无痴呆型血管性认知障碍患者认知功能量表与外周血炎性标志物的研究

发布时间：2018-04-25 21:50

本文选题：无痴呆型血管性认知障碍 + 蒙特利尔评估量表　；参考：《苏州大学》2013年硕士论文

【摘要】：背景血管性认知障碍（vascular cognitive impairment, VCI）涵盖了由脑血管病或脑血管病危险因素引起的从轻度认知障碍到痴呆的一大类综合征，包括无痴呆型血管性认知障碍（vascular cognitive impairment no dementia, VCIND）、血管性痴呆（vasculardementia, VD）和混合性痴呆。加拿大健康与衰老研究对10263名社区居民和住院患者为期5年的随访研究结果显示，VCIND患者有46％进展为痴呆，52％死亡，而且某些VCIND患者的症状可自动改善，提示VCIND并非肯定会进展为VD。VCIND是痴呆的临床前期阶段，早期识别和干预对痴呆的防治有着极为重要的意义。目的研究VCIND的认知损害特征，探讨蒙特利尔认知评估量表中文版（MontrealCognitive Assessment, MoCA）在苏州地区VCIND人群中筛查的应用价值，并与简易精神状态量表（Mini-Mental State Examination, MMSE）进行比较。方法对92例苏州地区的受试者进行成套神经心理学测试，包括视空间执行功能、记忆力、命名、注意力等内容，研究VCIND的认知功能特点，并进行MoCA和MMSE量表的比较。应用受试者工作特征曲线（ROC）分析MoCA量表识别VCIND的最佳灵敏度和特异度，确定其最佳分界值。结果VCIND组MoCA总平均分为（20.80±2.66）分，MMSE总平均分为（25.88±2.51）分，两者呈高度相关，相关系数r为=0.711。受教育程度对MoCA得分有显著影响，受教育年限≤9年者：MoCA评分除注意力和语言流畅性外，其余各分项在两组间差异有统计学意义（P＜0.05）。受教育程度＞9年者：MoCA评分除注意力、计算力、定向力及语言流畅性外，其余各分项在两组间差异有统计学意义（P＜0.05）。受教育程度≤9年者：MoCA的筛查最佳分界值为24/25分，此时筛查VCIND的敏感度为87.5%，特异度100%，MMSE筛查最佳分界值为26/27分，此时筛查VCIND的敏感度为68.8%，特异度100%；受教育程度＞9年者：MoCA的筛查最佳分界值为26/27分，此时筛查VCIND的敏感度为94.4%，特异度为70%，，MMSE的筛查最佳分界值为28/29分，此时筛查VCIND的敏感度为66.7%，特异度为80%。结论 1．VCIND患者存在包括视空间执行功能、记忆力、抽象思维、计算力等多个领域认知功能的损害。 2．MoCA是筛查VCIND的一个简便、有效的工具，MoCA用于VCIND的筛查优于MMSE。目的研究无痴呆型血管性认知障碍（VCIND）患者外周血炎性标志物CD64指数、白介素-6（Interleukin-6, IL-6）、C反应蛋白（C-reactive protein, CRP）等的变化特征，探讨其与认知障碍的关系，明确VCIND的血炎性标志物。方法共有92例受试者入选，其中无痴呆型血管性认知障碍组（VCIND）50例，男性30例，女性20例，年龄（66.68±8.75）岁，受教育年限（9.52±2.87）年。认知功能正常组（normal control, NC）42例，男性21例，女性21例，年龄（67.86±6.48）岁，受教育年限（11.00±2.91）年。对所有入选者采用流式细胞仪、免疫浊度法及血液分析仪分别测定其CD64指数和IL-6、CRP及白细胞计数和中性粒细胞比率，比较两组之间各炎性指标的差异，进而对炎性指标和认知障碍的关系行Spearman相关分析。结果与对照组相比，VCIND组CD64指数、IL-6、CRP、白细胞计数及中性粒细胞比率明显增高，差异有统计学意义（P＜0.05），VCIND组与NC组炎性指标情况如下：CD64指数（0.30±0.77与0.23±0.71, P=0.000）；IL-6（3.84±1.17与2.24±0.76,P=0.000）；CRP（5.22±0.25与5.04±0.35, P=0.007）；白细胞计数（6.48±1.92与5.39±1.11,P=0.001）；中性粒细胞比率（70.24±8.17与58.16±7.38, P=0.000）。对炎性指标和认知障碍的关系行Spearman相关分析后发现，CD64指数、IL-6分别与MoCA评分呈显著负相关（r=-0.803, P=0.000）、（r=-0.828, P=0.000），差异有统计学意义（P＜0.05）。结论炎症反应参与VCIND的病理过程，CD64指数及IL-6可能是VCIND的早期生物学标志物。
[Abstract]:Vascular cognitive impairment (VCI) covers a large class of syndromes from the risk factors of cerebrovascular disease or cerebrovascular disease from mild cognitive impairment to dementia, including non dementia vascular cognitive impairment (vascular cognitive impairment no dementia, VCIND), vascular dementia (vasculardementia,) VD) and mixed dementia. The results of a 5 year follow-up study of 10263 community and hospitalized patients in the Canadian health and aging study showed that 46% of VCIND patients progressed to dementia, 52% died, and the symptoms of some VCIND patients could be improved automatically, suggesting that VCIND would not advance to VD.VCIND as a preclinical stage of dementia, Early identification and intervention are of great importance to the prevention and treatment of dementia.
Objective to study the cognitive impairment characteristics of VCIND, and to explore the application value of the Chinese version of the Montreal cognitive assessment scale (MontrealCognitive Assessment, MoCA) in the VCIND population of Suzhou, and to compare it with the simple mental state scale (Mini-Mental State Examination, MMSE).
Methods a complete set of neuropsychological tests were conducted in 92 Suzhou subjects, including visual spatial execution, memory, naming, attention and so on. The cognitive functions of VCIND were studied and compared with the MoCA and MMSE scales. The optimal sensitivity and specificity of the MoCA scale for the identification of VCIND were analyzed by using the subject work feature curve (ROC). Degree, determine its best dividing value.
Results the total average of MoCA in group VCIND was (20.80 + 2.66), and the total average of MMSE was (25.88 + 2.51). The correlation coefficient r was =0.711., the education degree had a significant influence on the score of MoCA, and the number of years of education was less than 9 years. The difference of the other sub items in the MoCA score was statistically significant in the two groups, except for attention and language flow. P < 0.05). The degree of education for more than 9 years: MoCA score, except attention, calculation, orientation and language fluency, was statistically significant between the two groups (P < 0.05). The best demarcation value of MoCA was 24/25, and the sensitivity of screening VCIND was 87.5%, specificity 100%, and MMSE screening most. The best demarcation value was 26/27 points, at this time the sensitivity of screening VCIND was 68.8%, and the specificity was 100%; the best demarcation value of MoCA was 26/27 score for 9 years of education. At this time, the sensitivity of screening VCIND was 94.4%, the specificity was 70%, and the best dividing line for MMSE was 28/29 points, and the sensitivity of VCIND screening was 66.7% and the specificity was 80%.
conclusion
1.VCIND patients suffer from cognitive impairment in many areas including visual spatial executive function, memory, abstract thinking and computational power.
2.MoCA is a simple and effective tool for screening VCIND. MoCA for VCIND screening is better than MMSE..
Objective to study the changes in the CD64 index of peripheral blood inflammatory markers, -6 (Interleukin-6, IL-6), C reactive protein (C-reactive protein, CRP) in patients with dementia free vascular cognitive impairment (VCIND), and to explore the relationship between them and cognitive impairment, and to clarify the inflammatory markers of VCIND.
Methods a total of 92 subjects were selected, of which there were 50 cases of dementia vascular cognitive impairment (VCIND), 30 men, 20 women, age (66.68 + 8.75) years, years of Education (9.52 + 2.87) years. The cognitive function normal group (normal control, NC) 42 cases, 21 men, 21 cases, age (67.86 + 6.48) years, years of education years. The CD64 index, IL-6, CRP, white blood cell count and neutrophil ratio were measured by flow cytometry, immunoturbidimetry and blood analyzer, and the differences of inflammatory indices between the two groups were compared, and the relationship between the inflammatory index and cognitive impairment was analyzed by Spearman correlation.
Results compared with the control group, the CD64 index, IL-6, CRP, white blood cell count and neutrophil ratio in the VCIND group were significantly higher, and the difference was statistically significant (P < 0.05). The inflammatory indices in group VCIND and NC were as follows: CD64 index (0.30 + 0.77 and 0.23 + 0.71, P=0.000); IL-6 (3.84 + 1.17 and 2.24 + 0.76, P=0.000); CRP (5.22 + 0.25 and 5.04 + 0.35,) P=0.007); leukocyte count (6.48 + 1.92 and 5.39 + 1.11, P=0.001); neutrophils ratio (70.24 + 8.17 and 58.16 + 7.38, P=0.000). After Spearman correlation analysis on the relationship between inflammatory indices and cognitive impairment, the CD64 index and IL-6 were significantly negatively correlated with MoCA score (r=-0.803, P=0.000), (r=-0.828, P=0.000), and the difference was statistically significant Learning significance (P < 0.05).
conclusion
Inflammatory reaction is involved in the pathological process of VCIND. CD64 index and IL-6 may be early biomarkers of VCIND.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.16

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