缺血性脑白质病变与认知功能、血浆热休克蛋白70水平、步态的相关分析

发布时间：2018-01-04 06:06

本文关键词：缺血性脑白质病变与认知功能、血浆热休克蛋白70水平、步态的相关分析　出处：《安徽医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：探讨不同程度缺血性脑白质病变(WMIL)对认知功能的影响及其与血浆热休克蛋白70(HSP70)的相关性,同时,通过对不同程度WMIL者在单项任务和双项任务下的步态参数的评估,探讨WMIL、认知功能与步态障碍的相关性。方法：根据头颅MRI检查结果,选取WMIL患者75例,根据Fazekas分级量表评分将WMIL患者分为轻度组、中度组和重度组。纳入同期正常对照者40名作为对照组。应用蒙特利尔认知功能评估(MoCA)量表对研究对象进行认知功能评估；通过足印法对研究对象在单、双项任务下进行10m行走测试以评估步态变化；采用酶联免疫吸附试验(ELISA)测定研究对象血浆热休克蛋白70 (HSP70)水平。结果：轻、中、重度WMIL患者的MoCA总分,视空间与执行功能和延迟回忆评分明显低于对照组(P0.05),而重度WMIL患者的计算力和注意力评分亦均低于对照组(P0.05); WMIL的Fazekas评分与MoCA评分呈负相关关系(r=-0.884,P0.05)。轻、中、重度WMIL患者的血浆HSP70浓度明显高于对照组,差异具有统计学意义(P0.05); WMIL的Fazekas评分与血浆HSP70水平呈正相关关系(P0.05)。与对照组相比：单项任务下,中、重度WMIL者的步长缩短,步速减慢,步长的变异性和步宽的变异性明显增大,差异均有统计学意义(P0.05),重度WMIL者步宽明显增大,差异有统计学意义(P0.05)；双项任务下,轻、中、重度WMIL者的步长明显缩短、步速明显减慢,步长的变异性和步宽的变异性明显增大,差异均有统计学意义(P0.05)；中、重WMIL者步宽明显增大,差异有统计学意义(P0.05)。与单任务相比,双项任务下,轻、中、重度WMIL者的步长明显缩短,步速明显减慢,步宽、步长的变异性和步宽的变异性明显增大,差异均有统计学意义(P＜0.05)。单、双项任务下,WMIL者的步长、步速与WMIL的Fazekas评分呈负相关关系(P＜0.05),与MoCA评分呈正相关关系(P＜0.05)；步宽、步长的变异性和步宽的变异性与WMIL的Fazekas评分呈正相关关系(P＜0.05),与MoCA评分呈负相关关系(P＜0.05)。结论：WMIL患者存在认知功能和步态障碍,且随WMIL程度的增加,认知功能损害及步态改变越明显；双项任务下10米行走测试有助于早期发现WMIL者的步态障碍与其认知功能损害；WMIL者血浆HSP70水平增高,提示血浆HSP70可能在WMIL的发病中起一定作用。
[Abstract]:Objective: to investigate the effect of WMIL on cognitive function and its correlation with plasma heat shock protein 70 (HSP70). Through the evaluation of gait parameters of WMIL patients with different degrees under single task and double task, the correlation between cognitive function and gait dysfunction was discussed. Methods: according to the results of cranial MRI examination. 75 patients with WMIL were selected and divided into mild group according to Fazekas rating scale. In the moderate and severe groups, 40 normal controls were included as the control group. The subjects were assessed with the Montreal Cognitive function Assessment (MoCA) scale. The gait changes of the subjects were evaluated by walking test of 10 m under single and double tasks by the footmark method. The plasma levels of heat shock protein 70 (HSP70) were measured by Elisa. Results: the total score of MoCA in patients with mild, moderate and severe WMIL was measured. The scores of visual space, executive function and delayed recall were significantly lower than those of the control group (P 0.05), while the scores of computational power and attention in the patients with severe WMIL were lower than those in the control group (P 0.05). There was a negative correlation between Fazekas score and MoCA score in WMIL. The plasma HSP70 concentration in patients with severe WMIL was significantly higher than that in the control group (P 0.05). There was a positive correlation between the Fazekas score of WMIL and the level of plasma HSP70. Compared with the control group, the step length of the patients with moderate and severe WMIL was shorter than that of the control group. The variation of step length and step width increased obviously with the decrease of step speed, and the difference was statistically significant (P 0.05). In severe WMIL, the step width increased significantly, and the difference was statistically significant (P 0.05). Under two tasks, the step length of the patients with mild, moderate and severe WMIL was significantly shorter, the step speed was significantly slower, the variability of step length and step width were significantly increased, and the differences were statistically significant (P 0.05). Compared with the single task, the step length of the patients with moderate, moderate and severe WMIL was significantly shorter and the step speed was significantly slower than that of the single task. The variability of step width, step length and step width increased significantly (P < 0.05). There was a negative correlation between walking speed and Fazekas score of WMIL (P < 0.05) and a positive correlation with MoCA score (P < 0.05). The variability of step width, step length and step width was positively correlated with the Fazekas score of WMIL (P < 0.05). There was a negative correlation with MoCA score (P < 0.05). Conclusion there are cognitive dysfunction and gait dysfunction in patients with WMIL, and the more obvious changes of cognitive function and gait are with the increase of WMIL degree. The 10-meter walking test under two tasks was helpful for the early detection of gait disorders and cognitive impairment in patients with WMIL. The increase of plasma HSP70 level in patients with WMIL suggests that plasma HSP70 may play a role in the pathogenesis of WMIL.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

【参考文献】