本文選題：高血壓病　切入點：腦微出血　出處：《延安大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:1.以腦微出血(CMBs)作為生物標(biāo)志物,通過對認(rèn)知正常與認(rèn)知障礙中老年高血壓患者的比較,探討CMBs對認(rèn)知功能的影響。2.對高血壓CMBs的分布情況進(jìn)行分析,研究其好發(fā)部位及區(qū)域分布特點。3.通過分析CMBs與高血壓、CMBs與認(rèn)知功能之間的關(guān)系,研究三者間的相關(guān)性。方法:收集延安大學(xué)附屬醫(yī)院東關(guān)分院神經(jīng)內(nèi)科2015年11月-2016年10月收住院,并經(jīng)Mo CA量表認(rèn)定為認(rèn)知功能損害的高血壓病患者50例,及年齡、性別、吸煙史、飲酒史、受教育年限等相匹配的Mo CA量表認(rèn)定為無認(rèn)知功能損害的高血壓病患者50例。100例患者中有8例因MRI、CT及血管超聲等檢查發(fā)現(xiàn)明顯腦白質(zhì)疏松經(jīng)、頸動脈狹窄及腦梗死灶予以剔除。經(jīng)排除后最終入組92例,其中高血壓認(rèn)知正常組48例,高血壓認(rèn)知障礙組44例。收集每位入組患者的空腹血糖、血脂、Mo CA值總分及各分項值,行SWI掃描,根據(jù)SWI檢測到CMBs與否,分為CMBs陽性組和陰性組,并在SWI上記錄每位CMBs患者的病灶個數(shù),按出血灶多少分為4個等級。統(tǒng)計每位CMBs患者大腦半球深部、皮質(zhì)/皮質(zhì)下、腦干/小腦區(qū)域微出血陽性例數(shù)和病灶個數(shù),匯總總的出血例數(shù)及總的病灶個數(shù)。采用SPSS20.0軟件對數(shù)據(jù)進(jìn)行處理。研究方法如下:1.分析比較認(rèn)知功能正常組和認(rèn)知功能障礙組間CMBs陽性率是否有差異,并比較兩組患者相同區(qū)域間CMBs陽性率是否有差異;2.分析比較所有CMBs患者區(qū)域與區(qū)域之間出血陽性率以及病灶數(shù)構(gòu)成比是否有差異;3.分析比較CMBs嚴(yán)重程度分級與高血壓不同等級之間是否有相關(guān)性;4.分析比較CMBs與Mo CA總值及各分項值之間是否有相關(guān)性。結(jié)果:1.兩組患者一般臨床資料比較:年齡、性別、吸煙、飲酒、受教育年限、血糖、總膽固醇(TC)、低密度脂蛋白(LDL-C)等比較,結(jié)果無統(tǒng)計學(xué)差異(P0.05)。2.認(rèn)知正常組與認(rèn)知障礙組CMBs陽性率比較,結(jié)果有統(tǒng)計學(xué)差異(P0.05)。3.認(rèn)知正常組與認(rèn)知障礙組相同區(qū)域間CMBs陽性率比較,結(jié)果均有統(tǒng)計學(xué)差異(P0.05)。4.CMBs陽性組內(nèi)區(qū)域與區(qū)域間病灶數(shù)構(gòu)成比的比較,大腦半球深部與皮質(zhì)/皮質(zhì)下區(qū)域之間比較,結(jié)果無統(tǒng)計學(xué)差異(P0.05);其余兩組比較,均有統(tǒng)計學(xué)差異(P0.05)。5.CMBs陽性組內(nèi)區(qū)域與區(qū)域間CMBs陽性率比較,結(jié)果均有統(tǒng)計學(xué)差異(P0.05)。6.CMBs嚴(yán)重程度分級與高血壓不同等級的相關(guān)性研究發(fā)現(xiàn),兩者呈正相關(guān)(r=0.348)。7.CMBs嚴(yán)重程度分級與相應(yīng)Mo CA值之間相關(guān)性研究發(fā)現(xiàn),兩者呈負(fù)相關(guān)(r=-0.645)。8.CMBs病灶個數(shù)與認(rèn)知功能各項評分的相關(guān)性研究發(fā)現(xiàn),CMBs病灶個數(shù)與Mo CA總分、視空間和執(zhí)行功能、記憶力、注意力、語言、定向力及抽象思維評分呈負(fù)相關(guān),與命名能力無相關(guān)。結(jié)論:1.認(rèn)知障礙組CMBs陽性率明顯高于認(rèn)知正常組。2.高血壓患者CMBs灶主要分布于大腦半球深部及皮質(zhì)/皮質(zhì)下區(qū)域。3.CMBs嚴(yán)重程度分級與不同等級高血壓之間呈正相關(guān),認(rèn)為血壓越高CMBs越嚴(yán)重,微出血病灶越多。4.CMBs病灶個數(shù)與Mo CA評分呈負(fù)相關(guān),認(rèn)為CMBs數(shù)目越多患者的認(rèn)知功能損害越嚴(yán)重。
[Abstract]:Objective: 1. to cerebral microbleeds (CMBs) as a biomarker, through the comparison of elderly hypertensive patients with normal cognition and cognitive disorders, to investigate the effect of CMBs on cognitive function of.2. on blood pressure distribution of CMBs were analyzed, to study its predilection site and regional distribution characteristics of.3. through the analysis of CMBs and hypertension, relationship between CMBs and cognitive function. The correlation between the three. Methods: from Dongguan Branch Department of Neurology Affiliated Hospital of Yan'an University in November 2015 -2016 year in October admitted to the hospital, and the Mo CA scale as the cognitive impairment in patients with high blood pressure in 50 cases, and age, gender, smoking history, drinking history, education etc. to match the Mo CA scale identified as no cognitive impairment in patients with hypertension and 50 cases of.100 patients in 8 cases of MRI, CT and vascular ultrasound examination revealed obvious leukoaraiosis, cerebral and carotid artery stenosis The infarction be removed. After exclusion finally enrolled 92 patients, the cognition of hypertension in 48 cases of normal group, hypertension and cognitive impairment group 44 cases. Each group were collected in the fasting blood glucose, blood lipid, Mo value of CA total score and each item value, SWI scan, according to SWI CMBs is detected or not, divided into CMBs positive and negative groups, and record the number of lesions per CMBs in patients with SWI, according to the number of hemorrhage is divided into 4 grades. The deep statistics of each CMBs in patients with cerebral hemisphere, cortical / subcortical and brainstem cerebellar / regional micro hemorrhage and the number of positive cases of lesion number, the total number of cases of blood collection and the total number of lesions. The data were analyzed by SPSS20.0 software. The research methods are as follows: 1.. Analysis and comparison of the normal cognitive group and cognitive impairment group between the positive rate of CMBs whether there are differences, and compare the two groups of patients in the same region between the positive rate of CMBs whether there are differences between the 2. are analyzed; Between region and region in patients with bleeding CMBs positive rate and the number of lesions which have difference than whether; whether there is a correlation between the 3. analysis and comparison of CMBs severity grading and hypertension in different grades; whether there is a correlation between CMBs and Mo CA analysis and comparison of 4. gross and each item value. Results: 1. comparison of two groups of patients with clinical data. Age, sex, smoking, drinking, years of education, blood glucose, total cholesterol (TC), low density lipoprotein (LDL-C) comparison, showed no statistically significant difference (P0.05) positive rate comparison between normal group and cognitive impairment group CMBs cognitive.2., the results were statistically significant difference (P0.05) compared with normal group and.3. cognitive disorders the same regional cognitive group CMBs positive rate, the difference was statistically significant (P0.05) which compared the number of lesions between regions of.4.CMBs positive group, deep brain hemisphere and cortical / subcortical regions between the comparison results Statistical difference (P0.05); the remaining two groups had significant difference (P0.05) between.5.CMBs positive group in the region and the region between the positive rate of CMBs, the results were statistically significant difference (P0.05) classification and correlation of different grades of hypertension found a positive correlation between the severity of.6.CMBs (r=0.348).7.CMBs severity grading and the corresponding Mo CA the correlation between the value of the study found that there is a negative correlation (r=-0.645) correlation between.8.CMBs lesion number and cognitive function of the score, the number of Mo and CMBs lesions CA score, visual space and executive function, memory, attention, language, abstract thinking and orientation score was negatively correlated with no naming ability. Conclusion: 1. cognitive impairment group CMBs positive rate was significantly higher than that of normal cognitive group.2. in patients with essential hypertension CMBs foci are mainly distributed in deep cerebrum cortex and cortex / regional.3.CMBs severity There was a positive correlation between grading and different grades of hypertension. The higher the blood pressure is, the more severe the CMBs is. The more the micro hemorrhage is, the more the number of.4.CMBs lesions is negatively correlated with the Mo CA score. The more the number of CMBs is, the more serious the cognitive impairment is.

【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R544.1;R743.34

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 董智t@;李云霞;;高血壓與認(rèn)知功能障礙[J];轉(zhuǎn)化醫(yī)學(xué)雜志;2016年05期

2 趙大聰;魯廣華;郭江;孫小煜;李芳;余暉;;SWI在超急性大面積腦梗死中的應(yīng)用價值[J];實用放射學(xué)雜志;2016年04期

3 郭春鋒;李紅;丁玉枝;杜姣;;SWI在腦靜脈血管畸形診斷中的價值[J];實用放射學(xué)雜志;2016年01期

4 熊婧彤;苗強(qiáng);伍建林;吳昊;張清;;磁敏感加權(quán)成像檢測糖尿病患者腦微出血及其與認(rèn)知功能的相關(guān)性[J];中國醫(yī)學(xué)影像技術(shù);2015年12期

5 張彥;崔怡;董運芳;;高血壓大鼠血腦屏障緊密連接變化與腦白質(zhì)病變的相關(guān)性[J];中國老年學(xué)雜志;2015年22期

6 劉勁峰;;磁敏感加權(quán)成像在出血性腦梗死中的診斷價值分析[J];中國CT和MRI雜志;2015年09期

7 蘇慧;付孟莉;孔慶奎;;腦微出血與高血壓的相關(guān)性分析[J];磁共振成像;2015年04期

8 孫朋朋;姜興岳;鄭林豐;李康安;張貴祥;;磁敏感加權(quán)成像在顱內(nèi)腫瘤中的應(yīng)用價值[J];濱州醫(yī)學(xué)院學(xué)報;2015年02期

9 蘇玉濤;王文犀;王新亮;龐志宏;張元;郭立剛;姚寶軍;何志剛;荊鴻道;;磁敏感加權(quán)成像在CT陰性的彌漫性軸索損傷中的應(yīng)用[J];中國臨床醫(yī)學(xué)影像雜志;2015年03期

10 閆海燕;郗紅艷;王紅梅;張鳳春;曹端華;;磁敏感加權(quán)成像技術(shù)在腦出血早期診斷及病因判斷中的臨床應(yīng)用價值[J];中國醫(yī)學(xué)前沿雜志(電子版);2015年01期

相關(guān)博士學(xué)位論文 前1條

1 蔡堅;新疆維吾爾族、漢族缺血性腦卒中相關(guān)危險因素及與WNK1基因多態(tài)性的關(guān)聯(lián)研究[D];新疆醫(yī)科大學(xué);2013年

相關(guān)碩士學(xué)位論文 前3條

1 王越;腦微出血的相關(guān)危險因素及與腦卒中的關(guān)系[D];吉林大學(xué);2016年

2 程玲;高齡高血壓患者24小時血壓值與腔隙性腦梗死和腦白質(zhì)病變的關(guān)系[D];中國人民解放軍醫(yī)學(xué)院;2013年

3 潘靜;年齡相關(guān)性腦白質(zhì)改變與外周血內(nèi)皮祖細(xì)胞數(shù)量及認(rèn)知功能關(guān)系的研究[D];天津醫(yī)科大學(xué);2010年

，

本文編號：1651608