TCD检测脑血管反应性与轻度认知障碍的相关性研究
发布时间：2018-07-23 09:38
【摘要】：目的：轻度认知障功能障碍(mild cognitive impairment, MCI)是指多种原因导致的认知功能轻微受损,达不到痴呆水平,总体认知水平和日常生活能力基本正常的一种综合征。常见的类型为遗忘型轻度认知障碍(amnestic mild cognitive impairment,aMCI)、非痴呆血管性认知损害(vascular cognitive impairment-no dementia, VCIND)。目前由于痴呆尚无有效的治疗方法, MCI被认为是可识别可干预的痴呆早期阶段,故成为研究的热点。脑血管反应性(cerebrovascular reactivity,CVR)是脑微小血管自身通过血管舒张或收缩维持脑血流量稳定的代偿能力。有研究表明CVR损害与痴呆有关。屏气指数(breath-holding index,BHI)是反映脑血管反应性(cerebrovascular reactivity,CVR)的重要指标。本研究试图为TCD屏气试验测算BHI是否可能用于MCI的研究和aMCI与VCIND的鉴别提供参考依据。 方法：研究对象来源于自2011年3月至2011年12月常德市第一人民医院神经内科、老干科门诊和住院病人及体检中心。采用简易精神状态检测(MMSE)和蒙特利尔认知评定(MoCA)量表联合筛查MCI患者,分别按2010年中华医学会制定的“轻度认知障碍的诊断和治疗”指南及中国血管性认知功能损害专家共识标准诊断的aMCI和VCIND患者中,选取aMCI组30例、VCIND组30例。正常对照组30例,按年龄、性别及文化程度与病例组相匹配。对三组均进行TCD屏气试验。通过TCD监测屏气试验前后双侧大脑中动脉的平均血流速度(mean blood flow velocity,MBFV),记录流速趋势图及屏气时间,计算相应屏气时间的BHI。比较三组间MBFV、BHI、血管危险因素的特点,分析CVR与认知功能的关系。 结果：1、与正常对照组比较,aMCI组和VCIND组的BHI下降,差异有统计学意义(P0.001),而VCIND组与aMCI组比较,差异无统计学意义(P0.05)；aMCI组及VCIND组MBFV较正常对照组低,但各组组间比较,差异无统计学意义。2、BHI与MMSE、 MoCA呈正相关,MMSE、MoCA越高,BHI越高,有统计学意义(P0.001)。3、aMCI组及VCIND组的收缩压、空腹血糖、总胆固醇、高密度脂蛋白、低密度脂蛋白、甘油三酯高于正常对照组,糖尿病多于正常对照组,差异有统计学意义(P0.05)。但aMCI组与VCIND组间比较差异无统计学意义(P0.05)。 结论：1、脑血管反应性受损可能与轻度认知障碍有关；2.TCD屏气试验不能鉴别(?)MCI和VCIND;3、TCD检测BHI评价CVR对MCI患者的脑微小血管病变的早期发现有重要意义。
[Abstract]:Objective: mild cognitive impairment (mild cognitive impairment, MCI) is a kind of syndrome with mild impairment of cognitive function due to various causes, which can not reach the level of dementia, and the overall cognitive level and daily living ability are basically normal. The common type of amnesia was (amnestic mild cognitive impairmenta MCI, and (vascular cognitive impairment-no dementia with vascular cognitive impairment (VCIND). Because there is no effective treatment for dementia, MCI is considered to be a recognizable and interventional early stage of dementia, so it has become a hot research topic. Cerebrovascular reactivity is the compensatory ability of small cerebral vessels to maintain the stability of cerebral blood flow through vasodilation or contraction. Studies have shown that CVR damage is associated with dementia. Breath-holding index (BHI) is an important index to reflect cerebrovascular reactivity. This study is intended to provide a reference for the TCD breath-holding test to estimate whether BHI can be used in the study of MCI and the identification of aMCI and VCIND. Methods: the subjects of the study were from the Department of Neurology Department of the first people's Hospital of Changde City from March 2011 to December 2011. MCI patients were screened by MMSE and the Montreal Cognitive Assessment (MoCA) scale. According to the guidelines of "diagnosis and treatment of mild cognitive impairment" formulated by the Chinese Medical Association in 2010 and the Chinese expert consensus criteria for Vascular Cognitive impairment, 30 patients with AMCI and 30 patients with VCIND were selected. 30 cases of normal control group were matched with the case group according to age, sex and education level. TCD breath-holding test was performed in all three groups. The mean blood flow velocity of bilateral middle cerebral artery (mean blood flow velocity-MBFV) was monitored by (mean blood flow before and after breath-holding test, and the trend of flow velocity and breath-holding time were recorded, and the corresponding breath-holding time was calculated. The relationship between CVR and cognitive function was analyzed by comparing the characteristics of vascular risk factors between three groups. Results compared with the normal control group, the BHI of the two groups decreased significantly (P0.001), but there was no significant difference between the VCIND group and the aMCI group (P0.05), but the MBFV of the VCIND group and the VCIND group was lower than that of the normal control group, but there was no significant difference between the VCIND group and the VCIND group, but there was no significant difference between the VCIND group and the control group (P0.05), but there was no significant difference between the two groups. There was no significant difference between MMSE and MMSE, and there was a positive correlation between MMSE and MoCA. The higher the MoCA was, the higher the BHI was. The systolic blood pressure, fasting blood glucose, total cholesterol, high density lipoprotein, low density lipoprotein and triglyceride in VCIND group and VCIND group were higher than those in normal control group. Diabetes mellitus was more than normal control group, the difference was statistically significant (P0.05). However, there was no significant difference between aMCI group and VCIND group (P0.05). Conclusion: 1. Cerebral vascular reactivity impairment may be related to mild cognitive impairment. 2. TCD breath-holding test can not distinguish MCI from VCIND3TCD to evaluate CVR in the early detection of cerebral microvascular lesions in patients with MCI.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1
[Abstract]:Objective: mild cognitive impairment (mild cognitive impairment, MCI) is a kind of syndrome with mild impairment of cognitive function due to various causes, which can not reach the level of dementia, and the overall cognitive level and daily living ability are basically normal. The common type of amnesia was (amnestic mild cognitive impairmenta MCI, and (vascular cognitive impairment-no dementia with vascular cognitive impairment (VCIND). Because there is no effective treatment for dementia, MCI is considered to be a recognizable and interventional early stage of dementia, so it has become a hot research topic. Cerebrovascular reactivity is the compensatory ability of small cerebral vessels to maintain the stability of cerebral blood flow through vasodilation or contraction. Studies have shown that CVR damage is associated with dementia. Breath-holding index (BHI) is an important index to reflect cerebrovascular reactivity. This study is intended to provide a reference for the TCD breath-holding test to estimate whether BHI can be used in the study of MCI and the identification of aMCI and VCIND. Methods: the subjects of the study were from the Department of Neurology Department of the first people's Hospital of Changde City from March 2011 to December 2011. MCI patients were screened by MMSE and the Montreal Cognitive Assessment (MoCA) scale. According to the guidelines of "diagnosis and treatment of mild cognitive impairment" formulated by the Chinese Medical Association in 2010 and the Chinese expert consensus criteria for Vascular Cognitive impairment, 30 patients with AMCI and 30 patients with VCIND were selected. 30 cases of normal control group were matched with the case group according to age, sex and education level. TCD breath-holding test was performed in all three groups. The mean blood flow velocity of bilateral middle cerebral artery (mean blood flow velocity-MBFV) was monitored by (mean blood flow before and after breath-holding test, and the trend of flow velocity and breath-holding time were recorded, and the corresponding breath-holding time was calculated. The relationship between CVR and cognitive function was analyzed by comparing the characteristics of vascular risk factors between three groups. Results compared with the normal control group, the BHI of the two groups decreased significantly (P0.001), but there was no significant difference between the VCIND group and the aMCI group (P0.05), but the MBFV of the VCIND group and the VCIND group was lower than that of the normal control group, but there was no significant difference between the VCIND group and the VCIND group, but there was no significant difference between the VCIND group and the control group (P0.05), but there was no significant difference between the two groups. There was no significant difference between MMSE and MMSE, and there was a positive correlation between MMSE and MoCA. The higher the MoCA was, the higher the BHI was. The systolic blood pressure, fasting blood glucose, total cholesterol, high density lipoprotein, low density lipoprotein and triglyceride in VCIND group and VCIND group were higher than those in normal control group. Diabetes mellitus was more than normal control group, the difference was statistically significant (P0.05). However, there was no significant difference between aMCI group and VCIND group (P0.05). Conclusion: 1. Cerebral vascular reactivity impairment may be related to mild cognitive impairment. 2. TCD breath-holding test can not distinguish MCI from VCIND3TCD to evaluate CVR in the early detection of cerebral microvascular lesions in patients with MCI.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1
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