皮质下缺血性血管病患者血清碱性磷酸酶变化及其对认知功能的影响

发布时间：2018-03-13 22:31

  本文选题：碱性磷酸酶　切入点：脑缺血　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的 通过比较皮质下缺血性血管病(SIVD)患者和正常对照组的血清碱性磷酸酶(ALP)水平及认知功能评分结果,探讨ALP变化及其对认知功能的影响,并分析其中可能的机制。方法 收集158例就诊于安徽医科大学第一附属医院的SIVD患者,依据认知损害程度分为皮质下血管性轻度认知损害组(SVMCI,n=86)及皮质下血管性痴呆组(SVa D,n=72),选择67名认知功能正常的老年人作为对照组。依据头颅MRI将SIVD分为多发性腔隙性脑梗死组(LI)、脑白质疏松组(LA),并对LA程度进行分级。收集所有受试者空腹8h的静脉血,通过全自动分析仪测定血清ALP水平,并按照其浓度将受试者均分为1组(ALP71 U/L)、2组(ALP 71~86 U/L)和3组(ALP86 U/L);采用简易精神状态检查(MMSE)及剑桥老年认知检查表-中国修订版(CAMCOG-C)等量表对认知功能进行评价。比较不同认知损害程度组间血清ALP水平,不同ALP浓度间LI、LA及认知损害发生率,并将认知功能评分与ALP等进行相关分析和多元回归分析。结果 (1)SIVD患者受教育年限低于对照组;高血压、吸烟比例,血清尿素氮水平均高于对照组;SVa D、SVMCI患者血清ALP水平均显著高于对照组,3组间差异具有统计学意义(均P0.05)。(2)SVa D和SVMCI患者MMSE及CAMCOG-C评分均低于对照组,且SIVD患者CAMCOG-C各子项评分(包括定向、语言、记忆、注意、执行、计算、思维、知觉)也显著低于对照组,差异均具有统计学意义(均P0.05)。(3)将受试者ALP浓度按照三等分法均分为3组:1组(ALP71U/L)、2组(ALP 71~86 U/L)和3组(ALP86 U/L),每组均为75例,3组之间LI、LA及SVa D发生率差异具有统计学意义(χ2=8.008,P=0.018;χ2=17.998,P=0.000;χ2=12.255,P=0.002),结果显示随着血清ALP水平升高,其LI、LA及SVa D发生率均逐渐升高。(4)相关分析发现,ALP与MMSE、CAMCOG-C总分呈负相关(r=-0.350,P=0.000;r=-0.286,P=0.000);且ALP与CAMCOG-C评分子项中定向、语言、记忆、注意、执行、计算、思维、知觉等均呈负相关(r=-0.193,P=0.004;r=-0.238,P=0.000;r=-0.273,P=0.000;r=-0.261,P=0.000;r=-0.222,P=0.001;r=-0.210,P=0.002;r=-0.218,P=0.001;r=-0.161,P=0.015)。(5)多元回归分析在校正年龄、性别、吸烟、高血压等相关因素后,ALP与认知功能损害呈正相关,在控制变量中添加LA分级后,ALP与认知损害无明显相关性,提示血清ALP对SIVD患者认知功能的影响与LA严重程度密切相关。结论 校正性别、年龄及体重指数等因素后,SVMCI组和SVa D组血清ALP水平、高血压及吸烟比例等血管危险因素均高于对照组。SVMCI和SVa D组MMSE、CAMCOG-G及其各子项评分均显著低于对照组。控制年龄、性别、吸烟、高血压等相关因素后,血清ALP水平与认知功能损害呈正相关,尤其是脑白质疏松较为严重者。
[Abstract]:Objective to compare the subcortical ischemic vascular disease (SIVD) patients and normal control group, serum alkaline phosphatase (ALP) level and cognitive function score results, to explore the changes of ALP and its effects on cognitive function, and analyze its possible mechanism. Methods 158 patients from the First Affiliated Hospital of Medical University Of Anhui from SIVD patients, according to cognitive impairment the degree of subcortical vascular mild cognitive impairment group (SVMCI, n=86) and subcortical vascular dementia group (SVa D, n=72), selected 67 elderly normal cognitive function as the control group. According to the head MRI SIVD is divided into multiple lacunar infarction group (LI), cerebral white matter osteoporosis group (LA), and classification of LA. Venous blood samples were collected from all subjects fasting 8h, serum ALP levels were measured by automatic analyzer, and in accordance with the concentration of the subjects were divided into 1 groups (ALP71, U/L) group (ALP 71~86 U/L 2 ) and 3 group (ALP86 U/L); with the mini mental state examination (MMSE) and Cambridge cognitive examination - China Revised Edition (CAMCOG-C) scale to evaluate the cognitive function. Comparison of different levels of cognitive impairment between the serum level of ALP, different concentrations of ALP between LA and LI, and the incidence of cognitive impairment. The score of cognitive function and ALP for correlation analysis and multiple regression analysis. Results (1) patients with SIVD years of education than in the control group; the proportion of hypertension, smoking, serum urea nitrogen and water were higher than the control group; SVa, D, ALP in serum SVMCI level were significantly higher than the control group, the difference was statistically significant between the 3 groups (all P0.05). (2) SVa D and SVMCI in patients with MMSE and CAMCOG-C scores were lower than the control group, SIVD and CAMCOG-C in patients with sub item score (including orientation, language, memory, attention, executive, calculation, thinking, perception) is significantly lower than the control group, the differences were statistically 鎰忎箟(鍧嘝0.05).(3)灏嗗彈璇曡，

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