多发性腔隙性脑梗死和脑白质病变与血管性痴呆的相关研究
发布时间：2018-08-01 15:53
【摘要】：目的探讨缺血性小血管病(SVD)包括多发性腔隙性脑梗塞(MLI)和脑白质病变(WML)与血管性痴呆(VD)的关系,为VD的预防、早期诊断和干预提供依据。 方法选取2010年4月至2011年4月宁夏自治区人民医院神经内科住院及门诊的腔隙性脑梗塞患者、脑白质病患者及二者兼有的患者90例,所用病例诊断均符合全国第四届脑血管疾病学术会议制定的诊断标准。确定患者是否存在高血压、糖尿病、高脂血症、吸烟、饮酒史,采用Hachinski缺血指数量表(HIS)、哈密尔顿抑郁量表(HAMD)等神经心理学量表对患者进行评定。采用简易精神量表(MMSE)和蒙特利尔认知评估量表(MoCA)对90例经颅脑CT或颅脑MRI证实的SVD患者(单纯MLI组35例、MLI+WML组31例、单纯WML组24)和23例认知正常者进行检测并分析比较。 结果(1)单纯MLI组、MLI+WML组、单纯WML组MoCA评分分别为(22.40±6.83)、(21.35±5.55)及(26.41±3.48),MMS评分分别为(24.20±6.07)、(24.11±4.95)及(26.91±3.02)。单纯MLI组、MLI+WML组、单纯WML组MoCA与MMSE总分均有正相关性(r=0.895,p=0.000；r=0.761,p=0.000；r=0.932,p=0.000)。 (2)MMSE评分显示,与对照组比较,单纯MLI组即刻记忆、短程记忆、物体命名、语言复述、阅读理解、言语表达的分值均降低(均P0.05)：MLI+WML组时间定向、短程记忆、语言复述较对照组降低（均P＜0.05）；而单纯WML组与对照组比较，各分值均无显著差异（均P＞0.05）。单纯MLI组与MLI+WML组比较，阅读理解分值降低（P＜0.05）. （3）单纯MLI组、MLI+WML组、单纯WML组的MMSE评分在不同等级痴呆人数上有显著差异（P＜0.05）。 （4）单纯MLI组与MLI+WML组相比，各梗塞部位无显著性差别（P＞0.05）。 （5）单纯WML组与对照组logistic回归显示：高血压病史（P=0.045，OR=5.158）糖尿病病史（P=0.032，OR=0.049）与脑白质病变相关，其中高血压病史对脑白质病变影响大。结论单纯MLI组、MLI+WML组、单纯WML组三组患者MoCA与MMSE总分均呈正相关。三组患者中MLI+WML组最容易发生痴呆。缺血性小血管病变，，尤其单纯MLI可引起认知损害，主要表现在时间定向、地点定向、即可记忆等亚项。单纯WML者认知能力损害不明显，但WML可能促使痴呆发生，其中高血压对脑白质病变影响最大。
[Abstract]:Objective to investigate the relationship between ischemic small vascular disease (SVD), including multiple lacunar infarction (MLI), white matter lesion (WML) and vascular dementia (VD), so as to provide evidence for the prevention, early diagnosis and intervention of VD. Methods from April 2010 to April 2011, 90 patients with lacunar cerebral infarction, patients with leukoencephalopathy and both were selected from Department of Neurology, Ningxia Autonomous region people's Hospital. The diagnosis of all the cases was in accordance with the diagnostic criteria set by the fourth National Conference on Cerebrovascular Diseases. To determine the existence of hypertension, diabetes, hyperlipidemia, smoking, drinking history, the Hachinski Ischemia Index (HIS), Hamilton Depression scale (HAMD) were used to evaluate the patients. (MMSE) and (MoCA) were used to detect and compare 90 patients with SVD confirmed by craniocerebral CT or craniocerebral MRI (35 patients with MLI alone, 31 with MLI WML and 24 with WML) and 23 patients with normal cognition. Results (1) MoCA scores in MLI group and WML group were (22.40 卤6.83), (21.35 卤5.55 and (26.41 卤3.48), respectively (24.20 卤6.07), (24.11 卤4.95) and (26.91 卤3.02), respectively. There was a positive correlation between the total score of MoCA and MMSE in the MLI WML group and WML group (r 0.895p 0.000 ~ 0.000) MMSE score showed that compared with the control group, the MLI group had immediate memory, short range memory, object naming, language repetition, reading comprehension. The scores of speech expression in the WML group were significantly lower than those in the control group (P < 0. 05), but there was no significant difference between the WML group and the control group (all P > 0. 05). Compared with MLI WML group, the score of reading comprehension in MLI group was significantly lower than that in MLI WML group (P < 0. 05). (3). The MMSE scores in MLI group and WML group were significantly different in the number of dementia of different grades (P < 0. 05). (4). The scores of MMSE in MLI group and MLI WML group were significantly lower than those in MLI WML group (P < 0. 05). There was no significant difference among the infarct sites (P > 0. 05). (5). The logistic regression analysis between the WML group and the control group showed that the history of hypertension (P0. 045) diabetes mellitus (P0. 032) was related to the white matter lesions, and the history of hypertension had a great influence on the white matter lesions. Conclusion there was a positive correlation between the total score of MoCA and MMSE in MLI group and WML group. Of the three groups, the MLI WML group was most likely to develop dementia. Ischemic small vascular lesions, especially MLI alone, can cause cognitive impairment, mainly manifested in time orientation, location orientation, memory and other subitems. Cognitive impairment was not obvious in patients with WML alone, but WML might promote dementia, and hypertension had the greatest effect on leukoencephalopathy.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1
本文编号：2158076
[Abstract]:Objective to investigate the relationship between ischemic small vascular disease (SVD), including multiple lacunar infarction (MLI), white matter lesion (WML) and vascular dementia (VD), so as to provide evidence for the prevention, early diagnosis and intervention of VD. Methods from April 2010 to April 2011, 90 patients with lacunar cerebral infarction, patients with leukoencephalopathy and both were selected from Department of Neurology, Ningxia Autonomous region people's Hospital. The diagnosis of all the cases was in accordance with the diagnostic criteria set by the fourth National Conference on Cerebrovascular Diseases. To determine the existence of hypertension, diabetes, hyperlipidemia, smoking, drinking history, the Hachinski Ischemia Index (HIS), Hamilton Depression scale (HAMD) were used to evaluate the patients. (MMSE) and (MoCA) were used to detect and compare 90 patients with SVD confirmed by craniocerebral CT or craniocerebral MRI (35 patients with MLI alone, 31 with MLI WML and 24 with WML) and 23 patients with normal cognition. Results (1) MoCA scores in MLI group and WML group were (22.40 卤6.83), (21.35 卤5.55 and (26.41 卤3.48), respectively (24.20 卤6.07), (24.11 卤4.95) and (26.91 卤3.02), respectively. There was a positive correlation between the total score of MoCA and MMSE in the MLI WML group and WML group (r 0.895p 0.000 ~ 0.000) MMSE score showed that compared with the control group, the MLI group had immediate memory, short range memory, object naming, language repetition, reading comprehension. The scores of speech expression in the WML group were significantly lower than those in the control group (P < 0. 05), but there was no significant difference between the WML group and the control group (all P > 0. 05). Compared with MLI WML group, the score of reading comprehension in MLI group was significantly lower than that in MLI WML group (P < 0. 05). (3). The MMSE scores in MLI group and WML group were significantly different in the number of dementia of different grades (P < 0. 05). (4). The scores of MMSE in MLI group and MLI WML group were significantly lower than those in MLI WML group (P < 0. 05). There was no significant difference among the infarct sites (P > 0. 05). (5). The logistic regression analysis between the WML group and the control group showed that the history of hypertension (P0. 045) diabetes mellitus (P0. 032) was related to the white matter lesions, and the history of hypertension had a great influence on the white matter lesions. Conclusion there was a positive correlation between the total score of MoCA and MMSE in MLI group and WML group. Of the three groups, the MLI WML group was most likely to develop dementia. Ischemic small vascular lesions, especially MLI alone, can cause cognitive impairment, mainly manifested in time orientation, location orientation, memory and other subitems. Cognitive impairment was not obvious in patients with WML alone, but WML might promote dementia, and hypertension had the greatest effect on leukoencephalopathy.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1
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