缺血性脑白质病变与认知功能、外周血抗-MOG抗体、ICAM-1的临床关系研究

发布时间：2018-06-29 21:28

本文选题：缺血性脑白质病变 + 认知功能　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:探讨不同程度缺血性脑白质病变(White matter ischemic lesions,WMIL)对患者认知功能的影响及认知功能障碍的特点;检测不同程度WMIL患者外周血抗少突胶质细胞糖蛋白(Myelin oligodendrocyte glycoprotein,MOG)抗体及细胞间粘附分子-1(Intercellular adhesion molecule-1,ICAM-1)的水平表达情况,分析WMIL的相关因素及与抗-MOG抗体、ICAM-1的相关性。方法:连续纳入2015年11月1日至2016年12月31日安徽医科大学附属宿州医院神经内科住院患者,且经颅脑MRI证实为WMIL者115例。选取健康体检者经颅脑MRI证实无明确脑白质病变者21例。WMIL组患者根据Fazekas评分标准分为轻、中、重3组,轻度组为1-4分,中度组5-8分,重度组9-12分。根据病变部位不同分为脑室旁白质病变(PWML)和皮层下深部白质病变(DWML)。应用蒙特利尔认知功能评估(Mo CA)量表对研究对象进行认知功能评估。采用酶联免疫法(ELISA)测定外周血抗-MOG抗体和ICAM-1水平。结果:1.WMIL组Mo CA量表分值明显低于健康对照组(P0.05);轻度WMIL组Mo CA量表分值与健康对照组无明显差异(P0.05);中、重度WMIL组Mo CA量表分值显著低于健康对照组(P0.05);轻、中、重度WMIL三组患者Mo CA分值存在明显差异(P0.05),且相关分析显示Mo CA量表的分值与Fazekas评分呈负相关(P0.05);DWML组患者认知功能较PWML组明显降低(P0.05)。2.相关危险因素分析结果显示,WMIL组与健康对照组年龄、吸烟史、血脂、同型半胱氨酸均有明显差异(P0.05)。3.WMIL组外周血抗-MOG抗体水平明显高于健康对照组(P0.05);轻、中、重度WMIL三组患者外周血抗-MOG抗体水平存在差异(P0.05),相关分析显示外周血抗-MOG抗体水平与Fazekas评分呈正相关(P0.05),与Mo CA量表分值呈负相关(P0.05);PWML组外周血抗-MOG抗体明显高于DWML组(P0.05)。4.WMIL组患者外周血ICAM-1浓度明显高于健康对照组(P0.05);轻、中、重度WMIL三组患者外周血ICAM-1水平存在差异(P0.05),相关分析显示外周血ICAM-1与Fazekas评分呈正相关(P0.05),与Mo CA量表分值呈负相关(P0.05);DWML组及PWML组外周血ICAM-1水平无明显差异(P0.05)。结论:1.外周血抗-MOG抗体水平在WMIL的发病及病情进展中有一定的作用,可能是WMIL的一项重要危险因素,其可能与PWML有更密切的联系。2.外周血ICAM-1水平在WMIL的发病中起到一定的作用,可能为WMIL的危险因素之一。3.一定程度的WMIL可使患者的认知功能下降,且认知功能的下降程度可能与WMIL的严重程度呈正相关,且可能与病变部位有关。4.年龄、吸烟史、血脂异常、高同型半胱氨酸血症可能均为WMIL的危险因素。
[Abstract]:Objective: to investigate the effects of different degrees of ischemic white matter lesions (WMIL) on cognitive function and the characteristics of cognitive dysfunction. The levels of anti-oligodendrocyte glycoprotein (MOG) antibody and intercellular adhesion molecule-1 (ICAM-1) in peripheral blood of patients with WMIL were detected, and the correlation between WMIL and anti-MOG antibody ICAM-1 was analyzed. Methods: 115 patients were admitted to the Department of Neurology, Suzhou Hospital affiliated to Anhui Medical University from November 1, 2015 to December 31, 2016, and were confirmed as WMIL by craniocerebral MRI. According to the Fazekas score, 21 healthy persons with no clear white matter lesions confirmed by MRI were divided into 3 groups: mild, moderate, severe, 1-4, moderate, 5-8 and 9-12, respectively. According to the location of the lesion, it can be divided into ventricular collateral leukopathy (PWML) and subcortical deep white matter lesion (DWML). The Montreal Cognitive function Assessment (MOCA) scale was used to evaluate the cognitive function of the subjects. The levels of anti-MOG antibody and ICAM-1 in peripheral blood were measured by enzyme linked immunosorbent assay (Elisa). Results 1. The scores of Mo CA in WMIL group were significantly lower than those in the healthy control group (P0.05), there was no significant difference between the mild WMIL group and the healthy control group (P0.05); in the moderate and severe WMIL group, the Mo CA scale score was significantly lower than that in the healthy control group (P0.05); The scores of Mo CA in severe WMIL group were significantly different (P0.05), and the correlation analysis showed that the score of Mo CA scale was negatively correlated with Fazekas score (P0.05). The cognitive function of DWML group was significantly lower than that of PWML group (P0.05). The results of risk factors analysis showed that the age, smoking history, blood lipid and homocysteine levels in WMIL group were significantly higher than those in healthy control group (P0.05). There were significant differences among the three groups of patients with severe WMIL (P0.05). Correlation analysis showed that the level of anti-MOG antibody in peripheral blood was positively correlated with Fazekas score (P0.05), and negatively correlated with the score of Mo CA scale (P0.05). The level of anti-MOG antibody in PWML group was significantly higher than that in DWML group. The concentration of ICAM-1 in peripheral blood in WMIL group was significantly higher than that in healthy control group (P0.05). The level of ICAM-1 in peripheral blood of the three patients with severe WMIL was significantly different (P0.05). The correlation analysis showed that the level of ICAM-1 in peripheral blood was positively correlated with Fazekas score (P0.05), and negatively correlated with the score of Mo CA (P0.05). There was no significant difference in ICAM-1 level between DWML group and PWML group (P0.05). Conclusion 1. The level of anti-MOG antibody in peripheral blood may play an important role in the pathogenesis and progression of WMIL and may be an important risk factor of WMIL, which may be more closely related to PWML. The level of ICAM-1 in peripheral blood may play a role in the pathogenesis of WMIL and may be one of the risk factors of WMIL. To a certain extent, WMIL can decrease the cognitive function of the patients, and the degree of the decline of cognitive function may be positively correlated with the severity of WMIL, and may be related to the location of the lesion. Age, smoking history, dyslipidemia and hyperhomocysteinemia may all be risk factors for WMIL.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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