血管性痴呆的常见临床类型及其危险因素分析

发布时间：2018-03-20 21:32

本文选题：血管性痴呆　切入点：病因类型　出处：《大连医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：随着社会经济、文化及医疗条件等各方面的进步，我国社会人口老龄化的趋势越来越明显，而脑血管病又是中老年人群的高发和常见疾病，血管性因素引起的痴呆，其发病率更是逐年增高。血管性痴呆（Vascular Dementia，VaD）在痴呆中占有相当大的比例，是目前唯一可以防治的痴呆，具有一定的可逆性。这严重影响到了患者及其家庭的生活质量，，给国家和家庭带来了沉重的负荷。因此，越来越多的学者开始将目光投向这一领域。关注VaD的危险因素，及时延缓病情的发展，具有十分重要的意义。研究目的:本研究旨在研究VaD的常见临床类型及其相关的危险因素。研究方法:2011年2月至2013年2月在大连市中心医院神经内科住院治疗的VaD患者82例，无认知功能障碍的患者52例。按照规定的入组条件，符合标准条件的患者签署知情同意书后进行入组。 1.对所有患者的一般资料、神经系统检查、既往史、个人史、家族史及其用药情况进行详细询问并进行记录。 2.对所有患者依次进行HAMD、MMSE、MOCA、CDR、ADL和HIS量表得分评定，筛选出VaD组患者82例，正常对照组患者52例。 3.把VaD组患者按分类标准进行细化分组，找出VaD的临床常见类型及各种类型在VaD中所占的百分比。 4.对所有入组患者进行实验室检查，内容包括：血常规、尿常规、生化（血脂、血糖、血尿酸、血同型半胱氨酸、超敏C反应蛋白）及血纤维蛋白原。影像学检查：心电图、颅脑核磁及颈动脉超声检查。 5.统计学处理：采用SPSS17.0统计学软件对资料进行统计分析，计数资料用频数（百分比）或平均数±标准差（x±S）表示，参数分析采用配对t检验，对于分类资料采用X2检验。规定p㩳0.05有统计学意义。研究结果： 1.在本研究中，缺血性小血管性痴呆组共计有50人，占所有入组的血管性痴呆患者的60.98%。 2.血管性痴呆组与正常对照组在年龄、卒中次数、高血压、糖尿病、高脂血症、同型半胱氨酸（HCY）、纤维蛋白原（FIB）、颈动脉斑块形成、高尿酸血症、超敏C反应蛋白（Hs-crp）和吸烟之间差异有显著性意义（p＜0.05），而两组在性别、文化程度及房颤之间差异均无显著性意义（p＞0.05）。 3.缺血性小血管性痴呆组与正常对照组在年龄、卒中史、高血压、糖尿病、血脂、纤维蛋白原（FIB）、同型半胱氨酸（HCY）、吸烟和颈动脉斑块之间差异有显著性意义（p＜0.05），而两组在性别、受教育程度、超敏C反应蛋白（Hs-crp）、高尿酸血症（Hyperuricemia）以及房颤之间差异均无显著性意义（p＞0.05）。结论： 1.缺血性小血管性痴呆、缺血性大血管性痴呆及出血性痴呆是血管性痴呆常见的三种临床类型。 2.年龄、卒中次数、高血压、糖尿病、高脂血症、高纤维蛋白原血症、颈动脉斑块形成、高尿酸血症、超敏C反应蛋白以及吸烟是血管性痴呆的危险因素，而性别、高同型半胱氨酸血症、文化程度及房颤可能非其独立危险因素。 3.年龄、卒中次数、高血压、糖尿病、高脂血症、高同型半胱氨酸血症、高纤维蛋白原血症、颈动脉斑块形成及吸烟是缺血性小血管性痴呆的危险因素，而性别、高尿酸血症、超敏C反应蛋白、文化程度及房颤可能非其独立危险因素。
[Abstract]:Along with the social economy, the culture and medical conditions such as progress, the trend of our country ageing is more and more obvious, and cerebrovascular disease in the elderly population is a high incidence of common diseases and disease, vascular factors, its incidence is increasing year by year. Vascular dementia (Vascular Dementia, VaD) occupies a large proportion in dementia, dementia is currently the only can be prevented and is reversible. It seriously affects the quality of life of patients and their families, and brought a heavy burden to the country and family. Therefore, more and more scholars began to pay attention to this field. VaD the development of risk factors, timely delay the disease, it has very important significance.
Objective: the purpose of this study was to investigate the common clinical types of VaD and its related risk factors.
Research methods: from February 2011 to February 2013, 82 patients with VaD were enrolled in the Department of Neurology, Dalian Central Hospital, 52 patients without cognitive impairment. According to the prescribed entry conditions, the patients who met the criteria were informed of the informed consent.
1. the general information of all patients, neurological examination, previous history, personal history, family history and drug use were inquired and recorded in detail.
2. for all patients, the scores of HAMD, MMSE, MOCA, CDR, ADL and HIS were evaluated in turn, and 82 patients in group VaD and 52 in normal control group were selected.
3. groups of patients in group VaD were grouped according to the classification criteria to find out the common clinical types of VaD and the percentage of various types in VaD.
4. all the patients in the laboratory were examined, including blood routine, urine routine, biochemical (blood fat, blood sugar, blood uric acid, homocysteine, hypersensitive C reactive protein) and fibrinogen. Image examination: electrocardiogram, craniocerebral magnetic resonance and carotid artery ultrasonography.
5. statistical treatment:
The data were statistically analyzed by SPSS17.0 statistical software. The counting data were expressed by frequency (percentage) or mean + standard deviation (x + S). The paired t test was used for parameter analysis, and X2 test was used for categorical data. P 0.05 was statistically significant.
The results of the study:
1. in this study, there were 50 patients with ischemic small vascular dementia, which accounted for 60.98%. in all patients with vascular dementia.
2. vascular dementia group and normal control group in age, hypertension, diabetes, stroke frequency, hyperlipidemia, homocysteine (HCY), fibrinogen (FIB), carotid artery plaque formation, hyperuricemia, high sensitive C reactive protein (Hs-crp) had significant difference between smoking and smoking (P < 0.05), and differences between the two groups in gender, culture degree and atrial fibrillation was not significant (P > 0.05).
3. small ischemic vascular dementia group and normal control group in age, history of stroke, hypertension, diabetes mellitus, blood lipid, fibrinogen (FIB), homocysteine (HCY), there was a significant difference between smoking and carotid plaque (P < 0.05), while the two groups in gender, level of education. High sensitivity C reactive protein (Hs-crp), hyperuricemia (Hyperuricemia) and the difference between atrial fibrillation was not significant (P > 0.05).
Conclusion:
1. ischemic small vascular dementia, ischemic large vascular dementia and hemorrhagic dementia are the three common clinical types of vascular dementia.
2. age, stroke frequency, hypertension, hyperlipidemia, diabetes, high fibrinogen, carotid plaque formation, hyperuricemia, high sensitive C reactive protein and risk factors of vascular dementia is smoking, gender, hyperhomocysteinemia, cultural degree and non atrial fibrillation may be the independent risk factors.
3. age, stroke frequency, hypertension, hyperlipidemia, diabetes, high homocysteine, fibrinogen, carotid artery plaque formation and cigarette smoking is a risk factor for ischemic vascular dementia, small sex, hyperuricemia, high sensitive C reactive protein, the degree of atrial fibrillation and may be the independent risk factor.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.13

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