意義。因此,本研究選擇腦小血管病患者為研究對象,探討腦微出血的相關(guān)危險因素及其對認(rèn)知功能的影響。方法:從2015年1月至2016年12月連續(xù)選取96例皖南醫(yī)學(xué)院第一附屬醫(yī)院神經(jīng)內(nèi)科,無神經(jīng)系統(tǒng)缺損癥狀的非急性卒中患者。采集患者入院時的年齡、性別、入院時的收縮壓、舒張壓、空腹血糖、糖化血紅蛋白、總甘油三酯、總膽固醇、高密度脂蛋白、低密度脂蛋白等,詳細(xì)詢問患者既往病史,如冠心病病史、高血壓病病史、糖尿病病史等;對符合條件者行頭顱MRI+MRA+SWI,根據(jù)CMBs的有無分為腦微出血陽性組和腦微出血陰性組,將腦微出血的發(fā)生例數(shù)、每例發(fā)生的數(shù)目、部位等記錄下來,再分別記錄每例腔隙性腦梗死數(shù)目、腦白質(zhì)疏松程度、腦萎縮嚴(yán)重程度等狀況,應(yīng)用MMSE量表測試認(rèn)知功能。所有數(shù)據(jù)用SPSSl9.0進(jìn)行統(tǒng)計分析。結(jié)果:1.21例參與者存在至少1個以上CMBs灶(26.3%),陽性組與陰性組在年齡,性別,高脂血癥,冠心病,糖尿病上無差異,其在MMSE評分上差異有統(tǒng)計學(xué)意義(P0.05),CMBs陽性組MMSE評分顯著低于陰性組。2.CMBs陽性組與陰性組兩組在血壓分級上差異無統(tǒng)計學(xué)意義(P0.05),而兩組在腔梗分級、腦白質(zhì)疏松程度分級上有統(tǒng)計學(xué)意義(P0.05),陽性組在腔梗分級及腦白質(zhì)疏松嚴(yán)重程度上高于陰性組;Sperman等級相關(guān)檢驗(yàn)結(jié)果顯示CMBs與腔梗分級、腦白質(zhì)疏松程度分級存在正相關(guān)(P0.05),即腔隙性腦梗死數(shù)目越多,腦白質(zhì)疏松程度越重,越容易出現(xiàn)CMBs。3.CMBs陽性組與陰性組在MMSE評分中各項(xiàng)認(rèn)知領(lǐng)域的得分比較顯示,兩組在定向力和注意計算力上差異無統(tǒng)計學(xué)意義(P0.05),而在瞬時記憶、延時回憶、語言能力上差異有統(tǒng)計學(xué)意義(P0.05)。4.MMSE得分正常組的平均年齡小于低分組,有統(tǒng)計學(xué)意義(P0.05),但MMSE得分正常組與低分組在性別、高脂血癥、冠心病、糖尿病病史方面無差異(P0.05)。5.MMSE得分與腔隙性腦梗塞分級及腦白質(zhì)疏松程度分級上比較,顯示差異有統(tǒng)計學(xué)意義(P0.05),且MMSE得分與腔梗分級、腦白質(zhì)疏松程度分級存在負(fù)相關(guān)(P0.05),即腔隙性腦梗塞與腦白質(zhì)疏松程度越嚴(yán)重,MMSE得分越低。6.多因素Logistic回歸分析表明年齡、腦微出血、腦白質(zhì)疏松是認(rèn)知功能障礙獨(dú)立危險因素。結(jié)論:1.CMBs是認(rèn)知功能損害的獨(dú)立危險因素。2.CMBs與MMSE得分顯著相關(guān),尤其是與MMSE單項(xiàng)認(rèn)知領(lǐng)域中的瞬時記憶、延時回憶、語言能力下降密切相關(guān)。
[Abstract]:Objective: The purpose of this study is to explore the relationship between the CBRs and cognitive dysfunction in the small-sized brain, and to find the relevant risk factors of the CMBs. The small brain is common in the elderly population, and can be divided into symptomatic and non-symptomatic brain subscales according to the presence or absence of symptoms. The imaging diagnosis of the small brain tumor includes the lacunar infarction and the lacunar, the leukoaraiosis, the cerebral microhemorrhage and the brain atrophy, which rarely cause the dysfunction of the nervous system, so the clinical doctor is less concerned, and the cognitive function, the early stage is difficult to find, the diagnosis rate is very low, Leading to poor treatment effect in the later period, seriously affecting the quality of life of the patient, and placing a heavy burden on the family and the society. With the wide use of the magnetic sensitive weighted imaging sequence, the detection rate of cerebral microhemorrhage is becoming more and more frequent. The related risk factors of cerebral microhemorrhage and its effect on cognitive function are discussed in this paper. It is of great significance to intervene and control the risk factors as soon as possible. Therefore, the study on the risk factors of cerebral microhemorrhage and its effect on cognitive function were discussed in this study. Methods:96 patients with neurology and non-acute stroke in the first Affiliated Hospital of Anhui Medical College were selected from January 2015 to December 2016. the age, sex, systolic blood pressure, diastolic blood pressure, fasting blood sugar, glycosylated hemoglobin, total triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein and the like at the time of admission of the patient are collected, and the prior medical history of the patient, such as the medical history of the coronary heart disease, the medical history of the hypertension, The medical history of diabetes and the like; the head MRI + MRA + SWI was divided into the positive group of the cerebral microhemorrhage and the negative group of the micro-hemorrhage of the brain according to the presence or absence of the condition; the number of the cerebral microhemorrhage, the number of each occurrence, the position and the like were recorded, and the number of each lacunar cerebral infarction was recorded separately, The cognitive function was tested by MMSE scale, such as the degree of leukoaraiosis and the severity of the atrophy of the brain. All data were statistically analyzed with SPSSl92.0. Results: 1.21 participants had at least one CBRs (26.3%), and the positive and negative groups had no difference in the age, sex, hyperlipidemia, coronary heart disease and diabetes. The MMSE score of the positive group of CMBs was significantly lower than that of the negative group.2. There was no significant difference between the two groups in the control group (P0.05). The positive group was higher than that of the negative group in the stage of infarction and the degree of leukoaraiosis was significantly higher in the positive group than in the negative group (P <0.05). The more the number of lacunar cerebral infarction and the greater the degree of leukoaraiosis, the more the number of lacunar cerebral infarction. The more easily the CMBs.3. The score of the CMBs positive group and the negative group in the cognitive domain of the MMSE score showed that the two groups had no significant difference in the directional force and the attention calculation force (P0.05), and in the instant memory, the time-delay memory, In that mean age of the normal group, the mean age of the normal group was less than that of the low group (P0.05), but the normal group of the MMSE score and the low group were in the form of sex, hyperlipidemia, and coronary heart disease. There was no difference in the history of diabetes (P0.05). The more serious the degree of lacunar infarction and leukoaraiosis, the lower the MMSE score. Logistic regression analysis of multiple factors showed that age, cerebral microhemorrhage and leukoaraiosis were independent risk factors of cognitive impairment. Conclusion:1. CMBs are independent risk factors of cognitive impairment.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.34
本文編號：2509820
[Abstract]:Objective: The purpose of this study is to explore the relationship between the CBRs and cognitive dysfunction in the small-sized brain, and to find the relevant risk factors of the CMBs. The small brain is common in the elderly population, and can be divided into symptomatic and non-symptomatic brain subscales according to the presence or absence of symptoms. The imaging diagnosis of the small brain tumor includes the lacunar infarction and the lacunar, the leukoaraiosis, the cerebral microhemorrhage and the brain atrophy, which rarely cause the dysfunction of the nervous system, so the clinical doctor is less concerned, and the cognitive function, the early stage is difficult to find, the diagnosis rate is very low, Leading to poor treatment effect in the later period, seriously affecting the quality of life of the patient, and placing a heavy burden on the family and the society. With the wide use of the magnetic sensitive weighted imaging sequence, the detection rate of cerebral microhemorrhage is becoming more and more frequent. The related risk factors of cerebral microhemorrhage and its effect on cognitive function are discussed in this paper. It is of great significance to intervene and control the risk factors as soon as possible. Therefore, the study on the risk factors of cerebral microhemorrhage and its effect on cognitive function were discussed in this study. Methods:96 patients with neurology and non-acute stroke in the first Affiliated Hospital of Anhui Medical College were selected from January 2015 to December 2016. the age, sex, systolic blood pressure, diastolic blood pressure, fasting blood sugar, glycosylated hemoglobin, total triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein and the like at the time of admission of the patient are collected, and the prior medical history of the patient, such as the medical history of the coronary heart disease, the medical history of the hypertension, The medical history of diabetes and the like; the head MRI + MRA + SWI was divided into the positive group of the cerebral microhemorrhage and the negative group of the micro-hemorrhage of the brain according to the presence or absence of the condition; the number of the cerebral microhemorrhage, the number of each occurrence, the position and the like were recorded, and the number of each lacunar cerebral infarction was recorded separately, The cognitive function was tested by MMSE scale, such as the degree of leukoaraiosis and the severity of the atrophy of the brain. All data were statistically analyzed with SPSSl92.0. Results: 1.21 participants had at least one CBRs (26.3%), and the positive and negative groups had no difference in the age, sex, hyperlipidemia, coronary heart disease and diabetes. The MMSE score of the positive group of CMBs was significantly lower than that of the negative group.2. There was no significant difference between the two groups in the control group (P0.05). The positive group was higher than that of the negative group in the stage of infarction and the degree of leukoaraiosis was significantly higher in the positive group than in the negative group (P <0.05). The more the number of lacunar cerebral infarction and the greater the degree of leukoaraiosis, the more the number of lacunar cerebral infarction. The more easily the CMBs.3. The score of the CMBs positive group and the negative group in the cognitive domain of the MMSE score showed that the two groups had no significant difference in the directional force and the attention calculation force (P0.05), and in the instant memory, the time-delay memory, In that mean age of the normal group, the mean age of the normal group was less than that of the low group (P0.05), but the normal group of the MMSE score and the low group were in the form of sex, hyperlipidemia, and coronary heart disease. There was no difference in the history of diabetes (P0.05). The more serious the degree of lacunar infarction and leukoaraiosis, the lower the MMSE score. Logistic regression analysis of multiple factors showed that age, cerebral microhemorrhage and leukoaraiosis were independent risk factors of cognitive impairment. Conclusion:1. CMBs are independent risk factors of cognitive impairment.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.34
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