胆碱能通路白质高信号与认知功能关系的研究

发布时间：2018-03-23 19:55

  本文选题：胆碱能通路　切入点：脑白质高信号　出处：《中国人民解放军医学院》2012年硕士论文

【摘要】：研究背景和目的： 胆碱能系统是痴呆和正常老化的认知功能相关的主要的神经递质系统,该系统功能异常在认知功能障碍中起着重要作用。胆碱能系统功能障碍目前已确定为阿尔茨海默病(Alzheimer's disease, AD)的病理生理改变之一。 胆碱能通路高信号量表(Cholinergic Pathways Hyperintensities Scale, CHIPS)考虑了磁共振成像T2白质高信号(white matter hyperintensities, WMH)与从基底前脑胆碱能系统的Mynert基底核发出的胆碱能通路投射的空间相关性,评价了胆碱能通路WMH的程度。 因此,为探讨胆碱能通路上白质损伤对认知障碍及正常老年人认知功能的影响,本课题对胆碱能通路白质损伤的患病情况,胆碱能通路白质损伤与认知功能的关系及相关危险因素进行了研究。 材料和方法：选取我院查体病人216人,按照认知功能分为对照组182例,轻度认知功能损伤(mild cognitive impairment, MCI)组23例,AD组11例,按照年龄分为70岁、70-80岁与80岁组。采用CHIPS评分对胆碱能通路WMH进行评分,根据CHIPS总分分为正常(0分)、轻度异常(1-7分)及明显异常(≥8分)。同时采用Fazekas及ARWMC评分评估WMH。采用MoCA量表评价认知功能。收集临床患病及用药情况。 结果： 1、CHIPS反映的胆碱能通路WMH的患病率为78.7%,其中轻度异常占31.9%,明显异常占46.8%。70岁、70-80岁与80岁三组CHIPS总分分别为5.14±6.68、11.79±12.63、13.61±10.21分,CHIPS轻度以上异常的比例分别为64.2%、80.3%、96.6%,差异均具有统计学意义(p=0.000)。 2、CHIPS正常、轻度异常及明显异常组间认知损伤(MCI+AD)患病率分别为2.2%、8.7%、26.7%(X2=24.319,p=0.000)；Logistic回归显示,CHIPS损伤程度加重一级,认知损伤患病风险增加2.858倍(X2=46.438,p=0.000),MCI患病风险增加6.112倍(X2=32.614,p=0.000)。 CHIPS正常、轻度异常及明显异常组间仅MoCA语言项差异具有统计学意义(p=0.003),但调整年龄、文化因素的影响后,MoCA各项得分均不受CHIPS总分的影响(p0.05)。 3、CHIPS评分与Fazekas评分的脑室旁白质(ps=0.544,p=0.000)及深部白质(ps=0.729,p=0.000)的得分具有相关性。CHIPS评分与ARWMC评分具有相关性(r=0.819,p=0.000)。 4、CHIPS影响因素的分析显示,CHIPS明显损伤组中,高血压患病率为74.3%,服用ARB及CCB患者的比例明显增高(p0.05)。纳入MCI及AD组后,年龄(p=0.002)、认知(p=0.027)及高血压(p=0.025)是影响CHIPS评分的独立危险因素。而去除MCI与AD组后,年龄仍影响CHIPS总分(p=0.001),但高血压不再具有显著性意义(p=0.068)。 结论： 1、CHIPS所反映的胆碱能通路白质损伤在老年人中较为常见,随年龄的增加而加重。 2、胆碱能通路白质损伤增加MCI、AD患病的危险性。 3、胆碱能通路白质损伤的危险因素包括年龄、高血压,其评分与Fazekas及ARWMC评分相关,考虑与其他WML具有相似的病理生理机制。
[Abstract]:Background and objectives of the study:. Cholinergic system is the main neurotransmitter system associated with cognitive function of dementia and normal aging. The abnormal function of the system plays an important role in cognitive dysfunction. Cholinergic dysfunction has been identified as one of the pathophysiological changes of Alzheimer's disease (ADD). The Cholinergic Pathways Hyperintensities scale (CHIPS) considered the spatial correlation between Mr T 2white matter hyperintensions (WMHs) and the projection of cholinergic pathway from the Mynert basal nucleus of the basal forebrain cholinergic system. The degree of cholinergic pathway WMH was evaluated. Therefore, in order to investigate the effects of white matter injury on cognitive impairment and cognitive function in the elderly, the present study was designed to investigate the prevalence of white matter injury in cholinergic pathway. The relationship between white matter damage and cognitive function of cholinergic pathway and related risk factors were studied. Materials and methods: two hundred and sixteen patients in our hospital were divided into control group (n = 182) and mild cognitive impairment group (n = 23) according to their cognitive function. According to the age, the patients were divided into 70 and 80 years old and 80 years old groups. The WMH of cholinergic pathway was scored by CHIPS score. According to the total score of CHIPS, it was divided into normal (0 points, mild abnormal 1-7 points) and obvious abnormal (鈮，

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