血脂管理对VCI患者认知功能的影响

发布时间：2018-11-13 10:45

【摘要】：目的：探讨脑血管病危险因素血脂管理对VCI患者认知功能的影响。方法：选择2013年4月~2014年1月在吉林大学第三临床医学院神经内一科门诊及住院治疗的60~70岁脑血管病患者136例，回顾性分析记录既往10年吸烟史、饮酒史、家族史、血压、血糖、血脂、脑血管病史以及其他影响血管性认知障碍发生的可能情况，重点询问十年内患者血脂水平及管理状况，，根据血脂管理情况结合目前血脂水平将患者分为血脂正常组（对照组）、血脂管理良好组、血脂管理不良组。三组患者均进行蒙特利尔认知评估量表（MoCA）评估。比较各组认知障碍差别及认知域损伤特征。检测患者的血脂水平，包括空腹总胆固醇（TC）、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)和甘油三酯(TG)。对血脂管理不良组患者的血脂与损伤的认知域进行关联性分析。结果：血脂正常组、管理良好组和管理不良组三组之间年龄没有统计学差异（P=0.658）；三组之间性别比较没有统计学差异（P=0.248）；三组之间受教育年限也没有统计学差异（P=0.220）。三组之间MoCA总分（P=0.013）、视空间与执行得分（P=0.046）、注意力得分（P=0.020）和定向力得分（P=0.015）是有统计学差异的；三组之间命名得分（P=0.247）、复述得分（P=0.685）、语言流畅性（P=0.057）、抽象得分（P=0.457）和延迟回忆得分（P=0.256）是没有统计学差异的。在管理不良组中，甘油三脂与MoCA总分之间存在负相关关系（P0.001）；甘油三脂与视空间与执行得分之间存在负相关关系（P=0.006）；总胆固醇与MoCA总分之间存在负相关关系（P=0.010）；总胆固醇与注意力得分之间存在负相关关系（P=0.002）；低密度脂蛋白与MoCA总分之间存在负相关关系（P=0.005）；高密度脂蛋白与MoCA总分之间存在正相关关系（P=0.020）。结论：1.长期血脂管理不良可影响患者认知功能。2.血脂管理不良尤其对视空间、执行能力、注意力及定向力影响明显。3.甘油三脂越高，视空间障碍与执行障碍越明显；总胆固醇越高注意力障碍越明显。4.早期干预脑血管病危险因素是预防VCI的基本措施。
[Abstract]:Objective: to investigate the effect of lipid management on cognitive function of patients with VCI. Methods: from April 2013 to January 2014, 136 patients with cerebrovascular diseases aged 6070 years were enrolled in the Department of Neurology, Jilin University third School of Clinical Medicine from April 2013 to January 2014. The past 10 years of smoking, drinking, family history and blood pressure were retrospectively analyzed and recorded. Blood sugar, blood lipids, history of cerebrovascular disease and other possible conditions affecting vascular cognitive impairment were asked to focus on blood lipid levels and management status within 10 years. Patients were divided into normal group (control group), good blood lipid management group and poor blood lipid management group according to blood lipid management and current blood lipid level. Three groups of patients were assessed with Montreal Cognitive Assessment scale (MoCA). The difference of cognitive impairment and the characteristics of cognitive domain injury were compared. Blood lipid levels, including fasting total cholesterol, (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglyceride (TG)., were measured. The relationship between lipid and cognitive domain of patients with poor blood lipid management was analyzed. Results: there was no significant difference in age (P0. 658) among the three groups (P0. 658), but there was no statistical difference between the three groups (P0. 248). There was no significant difference in the number of years of schooling between the three groups (P0. 220). The total score of MoCA (P0. 013), the score of visual space and execution (P0. 046), the score of attention (P0. 020) and the score of orientation (P0. 015) were significantly different among the three groups. There were no statistical differences among the three groups in naming score (P0. 247), retelling score (P0. 685), language fluency (P0. 057), abstract score (P0. 457) and delayed recall score (P0. 256). In the poorly managed group, there was a negative correlation between triglyceride and total MoCA score (P0. 001), a negative correlation between triglyceride and visual space and executive score (P0. 006). There was a negative correlation between total cholesterol and total MoCA score (P0. 010), total cholesterol and attention score (P0. 002), low density lipoprotein (LDL-C) and total MoCA score (P0. 005). There was a positive correlation between high density lipoprotein and total score of MoCA (P0. 020). Conclusion 1. Long-term poor blood lipid management can affect the cognitive function of patients. 2. 2. Poor blood lipid management, especially on the visual space, executive ability, attention and orientation. 3. The higher the triglyceride, the more obvious the visual space disorder and the executive disorder, and the higher the total cholesterol, the more obvious the attention disorder. 4. Early intervention in risk factors of cerebrovascular disease is the basic measure to prevent VCI.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R749.13

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