快眼动睡眠行为障碍与自主神经功能障碍的相关性研究

发布时间：2018-06-07 10:24

本文选题：快眼动睡眠行为障碍 + α-突触核蛋白病　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:研究快眼动睡眠行为障碍(REM sleep behavior disorder,RBD)及孤立性RSWA(REM sleep without atonia,RSWA)与自主神经功能之间的相关性,并评价RBD及孤立性RSWA的动态脑血流自动调节改变。方法:本研究选取2016年2月至2017年2月期间就诊于吉林大学第一医院神经内科门诊及住院的存在“失眠、多梦、说梦话、尖叫、肢体舞动”等表现的患者,经视频多导睡眠监测(v PSG)符合RBD诊断的患者17例(其中特发性RBD 6例,帕金森病(PD)伴RBD 6例,很可能的多系统萎缩(MSA)伴RBD 5例)、符合孤立性RSWA诊断的患者6例以及健康对照组6例作为研究对象。应用帕金森病自主神经功能评定量表(Scales for Outcomes in PArkinson’s disease-AUT,SCOPA-AUT)进行自主神经功能评估;并采用经颅多普勒超声(transcranial dopple,TCD)与连续指尖血压监测仪联合,同步记录连续10分钟双侧大脑中动脉血流速度和平均动脉血压,应用传递函数分析方法导出动态脑血流自动调节(dynamic cerebral autoregulation,d CA)的相关参数:相位差、增益、相关函数,评价RBD及孤立性RSWA的动态脑血流自动调节的改变。结果:1.不同组别研究对象SCOPA-AUT量表得分结果:(1)SCOPA-AUT总分:孤立性RSWA组、i RBD组、PD伴RBD组、很可能MSA伴RBD组总分得分均值(7.33±3.83、17.83±7.94、19.50±5.79、21.40±10.60)较对照组(1.67±0.82)明显升高(P0.05);孤立性RSWA组总分均值介于对照组及i RBD组之间,RBD各组之间总分差异无显著性。(2)SCOPA-AUT各系统得分:孤立性RSWA组、i RBD组、PD伴RBD组及很可能的MSA伴RBD组消化系统得分(5.00±2.83、6.00±3.16、7.17±2.32、6.40±4.28)高于对照组(0.50(1.00))(P0.05);i RBD组、PD伴RBD组、很可能的MSA伴RBD组泌尿系统得分(5.67±2.88、7.00±3.58、11.00(9.00))与对照组(1.00±0.89)比较明显增高(P0.05),孤立性RSWA组泌尿系统得分低于很可能的MSA伴RBD组得分(P0.05);与对照组(0.00(0.00))相比,i RBD组、PD伴RBD组、很可能的MSA伴RBD组的心血管系统得分(1.83±1.17、2.00(2.00)、4.20±2.05)得分明显升高(P0.05),与孤立性RSWA组相比,很可能的MSA伴RBD组心血管系统得分明显升高(P0.05);i RBD组、PD伴RBD组及很可能MSA伴RBD组性功能得分(2.33±2.42、1.80±1.10、4.00±1.83)高于对照组得分(0.00)(P0.05),其中与孤立性RSWA组比较,很可能的MSA伴RBD组性功能得分明显增高(P0.05)。2.动态脑血流自动调节相关参数结果:(1)相位差:孤立性RSWA组、i RBD组、PD伴RBD组、很可能MSA伴RBD组的左相位差(44.63±10.29°、37.08±14.5°、40.69±11.16°、38.72±6.04°)与对照组数值(58.26±8.28°)比较均明显下降(P0.05),i RBD组、PD伴RBD组、很可能MSA伴RBD右相位差(36.20±14.89°、40.09±12.62°、41.34±8.74°)与对照组数值(56.89±3.64°)比较均明显下降(P0.05),其中,孤立性RSWA组的左右侧相位差介于对照组及i RBD组之间。(2)增益:孤立性RSWA组、i RBD组的右侧增益(1.24±0.48、1.13±0.20)与对照组、PD伴RBD组(0.74(0.10)、0.76±0.20)比较明显升高(P0.05)。结论:1.孤立性RSWA患者自主神经功能障碍以消化系统系统损害为著。2.特发性RBD及继发性RBD患者自主神经功能障碍以消化、泌尿、心血管系统及性功能损害为著。3.孤立性RSWA、特发性RBD及继发性RBD患者d CA受损。
[Abstract]:Objective: To study the correlation between REM sleep behavior disorder (RBD) and isolated RSWA (REM sleep without atonia, RSWA) and autonomic nervous function, and to evaluate the dynamic changes in the dynamic cerebral blood flow regulation of RBD and isolation. Methods: This study was selected from February 2016 to February 2017 at the Jilin University The patients in the Department of Neurology in the first hospital, including "insomnia, dream, dream talk, screaming, limb dancing", were 17 patients with RBD diagnosis by video polysomnography (V PSG), including 6 cases of idiopathic RBD, 6 cases of Parkinson's disease (PD) with RBD, and 5 cases of MSA with RBD, which were in line with isolated RSWA diagnosis. 6 cases of broken patients and 6 healthy controls were used as subjects. The autonomic nervous function assessment was performed by using the Scales for Outcomes in PArkinson 's disease-AUT, SCOPA-AUT, and the combination of transcranial Doppler (transcranial Dopple, TCD) and continuous fingertip blood pressure monitor was used. The blood flow velocity and mean arterial blood pressure of the bilateral middle cerebral arteries were recorded for 10 minutes. The related parameters of dynamic cerebral autoregulation (D CA) were derived by the transfer function analysis method: phase difference, gain, correlation function, and the changes of dynamic cerebral blood flow regulation of RBD and isolated RSWA. Results: 1. The results of the SCOPA-AUT scale in the same group were: (1) the total score of SCOPA-AUT: isolated RSWA group, I RBD group, PD with RBD group, the total score of MSA with RBD group (7.33 + 3.83,17.83 + 7.94,19.50 + 5.79,21.40 + 10.60) was significantly higher than that of the control group (1.67 + 0.82). There was no significant difference in total score between RBD groups. (2) scores of SCOPA-AUT system: isolated RSWA group, I RBD group, PD with RBD group and very likely MSA with RBD (5 + 2.83,6.00 + 3.16,7.17 + 2.32,6.40 + 4.28) were higher than that of the control group (0.50 (1)). The score of 2.88,7.00 + 3.58,11.00 (9)) was significantly higher than that in the control group (1 + 0.89). The score of urinary system in the isolated RSWA group was lower than that of the very likely group of MSA with RBD (P0.05). Compared with the control group (0 (0)), the score of the I RBD group and PD with RBD group was likely to score the score of the cardiovascular system (1.83 + 2) and 4.20 + 2.05) in the MSA companion group. Significantly higher (P0.05), compared with the isolated RSWA group, the possible score of the cardiovascular system in the group of MSA with RBD was significantly higher (P0.05), and in the I RBD group, the score of PD with RBD and the likely MSA companion of the RBD group (2.33 + 2.42,1.80 + 1.83) was higher than that of the control group (0), which was more likely than the isolated group. The function score increased significantly (P0.05).2. dynamic cerebral blood flow automatic regulation related parameters: (1) phase difference: isolated RSWA group, I RBD group, PD accompanied with RBD group, it is very likely that the left phase difference of MSA with RBD group (44.63 + 10.29, 37.08 + 14.5, 40.69 + 11.16, 38.72 + 6.04 degree) and the control group (58.26 + 8.28 degrees) and the control group (P0.05), I RBD group, With the RBD group, it was possible that the right phase difference between MSA and RBD (36.20 + 14.89, 40.09 + 12.62, 41.34 + 8.74) and the control group (56.89 + 3.64 degrees) decreased significantly (P0.05). The left and right side phase differences of the isolated RSWA group were between the control group and the I RBD group. (2) gain: the isolated RSWA group and the right gain of the I RBD group (1.24 + 0.48,1.13 + 0.20). Compared with the control group, PD with RBD group (0.74 (0.10), 0.76 + 0.20) was significantly increased (P0.05). Conclusion: 1. isolated RSWA patients with autonomic dysfunction with digestive system damage to.2. idiopathic RBD and secondary RBD patients with autonomic dysfunction with digestive, urinary, cardiovascular system and sexual dysfunction are.3. isolated RSWA, special hair. D CA in patients with sexual RBD and secondary RBD was impaired.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R740

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