海马体积测量在认知功能障碍中的应用

发布时间：2018-06-28 02:47

本文选题：阿尔茨海默病 + 轻度认知功能损害　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:认知功能障碍是指多个认知域发生的障碍,认知域包括定向力、记忆力、计算力、执行力、理解判断力等。痴呆是其中一种损害范围广泛、临床症状较重的认知功能障碍类型,其高发病率和高致残率越来越引起人们的重视。阿尔茨海默病(Alzheimer's disease,AD)是最常见的一种痴呆类型,早期仅表现为记忆力的下降,后期才会出现全面性的认知功能损害。由于中晚期AD已严重影响患者的生存质量,而目前对中晚期AD又缺乏有效的治疗措施,因此,对AD的早期发现及干预成为医学界研究的焦点。既往关于AD的研究发现,AD患者在表现为临床痴呆前已经出现一定程度的病理改变,在此前提下,人们提出轻度认知功能损害(mild cognitive impairment,MCI)的概念。MCI以记忆力减退为主要临床症状,但未达到痴呆的诊断标准,是介于AD与正常人之间的过渡状态,海马是其病理改变早期常累及的部位,当海马结构(hippocampal formation,HPF)损害到一定程度时,则会出现海马体积(hippocampal volume,HV)的变化。研究表明,海马与记忆密切相关,尤其是对近记忆力影响显著,因此,HV测量在认知功能损害中的诊断价值引起人们的高度关注。本研究通过3.0T磁共振成像(magnetic resonance imaging,MRI)测量HV,分析AD、MCI患者与正常人HV的区别以及其与临床指标的相关关系等,探讨HV在认知功能损害中的临床应用价值。方法:选择2013年3月至2014年12月在我院神经内科门诊就诊及住院的认知功能障碍患者及正常老年人作为研究对象,根据患者临床查体及神经心理学量表筛选出AD组、MCI组和正常对照组(normal control,NC),共90例,均为右利手。其中,男性48名,女性42名,年龄位于65-80岁之间,平均年龄为72.34±3.95岁。AD组符合美国神经病学、语言障碍和卒中-老年性痴呆和相关疾病学会(NINCDS-ADRDA)诊断标准,MCI组符合Petersen等1999年制定的标准。收集所有受试者痴呆的危险因素,在无禁忌的情况下,行常规3.0T MRI(包括T1W1、T2W1、FLAIR和DWI),除外颅内肿瘤、脑积水及多发梗塞等疾病,对符合条件者行海马斜冠状位扫描。海马边界参考Watson等的定界方法,完成扫描后,在重建的图像上手动勾画海马边界、计算HV,并对所测得的HV进行标准化处理。为确保结果的准确性,每位患者HV均由同1位影像科技师测量完成。通过综合分析AD组、MCI组和NC组HV及临床一般资料(简易精神状态量表评分(mini-mental state examination,MMSE)、血脂、血糖、同型半胱氨酸(homocysteine,Hcy)等),评价HV测量在认知功能损害中的应用价值。应用SPSS13.0统计软件对所有数据行统计学分析,计量资料比较采用方差分析和非参数检验,各指标间相关分析采用Spearman相关分析。结果:1一般资料90例受试者中,AD组、MCI组和NC组各30例,3组年龄、性别、受教育年限的分布差异,经统计学分析均无统计学意义(P0.05)。2 MMSE评分AD组、MCI组和NC组3组MMSE评分分别为19.97±4.27分、27.30±2.32分、29.10±1.12分。3组MMSE评分两两比较,差异均具有统计学意义(P0.05)。3标准化后HV AD组左右两侧及总HV分别为3.005±0.417cm3、3.135±0.376cm3、6.141±0.791cm3;MCI组左右两侧及总HV分别为3.202±0.193cm3、3.313±0.203cm3、6.515±0.394cm3;NC组左右两侧及总HV分别为:3.377±0.302cm3、3.477±0.318cm3、6.854±0.619cm3。AD组、MCI组和NC组3组两两比较,左右两侧及总HV均具有统计学差异(P0.05)。4标准化后HV与MMSE评分相关关系所有受试者左右两侧和总HV分别与MMSE评分进行相关分析,三者均呈正相关关系(r=0.520,P0.05;r=0.510,P0.05;r=0.519,P0.05)。5生化指标AD组、MCI组和NC组3组血脂、血糖及其他生化指标经统计学分析均无统计学差异(P0.05)。3组Hcy水平两两比较,均具有统计学差异(P0.05)。标准化后HV与Hcy水平之间相关关系所有受试者左右两侧和总HV与Hcy水平均不具有相关关系。所有受试者MMSE评分与Hcy水平呈负相关关系(r=-0.438,P0.05)。结论:1 MRI作为无创性诊断技术,是HV测量的最佳工具之一。2 HV的变化可早期体现患者认知功能状态,同时可作为评估患者认知功能损害程度的重要依据。3 HV测量联合MMSE评分,可更准确的为MCI、AD患者早期诊断和治疗提供客观依据。4 Hcy可能为认知功能损害的危险因素之一。
[Abstract]:Objective: cognitive dysfunction refers to the obstacles in multiple cognitive domains. Cognitive domains include orienteering, memory, computational power, execution, and understanding judgment. Dementia is one of the types of cognitive impairment which has a wide range of impairment and severe clinical symptoms, and its high incidence and high disability rate have attracted more and more attention. Alzheimer's disease (AD) is the most common type of dementia. Early memory only shows a decline in memory, and comprehensive cognitive impairment appears in the later period. Since intermediate and late AD has seriously affected the patient's quality of life, and at present, there is no effective treatment for middle and late AD. Therefore, early detection and intervention of AD has become a result. The focus of medical research. A previous study of AD found that AD patients showed a certain degree of pathological changes before clinical dementia. On this premise, people proposed that the concept of mild cognitive impairment (mild cognitive impairment, MCI).MCI was the main clinical symptom in memory reduction, but did not reach the diagnostic criteria for dementia. It is a transitional state between the AD and the normal people. The hippocampus is an early part of its pathological changes. When the hippocampal formation (HPF) is damaged to a certain extent, the hippocampal volume (hippocampal volume, HV) changes. The study shows that the hippocampus is closely related to memory, especially to memory. Therefore, the diagnostic value of HV measurement in cognitive impairment causes people's attention. This study uses the 3.0T magnetic resonance imaging (magnetic resonance imaging, MRI) to measure HV, analyzes the difference between AD, MCI patients and normal HV, and its correlation with clinical indicators, and discusses the clinical value of HV in cognitive impairment. Methods: the subjects were selected from March 2013 to December 2014 in the outpatient department of Neurology Department of Department of Neurology and hospitalized cognitive impairment patients and normal elderly people. According to the patients' clinical examination and neuropsychological scale, AD group, MCI group and normal control group (normal control, NC) were selected, all 90 cases were right hand. Among them, 48 men, women 42, between the age of 65-80 years, and the average age of 72.34 + 3.95 years old, group.AD conforms to American neurology, language disorders and stroke - Alzheimer's and related disease association (NINCDS-ADRDA) diagnostic criteria, and the MCI group conforms to the standards established in 1999, such as Petersen. Rules 3.0T MRI (including T1W1, T2W1, FLAIR and DWI), except intracranial tumor, hydrocephalus and multiple infarction, and other diseases such as intracranial tumor, cerebral hydrocephalus and multiple infarction. The boundary of hippocampal oblique coronal scan, hippocampal boundary reference Watson and so on were performed. After completing the scan, the sea horse boundary was manually outlined on the reconstructed image, HV was calculated, and the measured HV was standardized. To ensure the accuracy of the results, each patient's HV was measured by the same 1 image technicians. Through the comprehensive analysis of group AD, group MCI and NC, HV and clinical general data (simple mental state scale score (Mini-Mental State Examination, MMSE), blood lipids, blood sugar, homocysteine (homocysteine, Hcy), etc.), to evaluate the cognitive impairment in HV measurement. SPSS13.0 statistical software was applied to statistical analysis of all data. The measurement data were compared with variance analysis and non parametric test, and the correlation analysis between each index was analyzed by Spearman correlation analysis. Results: 1 general data of 90 subjects, group AD, group MCI and NC group were 30 cases, 3 groups of age, sex, and the distribution of years of education. The difference was not statistically significant (P0.05).2 MMSE score AD group. The 3 groups of MMSE scores in group MCI and NC group were 19.97 + 4.27, 27.30 + 2.32, 29.10 + 1.12,.3 group MMSE score 22, the difference was statistically significant (P0.05).3 after the standardization of the two sides of HV .141 + 0.791cm3; the left and right sides of group MCI and total HV were 3.202 + 0.193cm3,3.313 + 0.203cm3,6.515 + 0.394cm3 respectively. The left and right sides of the NC group and the total HV were 3.377 + 0.302cm3,3.477 + 0.318cm3,6.854 + 0.619cm3.AD groups respectively. The correlation analysis between the left and right sides and the total HV of all subjects and the total HV were analyzed with the MMSE score respectively. All the three were positive correlation (r=0.520, P0.05; r=0.510, P0.05; r=0.519, P0.05).5 biochemical index AD group, MCI group and NC group 3 groups of blood lipids, blood sugar and other biochemical indexes were not statistically different (22). There was statistical difference (P0.05). The correlation between HV and Hcy level after standardization was not related to all subjects on both sides and the total HV and Hcy level. The MMSE score of all subjects was negatively correlated with the Hcy level (r=-0.438, P0.05). Conclusion: 1 MRI as a non-invasive diagnostic technique, is one of the best tools for HV measurement.2 The changes can early reflect the state of cognitive function of patients, and can be used as an important basis for assessing the degree of cognitive impairment of patients with.3 HV measurement of combined MMSE score, which can provide an objective basis for the early diagnosis and treatment of MCI and AD patients with an objective basis for the possible risk factors of cognitive impairment by.4 Hcy.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R749.1

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