功能性经颅多普勒对AD与VaD患者胆碱酯酶抑制剂疗效的评价

发布时间：2018-05-06 19:37

  本文选题：痴呆 + 屏气指数　； 参考：《南华大学》2013年硕士论文

【摘要】：目的：（1）探讨阿尔茨海默病(Alzheimer Disease, AD)和血管性痴呆(Vas-cular dementia, VaD)患者屏气指数及事件相关性血流的变化。（2）探讨AD与V-aD患者胆碱酯酶抑制剂疗效的脑血流动力学评价指标。 方法：收集2011年8月至2012年12月我院神经内科住院部及认知障碍门诊诊断的痴呆患者72例，其中阿尔茨海默病（AD）组32例，血管性痴呆（VaD）组40例，同时选取同时期年龄匹配的健康体检者42例作为对照组（normal cont-rols，NC）；采用经颅多普勒仪（Transcranial Doppler, TCD）检测三组受试者双侧大脑中动脉（Middle C-erebral Artery, MCA）平均血流速度（Mean blood flo-w velocity, MFV）、搏动指数（Pulsatility Index, PI），并通过屏气实验计算三组受试者双侧MCA屏气指数(B-reath holding index, BHI)；记录三组受试者默读前后双侧MCA MFV，计算事件相关性血流变化百分率（Percent change of blood fl-ow velocity, pCBFV）。给予痴呆患者服用胆碱酯酶抑制剂（安理申）进行治疗12周后再次以简易精神状态量表（Mini-Mental State Examination, MMSE）行神经心理学评分并采集TCD血流参数资料作为统计分析指标。 结果：1、AD组和VaD组合并高血压病、糖尿病及脑卒中的比例高于NC组（P0.05），而在吸烟史、饮酒史、冠心病及高脂血症的比例上三组差异无统计学意义（P＞0.05）。 2、服药前三组受试者神经心理学评分比较：AD组及VaD组MMSE分值均低于NC组，差异具有统计学意义（P＜0.05），AD组及VaD组间MMSE分值差异无统计学意义（P＞0.05）。 3、服药前三组受试者TCD血流参数比较：AD组及VaD组MFV、BHI值均低于NC组，差异具有统计学意义（P＜0.05），而AD组与VaD组比较MFV及BHI值无明显差异（P＞0.05）；AD组及VaD组PI值高于NC组，差异具有统计学意义（P＜0.05），且VaD组PI值高于AD组，差异有统计学意义（P＜0.05）。AD组、VaD组平均pCBFV均低于NC组（P＜0.05），且AD组平均pCBFV亦低于VaD组（P＜0.05）；NC组左右两侧pCBFV比较差异有统计学意义（P＜0.05），右侧低于左侧；VaD组左右两侧pCBFV比较差异有统计学意义（P＜0.05），左侧低于右侧；AD组左右两侧pCBFV差异无统计学意义。 4、二组患者服药后神经心理学评分变化：与服药前相比较，VaD组患者服药后MMSE分值较服药前有显著性提高（P＜0.05），而AD组患者MMSE分值虽有所提高，但差异无统计学意义（P＞0.05）。 5、二组患者服药后TCD血流参数变化：与服药前相比较，二组患者服药后MFV值及BHI值较服药前均有显著性提高（P＜0.05）。与服药前同侧相比，AD组服药后左侧及右侧pCBFV值均较服药前提高，差异有统计学意义（P＜0.05），而VaD组服药后左侧及右侧pCBFV值虽有所提高，，但差异无统计学意义（P＞0.05）。 6、认知功能改善组及认知功能恶化组TCD血流参数比较：与认知功能恶化组比较，认知功能改善组BHI值及pCBFV值较高，差异有统计学意义（P＜0.05），而MFV值及PI值两组间无差异（P＜0.05）。 7、相关性分析：△BHI、△pCBFV值与△MMSE分值呈正相关（P＜0.01），而△MFV、△PI值与△MMSE分值无明显相关性（P＞0.05）。 结论：1、AD和VaD患者事件相关性血流的偏侧化现象受损； 2、pCBFV、BHI可考虑列为评价胆碱酯酶抑制剂疗效的重要参考指标。
[Abstract]:Objective: (1) to explore the changes of breath holding index and event related blood flow in patients with Alzheimer Disease (AD) and Vas-cular dementia (VaD). (2) to explore the cerebral hemodynamic evaluation index of the efficacy of cholinesterase inhibitors in AD and V-aD patients.
Methods: from August 2011 to December 2012, 72 patients with dementia diagnosed in the inpatient department of Neurology and the cognitive disorder clinic were collected, including 32 cases of Alzheimer's disease (AD), 40 cases of vascular dementia (VaD), and 42 cases of normal cont-rols (NC) as the control group. Transcranial Doppler (TCD) was used to detect the mean blood flow velocity (Mean blood flo-w velocity, MFV) and pulsatile index of the bilateral middle cerebral arteries (Mean blood flo-w, MCA) in three groups of subjects, and the three groups of subjects were calculated by the breath holding experiment, and the three groups were recorded. Before and after reading the bilateral MCA MFV, the participants calculated the percentage of event related blood flow (Percent change of blood fl-ow velocity, pCBFV). After 12 weeks of treatment for the dementia patients taking cholinesterase inhibitor (An Lishen), the neuropsychological score was followed by a simple mental state scale (Mini-Mental State Examination). The data of TCD blood flow parameters were used as the statistical analysis index.
Results: 1, the proportion of group AD and VaD combined with hypertension, diabetes and stroke was higher than that of group NC (P0.05), but there was no significant difference in the proportion of smoking history, drinking history, coronary heart disease and hyperlipidemia (P > 0.05).
2, the neuropsychological scores of the three groups before taking the medicine were compared: the MMSE scores in group AD and VaD were all lower than those in group NC (P < 0.05), and there was no statistical difference between AD and VaD groups (P > 0.05).
3, the TCD blood flow parameters in the three groups were compared: MFV and BHI in group AD and VaD were lower than those in group NC (P < 0.05), but there was no significant difference in MFV and BHI (P > 0.05) in AD and VaD groups (P > 0.05). The average pCBFV in group VaD (P < 0.05) was lower than that in group NC (P < 0.05), and the average pCBFV in group AD was also lower than that in group VaD (P < 0.05). The difference between the two sides of the NC group was statistically significant (0.05), and the right side was lower than that in the left side. The left and right side of the group had a statistically significant difference (0.05) and left side lower than the right side. There was no statistically significant difference between the two sides of pCBFV.
4, two groups of patients after taking medicine neuropsychological score changes: compared with the before taking medicine, the MMSE score of group VaD patients was significantly higher than before taking medicine (P < 0.05), while the MMSE score of group AD increased, but the difference was not statistically significant (P > 0.05).
5, two groups of patients after taking the TCD blood flow parameters changes: compared with the pre medication, the MFV value and BHI value of the two groups were significantly higher than before taking the medicine (P < 0.05). Compared with the ipsilateral before taking the medicine, the left and right pCBFV values of the AD group were higher than those before taking the medicine (P < 0.05), and the left and right after the VaD group took the medicine. Although the side pCBFV value increased, the difference was not statistically significant (P > 0.05).
6, the comparison of TCD blood flow parameters in the cognitive functional improvement group and the cognitive function deterioration group: compared with the cognitive function deterioration group, the BHI value and the pCBFV value of the cognitive functional improvement group were higher (P < 0.05), but there was no difference between the two groups of MFV and PI values (P < 0.05).
7, correlation analysis: Delta BHI, Delta pCBFV value is positively correlated with delta MMSE score (P < 0.01), while Delta MFV, Delta PI value has no significant correlation with delta MMSE score (P > 0.05).
Conclusion: 1, the lateralization of event related blood flow in AD and VaD patients is impaired.
2, pCBFV and BHI can be considered as important reference indicators for evaluating the efficacy of cholinesterase inhibitors.

【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.13

【共引文献】

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