血管狭窄对脑白质疏松患者认知功能的影响

发布时间：2018-01-12 15:19

本文关键词：血管狭窄对脑白质疏松患者认知功能的影响　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：背景与目的随着人口的不断老龄化和影像学技术的发展,脑白质疏松(LA)逐渐受到人们的关注。目前认为LA不仅与认知功能损害密切相关,同时也是脑卒中的独立危险因素。LA一直被认为是小血管病变所致,但近年来越来越多的研究认为LA与大血管病变也密切相关。LA患者多存在以执行和注意功能受损为主的多领域认知功能损害,但对于这种高级功能的损害与大血管狭窄之间的关系鲜有报道。本文拟通过对LA患者的白质疏松等级及血管狭窄程度进行评价,探讨LA患者血管狭窄与认知功能之间的关系。材料与方法选择2013年9月至2014年6月于安徽医科大学第一附属医院神经内科门诊和住院的LA患者101例,按照认知功能损害不同分为皮质下血管性认知功能损害(SVCI)组(n=54)及认知功能正常(NC)组(n=47),采用包括简易智能精神状态量表(MMSE)、剑桥老年认知功能评估量表-中文版(CAMCOG-C)以及蒙特利尔量表(Mo CA)等多项认知功能量表评价认知功能,使用3.0T头颅MRI扫描并按照Fazekas的评分标准将白质疏松严重程度分为3级(1级、2级、3级),应用头颅CT血管造影(CTA)或头颅磁共振血管成像(MRA)对LA患者脑血管狭窄程度进行评价。结果SVCI组LA等级及血管狭窄程度(2.0±0.8、2.6分±1.0分)均显著高于NC组(1.1±0.6、2.0分±1.0分)(P=0.020,P=0.003);将LA患者按照白质等级进行分组后发现,LA等级越高者,其血管狭窄程度越严重,认知评分逐渐降低,且三组间MMSE(25分±4分、24分±6分、22分±4分)及CAMCOG-C(83分±14分、80分±14分、73分±14分)评分差异具有统计学意义(P=0.012,P=0.014)。同时为了进一步探讨LA等级、血管狭窄程度和认知功能三者之间的关系,我们将LA患者MMSE评分与各相关因素进行相关分析,结果发现LA患者认知功能与LA等级(r=-0.317,P=0.001)及血管狭窄程度(r=-0.284,P=0.004)均成显著负相关。为进一步探讨LA患者认知功能损害的相关危险因素,我们进行多元逻辑回归分析后发现,在控制性别、年龄、文化程度、高血压、糖尿病及吸烟、饮酒等各项因素后LA等级(OR=2.025,95%CI=1.037~3.954)及血管狭窄程度(OR=1.812,95%CI=1.129~2.908)仍是LA患者认知功能损害的危险因素。结论血管狭窄和白质疏松病变均与患者的认知功能密切相关,血管狭窄在与其他因素共同作用导致白质病变的同时,其本身也可能导致患者认知功能下降。早期发现血管狭窄患者并进行神经介入等处理,不仅可减轻脑白质病变,而且对改善患者认知损害可能也具有较好远期作用,本研究结果也为防治血管性痴呆的发生提供了新的途径。
[Abstract]:Background and objective with the aging of population and the development of imaging technology, leukoaraiosis (LAA) has attracted more and more attention. It is believed that LA is not only closely related to cognitive impairment. It is also an independent risk factor for stroke. La has been considered to be the result of small vascular disease. However, in recent years, more and more studies believe that LA is also closely related to macrovascular disease. LA patients have multi-domain cognitive impairment, which is mainly caused by impairment of executive and attention function. However, there are few reports on the relationship between the damage of advanced function and the stenosis of large vessels. This article intends to evaluate the grade of leukoaraiosis and the degree of vascular stenosis in patients with LA. To explore the relationship between vascular stenosis and cognitive function in LA patients. Materials and methods LA patients were selected from September 2013 to June 2014 in Department of Neurology, Department of Neurology, first affiliated Hospital of Anhui Medical University. 101 cases. Patients with subcortical vascular cognitive impairment were divided into subcortical vascular cognitive impairment (SVCI) group (n = 54) and normal cognitive function group (n = 47) according to cognitive impairment. MMSE was used to measure mental state including simple mental state. The Chinese version of the Cambridge scale for the Assessment of Cognitive function for the elderly (CAMCOG-C) and the Montreal scale (MOCA) were used to evaluate the cognitive function. The severity of leukoaraiosis was divided into 3 grades (grade 1, grade 1, grade 2, grade 3) by MRI scan of 3.0T head and according to the standard of Fazekas. The degree of cerebral vascular stenosis in patients with LA was evaluated by using CT angiography (CTAA) or magnetic resonance angiography (MRAA). Results the grade of LA and the degree of stenosis were evaluated in SVCI group (P < 0.05). 2.0 卤0.8. The scores of 2.6 卤1.0) were significantly higher than those of NC group (1.1 卤0.6 卤2.0 卤1.0). The patients with LA were classified according to the white matter grade. The higher the grade of LA, the more severe the stenosis and the lower the cognitive score, and the MMSE was (25 卤4, 24 卤6) between the three groups. The scores of 22 卤4), CAMCOG-C(83 卤14, 80 卤14 and 73 卤14) were significantly different (P < 0.012). In order to further study the relationship among LA grade, vascular stenosis and cognitive function, we analyzed the correlation between the MMSE score of LA patients and the relevant factors. The results showed that the cognitive function of the patients with LA was related to the grade of LA (r = 0.317P = 0.001), and the degree of stenosis was r = -0.284. In order to further study the risk factors of cognitive impairment in LA patients, we conducted multivariate logistic regression analysis and found that control gender, age, and education level. After hypertension, diabetes, smoking and drinking, the LA grade was 2.025 ~ 95 CI 1.037 ~ 3.954) and the degree of stenosis was 1.812. Conclusion Vascular stenosis and leukoaraiosis are closely related to cognitive function in patients with LA. Vascular stenosis, together with other factors, may lead to white matter lesions, but also may lead to cognitive decline in patients. Early detection of vascular stenosis patients and nerve intervention and other treatment. Not only can reduce the white matter lesions, but also improve the cognitive impairment of patients may have a good long-term effect, this study also provides a new way to prevent and treat vascular dementia.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3

【参考文献】