轻度OSAHS患者合并认知功能障碍相关因素分析

发布时间：2018-01-01 08:33

本文关键词：轻度OSAHS患者合并认知功能障碍相关因素分析　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea Hypopnea Syndrome,OSAHS)容易造成认知功能障碍,但机制尚不明确。本研究对轻度OSAHS认知功能障碍患者行磁共振弥散张量成像(Diffusion Tensor Imaging,DTI)观察脑白质结构变化,检测超敏C反应蛋白(highsensitivity C-reactive protein,hsCRP),评估低氧参数包括呼吸暂停低通气指数(Apnea-Hypopnea Index,AHI)、最低血氧饱和度(Lowest 02 saturation,LSa02)、平均血氧饱和度(Mean O2 saturation,MSa02),分析轻度OSAHS认知功能障碍与脑白质结构变化、hsCRP、AHI、LSa02、MSa02相关性,探讨轻度OSAHS认知功能障碍可能发病机制,为轻度OSAHS认知功能障碍患者早期干预提供依据。方法:收集轻度OSAHS认知功能障碍患者12例(OSAHS组),其中男5例,女7例;与之匹配的单纯打鼾非认知功能障碍患者12例(对照组),其中男6例,女6例。通过PSG检查获取两组患者低氧参数:AHI、LSa02、MSa02。检测两组患者晨间空腹血清中的hsCRP水平。入组患者均接受DTI检查,选取感兴趣区(Region of Interest,ROI)观察白质区域部分各向异性(fractional anisotropy,FA)图,分别测量FA值。分析MoCA和MMSE评分与FA值、hsCRP、PSG参数、ESS评分之间的相关性。统计采用SPSS 20.0软件包处理。结果:1.OSAHS 组与对照组比较,MoCA 评分降低(25.3±1.42vs27±1.33,p=0.013),AHI 升高(7.44±2.28 vs 1.99±1.63,P=0.000),hsCRP 升高(1.96±1.72 vs 0.61±0.90,P=0.041),差异有统计学意义;MMSE评分降低(27.9±1.73vs28.1±1.47),差异无统计学意义;LSa02、MSa02、ESS评分差异无统计学意义。2.OSAHS组与对照组FA值比较,左侧大脑脚(0.721±0.09vs0.824±0.046,P=0.009)、右侧后扣带回(0.25±0.14 vs 0.43±0.024,P=0.045)、左侧内囊后肢(0.56±0.24vs0.75±0.04,P=0.016)、右侧内囊后肢(0.57±0.21vs0.72±0.05,P=0.028)、左侧海马旁回(0.25±0.11vs0.35±0.06,P=0.033)下降,差异有统计学意义;右侧大脑脚、双侧额叶白质、胼胝体膝、胼胝体干、胼胝体压、双侧前扣带回、左侧后扣带回、左侧内囊前肢、双侧内囊膝部、双侧半卵圆中心、双侧前角周围白质、双侧后角周围白质、双侧丘脑、右侧海马旁回的FA值与对照组差异无统计学意义。3.Spearsman秩相关分析发现:MoCA评分与AHI呈负相关(r=-0.708,P=0.022),而与年龄、BMI、高血压、糖尿病、吸烟、饮酒、平均FA值、LSa02、MSa02均无相关性(P0.05)。4.线性回归分析提示MoCA评分与AHI之间存在数量关系(B=-0.440,T=-2.838,P=0.022),即AHI每增加1次/分,MoCA评分下降0.44分。结论:(1)轻度OSAHS患者存在轻度认知功能障碍,炎症反应可能参与其发病,AHI是其独立危险因素,AHI每增加1次/分,MoCA评分下降0.44分;(2)轻度OSAHS患者发生轻度认知功能障碍时存在脑白质结构改变,部位主要分布在左侧大脑脚、右侧后扣带回、双侧内囊后肢、左侧海马旁回。
[Abstract]:Objective: sleep apnea hypopnea syndrome (Obstructive Sleep Apnea Hypopnea Syndrome, OSAHS) can cause cognitive dysfunction, but the mechanism is not clear. The study of OSAHS for mild cognitive dysfunction in patients with magnetic resonance diffusion tensor imaging (Diffusion Tensor, Imaging, DTI) to observe the changes of cerebral white matter structure, high sensitive C reactive protein (highsensitivity C-reactive protein, hsCRP), hypoxia evaluation parameters including apnea hypopnea index (Apnea-Hypopnea, Index, AHI), the lowest oxygen saturation (Lowest 02 saturation, LSa02), the average oxygen saturation (Mean O2, saturation, MSa02, OSAHS) analysis of mild cognitive impairment and brain white matter changes, hsCRP, AHI, LSa02, MSa02 to explore the possible correlation between the mild cognitive impairment, the pathogenesis of OSAHS, for the avoidance of cognitive function in mild OSAHS patients because of early intervention. Methods: to collect light The degree of cognitive dysfunction in patients with OSAHS 12 cases (OSAHS group), 5 cases were male, 7 were female; and simple snoring, non cognitive dysfunction in patients with 12 cases (control group), 6 cases were male, 6 were female. Two groups of patients with hypoxia parameters are obtained through AHI, LSa02, PSG examination: the level of hsCRP MSa02. the two groups were detected in the morning fasting serum. The patients underwent DTI examination, the region of interest (Region of, Interest, ROI) to observe the white matter fractional anisotropy (fractional anisotropy, FA), FA values were measured. The analysis of MoCA and MMSE score and FA, hsCRP, PSG parameters, correlation the ESS score between the statistics. Using SPSS 20 software. Results: comparing 1.OSAHS group with control group, MoCA score was lower (25.3 + 1.42vs27 + 1.33, p=0.013), AHI increased (7.44 + 2.28 vs 1.99 + 1.63, P=0.000), hsCRP increased (1.96 + 1.72 vs 0.61 + 0.90, P=0.041), difference there was statistically significant Yi; MMSE score was lower (27.9 + 1.73vs28.1 + 1.47), the difference was not statistically significant; LSa02, MSa02, ESS score was no significant difference between.2.OSAHS group and control group FA values compared with left cerebral peduncle (0.721 + 0.09vs0.824 + 0.046, P=0.009), right posterior cingulate (0.25 + 0.14 vs 0.43 + 0.024, P=0.045), the left posterior limb of the internal capsule (0.56 + 0.24vs0.75 + 0.04, P=0.016), right posterior limb of the internal capsule (0.57 + 0.21vs0.72 + 0.05, P=0.028), left parahippocampal gyrus (0.25 + 0.11vs0.35 + 0.06, P=0.033) decreased, the difference was statistically significant; on the right side of the brain, frontal white matter, genu of corpus callosum, corpus callosum the stem, corpus callosum, bilateral anterior cingulate, left posterior cingulate gyrus, left anterior limb, bilateral genu, bilateral centrum semiovale, bilateral anterior horn of the surrounding white matter, white matter around the bilateral posterior horn, bilateral thalamus, right parahippocampal gyrus FA and the control group had no significant difference.3.Spearsman Rank correlation analysis showed that MoCA scores was negatively correlated with AHI (r=-0.708, P=0.022), and with age, BMI, hypertension, diabetes, smoking, alcohol consumption, the average value of FA, LSa02, MSa02 had no correlation (P0.05).4. linear regression analysis of relationship between the number of MoCA score (B=-0.440, T=-2.838, and AHI P=0.022), each additional AHI 1 / min, MoCA score decreased 0.44 points. Conclusion: (1) mild OSAHS patients have mild cognitive impairment, inflammatory response may be involved in the pathogenesis of AHI, are the independent risk factors for every 1 increase in AHI / min, MoCA score decreased 0.44 points; (2) patients with mild OSAHS had mild cognitive when there is dysfunction of cerebral white matter changes in the structure, the main sites in the left cerebral peduncle, right posterior cingulate, bilateral posterior, left parahippocampal gyrus.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766;R749.1

【参考文献】