阻塞性睡眠呼吸暂停低通气综合征患者MRI大脑结构变化与认知功能障碍相关性探讨

发布时间：2018-02-04 15:52

本文关键词： 阻塞性睡眠呼吸暂停低通气综合征海马脑白质认知蒙特利尔认知评估量表　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者颅脑磁共振（MRI）显像中海马体积及脑白质的改变和认知功能变化，分析认知功能评分与海马体积、脑白质变化之间的相关性，评估颅脑MRI在评价OSAHS患者认知功能障碍中的临床价值。方法：从2012年3月至2013年8月因打鼾在苏州大学附属第二医院睡眠中心行多导睡眠图（PSG）监测的患者中，纳入符合本研究入排标准的患者81例，依据睡眠呼吸暂停低通气指数（AHI）分为轻度OSAHS组（23例）、中度OSAHS组（18例）、重度OSAHS组（23例）及单纯鼾症组（17例）。采用颅脑MRI常规序列及垂直于双侧海马的液体衰减反转恢复（FIAIR）序列进行成像，并根据Scheltens标准及Fukudas法分别对大脑海马体积萎缩、脑白质病变相关的侧脑室周围高信号灶（PVH）的严重程度进行评分，分析不同严重程度OSAHS对大脑相关结构的影响。应用蒙特利尔认知评估（MoCA）量表、简易精神状态（MMSE）量表评估各组OSAHS患者认知功能的变化，并分析认知功能评分与海马、脑白质结构改变及PSG参数的相关性。检测部分OSAHS患者空腹血脂、凝血功能指标及红细胞压积的变化，分析血清指标与大脑结构改变的关系。结果：随着OSAHS严重程度的加重，患者认知评分尤其是MoCA评分在组间呈下降趋势，海马体积萎缩程度及PVH均呈升高趋势。与单纯鼾症组比较，，重度OSAHS组海马体积萎缩评分升高（[1.5±1.2）比（2.4±1.2）分，P=0.007]，PVH评分升高（[1.6±1.8）比(3.6±1.0)分，P=0.000]，MoCA和MMSE评分降低[（28.0±1.9）比（24.5±2.7）分，P=0.000和（28.7±1.3）比（27.5±1.4）分，P=0.013]，认知功能受损主要表现在视空间与执行力、延迟记忆力等方面。海马体积萎缩、PVH评分与MoCA评分负相关（r=－0.30、－0.30，P=0.010、0.006）。多元线性回归分析提示，决定MoCA量表评分的主要危险因素为AHI和海马体积萎缩程度（标准化回归系数为：－0.386、－0.247，P=0.000、0.020）。OSAHS患者海马体积萎缩、PVH严重程度评分与AHI、氧减指数（ODI）、呼吸相关微觉醒指数（RI）正相关，与最低脉氧饱和度（LSaO2）、平均脉氧饱和度（MSaO2）负相关（均P＜0.05）。而各组间患者的血脂四项、红细胞压积、D-二聚体及纤维蛋白元凝血指标无统计学差异，且海马体积萎缩、PVH评分与上述血清指标亦无相关性（均P＞0.05）。结论：OSAHS可引起患者海马体积萎缩和脑白质病变，出现不同程度的认知功能障碍；认知功能障碍与海马体积萎缩和脑白质病变相关；颅脑MRI技术可为诊断OSAHS患者的认知功能障碍提供客观影像学依据。
[Abstract]:Objective: To investigate the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) patients with brain magnetic resonance (MRI) and volume changes in the white matter of the brain imaging and cognitive function of Naka Haima, analysis the score of cognitive function and hippocampal volume, the correlation between the brain white matter changes and clinical value of brain MRI in the evaluation of cognitive dysfunction in OSAHS patients in.
Methods: from March 2012 to August 2013 due to snoring in the sleep center of The Second Hospital Affiliated to Suzhou University underwent polysomnography (PSG) monitoring in patients in the 81 cases of patients with discharge standards, according to apnea hypopnea index (AHI) were divided into mild OSAHS group (23 cases), moderate OSAHS group (18 cases), severe OSAHS group (23 cases) and primary snoring group (17 cases). The brain MRI attenuated inversion recovery sequence and conventional liquid perpendicular to the bilateral hippocampus (FIAIR) image sequence, and according to the standards of Scheltens and Fukudas respectively on hippocampal atrophy, around the lateral ventricle of cerebral white matter lesions is high signal intensity (PVH) severity score, analysis of the influence of different severity of OSAHS on brain related structure. The application of Montreal cognitive assessment (MoCA) scale, Mini Mental State Scale (MMSE) assessment of cognitive function in patients with OSAHS Then we analyzed the correlation between cognitive function score and hippocampus, white matter structure and PSG parameters. We detected the changes of fasting blood lipids, coagulation function and hematocrit in some OSAHS patients, and analyzed the relationship between serum indexes and brain structure changes.
Results: with the increase of the severity of OSAHS patients, especially the cognitive score MoCA score decreased in group, hippocampal atrophy and PVH increased. Compared with simple snoring group, severe OSAHS group hippocampal volume atrophy score increased ([1.5 + 1.2) than (2.4 + 1.2), P=0.007]. The PVH score increased ([1.6 + 1.8) than (3.6 + 1), P=0.000], MoCA and MMSE scores decreased [(28 + 1.9) than (24.5 + 2.7), and P=0.000 (28.7 + 1.3) than (27.5 + 1.4), P=0.013], impaired cognitive function is mainly manifested in the visual space and executive force, delayed memory and so on. Hippocampal atrophy, PVH score and MoCA score in negative correlation (R=0.30, 0.30, P=0.010,0.006). Multiple linear regression analysis showed that the main risk decision MoCA scale factor AHI and hippocampal atrophy (standardized regression coefficient: 0.386, 0.247, P=0.000,0.020).OSAHS Patients with hippocampal volume atrophy, PVH severity score and AHI, oxygen desaturation index (ODI), respiratory related microarousal index (RI) was positively correlated with the lowest pulse oxygen saturation (LSaO2), mean pulse oxygen saturation (MSaO2) negative correlation (P < 0.05). Groups of four blood lipids. Hematocrit, no significant difference between the two D- dimer and fibrinogen clotting index, and hippocampal volume shrinking, there is no correlation between PVH score and the serum index (P > 0.05).
Conclusion: OSAHS patients can cause hippocampal volume atrophy and cerebral white matter lesions appear different levels of cognitive impairment; cognitive dysfunction associated with hippocampal atrophy and white matter lesions; brain MRI technology can provide objective imaging for cognitive dysfunction in the diagnosis of patients with OSAHS basis.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R766;R445.2

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