缺血性脑白质疏松症MoCA评分与颅内外血流动力学的相关研究

发布时间：2018-01-30 02:07

本文关键词： 缺血性脑白质疏松症（ILA）认知障碍血流动力学　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探索一种实用、方便、经济的能够早期发现并实时监测缺血性脑白质疏松症（ischemic leukoaraiosis，ILA）相关认知障碍病情变化的方法，综合分析脑血管病危险因素与上述认知障碍的关系，以及进一步认识ILA相关认知障碍的临床特点。方法：本研究共收集了2013年2月至2014年1月于大连市中心医院神经内二科住院并经临床确诊的ILA的患者61例。入院后采集病史，完善必要的化验检查，联合应用经颅多普勒超声（Transcranial Doppler ultrasound，TCD）和颈部血管超声对颅内外血流动力学进行检测，通过北京版蒙特利尔量表（Montreal cognitiveassessment, MoCA）对患者的认知水平进行评估。最后分析患者的MoCA评分与大脑中大动脉（middle cerebral artery，MCA）和大脑前动脉（anterior cerebral artery，ACA）的搏动指数（pulsatility index,PI）、平均血流（mean velocity,Vm）及颈动脉内膜中层厚度（intima-media thickness,IMT）的相关性、脑血管病的危险因素与MoCA评分的关系以及ILA患者认知域损害的特点。结果：1.患者总数为61例，其中男性30人，女性31人，总体年龄跨度为43-86岁，平均年龄：69.61±7.34岁。吸烟者及饮酒者占总体的比例分别为18%、8%，高血压病、糖尿病、冠心病的患病率分别为70%、28%、16%。认知障碍组和认知正常组的年龄、性别、吸烟、饮酒及高血压病、糖尿病、冠心病等因素通过比较分析均无统计学意义（P值0.05）。 2.认知障碍组与认知正常组的同型半胱氨酸（homocysteine，Hcy）水平、颈动脉内膜中层厚度、大脑中动脉及大脑前动脉的搏动指数单因素分析P值0.05，具有统计学意义；两组的MCA-Vm及ACA-Vm比较无统计学差异（P值0.05）。 3.多元线性回归提示只有血同型半胱氨酸及大脑中动脉搏动指数与缺血性脑白质疏松症相关认知障碍呈线性相关，回归方程为Y=40.984-0.982X1-8.071X2，P值0.01，具有显著统计学意义。 4.延迟回忆力对ILA相关认知障碍的诊断价值最高，而命名能力的分析结果提示P值0.05，无统计学意义。入组患者中总体认知水平下降的为49人，占总人数80.33%，延迟回忆力受损人数为59人，占总人数的96.72%，视空间/执行功能、语言功能、抽象能力、注意力、命名能力及定向力的受损人数分别为54人、49人、38人、33人、28人、22人，占总人数的88.52%、80.33%、62.30%、54.10%、45.90%、36.07%。结论：1.同型半胱氨酸水平及大脑中动脉搏动指数与缺血性脑白质疏松症MoCA评分呈线性相关，，即Hcy及MCA-PI越高，患者的MoCA评分越低，相应的认知损害越重。 2.大脑前大动脉的搏动指数及颈动脉内膜中层厚度与ILA相关认知障碍有关，相关机制仍需进一步研究。 3.延迟回忆力对缺血性脑白质疏松症相关认知障碍的诊断价值最高；而受累的认知域主要涉及延迟回忆力、视空间/执行功能、语言能力，累及定向力的最少。 4.高同型半胱氨酸血症为缺血性脑白质疏松症相关认知障碍的重要危险因素；大脑中动脉搏动指数的增高对于ILA相关的认知损害具有早期预测价值，联合应用颈部血管超声及TCD对于ILA相关认知障碍的防治具有重要意义。
[Abstract]:Objective: To explore a practical, convenient, economy can be found early and real-time monitoring of ischemic leukoaraiosis (ischemic leukoaraiosis ILA) method was related to cognitive impairment changes, the relationship between the comprehensive analysis of the risk factors of cerebrovascular disease and cognitive impairment, and further understanding of clinical characteristics of ILA associated cognitive impairment.
Methods: This study collected from February 2013 to January 2014 in Dalian Central Hospital in two nervous inpatients and 61 cases with clinically diagnosed ILA patients. After admission history, perfecting the necessary laboratory examination, ultrasound and transcranial Doppler (Transcranial Doppler, ultrasound, TCD) and neck vascular ultrasound to detect intracranial hemodynamics. The Beijing version of the Montreal scale (Montreal cognitiveassessment MoCA) to assess the patient's cognitive level. Finally, analysis of large artery and brain in patients with MoCA score (middle cerebral, artery, MCA) and the anterior cerebral artery (anterior cerebral, artery, ACA) pulsatility index (pulsatility index, PI), the average blood flow (mean velocity Vm), and carotid intima-media thickness (intima-media thickness, IMT) the correlation between risk factors of cerebrovascular disease and MoCA score and I The characteristics of cognitive impairment in LA patients.
Results: 1. a total of 61 patients, including 30 males and 31 females, the age span of 43-86 years, average age: 69.61 + 7.34 years. Smokers and drinkers accounted for the overall proportion were 18%, 8%, hypertension, diabetes, coronary heart disease prevalence rate were 70%, 28%, 16%. cognitive impairment group and cognitive normal group in age, gender, smoking, drinking and hypertension, diabetes, coronary heart disease and other factors through the comparison analysis were not statistically significant (P = 0.05).
Homocysteine 2. cognitive dysfunction group and cognitive normal group (homocysteine, Hcy) level, carotid intima-media thickness, pulsatility index of artery and anterior cerebral artery in the brain of the single factor analysis and P value was 0.05, with statistical significance; MCA-Vm and ACA-Vm two groups showed no statistically significant difference (P = 0.05).
3. multivariate linear regression showed that only blood homocysteine and middle cerebral artery pulsation index were linearly correlated with cognitive impairment of ischemic leukoaraiosis. The regression equation was Y=40.984-0.982X1-8.071X2 and P value was 0.01, which had significant statistical significance.
4. the delayed memory of ILA cognitive impairment in the diagnostic value of the highest, and the naming ability analysis showed that the P value is 0.05, not statistically significant. The overall level of cognitive decline in patients with 49 people, accounted for 80.33% of the total number of the delayed memory impairment for the number 59, accounting for 96.72% of the total number, visual space / executive function, language function, abstract ability, attention, orientation and number of impaired naming ability were 54 people, 49 people, 38 people, 33 people, 28 people, 22 people, accounting for 88.52% of the total number, 80.33%, 62.30%, 54.10%, 45.90%, 36.07%.
Conclusion: 1., homocysteine level and middle cerebral artery pulsatility index are linearly correlated with MoCA score of ischemic leukoaraiosis. The higher the Hcy and MCA-PI, the lower the MoCA score is, the more the cognitive impairment is.
2. the pulsatile index of the anterior cerebral artery and the thickness of the carotid artery intima are related to the cognitive impairment associated with ILA, and the related mechanisms need to be further studied.
3., delayed recall has the highest diagnostic value for the related cognitive impairment of ischemic leukoaraiosis, and the involved cognitive domain mainly involves delayed recall, visual space / executive function, language ability and the least directional power.
4. hyperhomocysteinemia is an important risk associated with cognitive ischemic leukoaraiosis disorder factors; increased middle cerebral artery pulsatility index for cognitive impairment associated with ILA early predictive value, has important significance for prevention and treatment of combined application of neck vascular ultrasound and TCD for ILA related cognitive disorders.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743

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