视神经脊髓炎谱系疾病疲劳、睡眠和认知障碍特征的初步研究

发布时间：2018-04-10 21:22

本文选题：视神经脊髓炎谱系疾病 + 多发性硬化　；参考：《天津医科大学》2015年博士论文

【摘要】：研究目的研究调查视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorder,NMOSD)患者系统性症状:疲劳、睡眠障碍及认知功能障碍。探讨这些系统性症状相关因素,扩展对NMOSD患者症状的认识,加深对NMO病理损坏的理解,从而为更好的管理NMOSD患者提供理论依据。研究内容和方法2013年9月-2014年6月连续收集就诊于天津医科大学总医院神经内科的临床确诊的NMOSD患者33例,健康对照20例。两组的年龄、性别、受教育年限相匹配。记录分析临床影像资料;对患者进行系列量表测评:匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)、艾普沃斯嗜睡量表(Epworth Sleepiness Scale,ESS)、疲劳量表(Fatigue Questionnaire,FQ)、Beck抑郁量表(Beck Depression Inventory,BDI)、日常生活能力量表(Activities of Daily Living Scale,ADL)、多发性硬化简易认知功能测评量表(The Minimal Assessment of Cognitive Function in Multiple Sclerosis,MACFIMS);24小时多导睡眠图(polysomnography,PSG)监测。采用SPSS17.0统计软件包对数据进行统计分析。检验水准取α=0.05,P0.05为有统计学意义。研究结果1.疲劳(1)疲劳发生的调查结果:NMOSD组的疲劳发生率高于正常对照组(64%vs 35%,P=0.043)。两组的疲劳量表总分、躯体疲劳、脑力疲劳评分分别为6.4 vs 3.8(P=0.001),4.4 vs2.8(P=0.002),2.0 vs 1.1(P=0.007)。根据FQ量表评分,将病例组分为疲劳组(FQ≥4,n=21)和非疲劳组(FQ4,n=12)。疲劳患者日常生活能力明显低于非疲劳组(ADL:31.9 vs 23.7,P=0.003),并且疲劳程度与ADL分值呈正相关(r=0.455,P=0.008)。(2)在nmosd患者中发生疲劳的相关因素分析结果:两组在临床特征上无差异。相对于非疲劳组,疲劳组bdi分值增高(16.6vs7.3,p=0.016);疲劳组平均、最低血氧浓度(meanspo2,nadirspo2)均降低(90%vs94%,p=0.004;87%vs93%,p=0.002)。疲劳组患者相对于非疲劳组患者,主观夜间睡眠差,白天易嗜睡(psqi:9.2vs5.8,p=0.044;ess:7.3vs3.8,p=0.024);非快速眼动睡眠期n3期所占比例降低(6.7%vs11.6%,p=0.033),睡眠期转换次数增高(131.3vs103.5,p=0.049)。相关分析显示,疲劳程度与抑郁程度呈正相关(r=0.599,p0.001);与meanspo2,nadirspo2呈负相关(r=-0.457,p=0.007;r=-0.558,p=0.001);与psqi评分呈明显正相关(r=0.453,p=0.008)。2.睡眠障碍nmosd患者psg睡眠特征:①睡眠效率(sleepefficiency,se)减低:与正常对照组相比,病例组se下降(78%vs86%,p=0.034);入睡后再清醒时间增加44分钟(p0.0001)。②睡眠结构:与正常对照组相比,病例组在快速眼动期、非快速眼动期n1期分别增加4%(p=0.042)和6%(p=0.001),非快速眼动期n3期减少12%(p0.0001),觉醒指数较正常对照组降低(6vs12,p=0.014)。③呼吸事件:病例组中,呼吸睡眠暂停的患者比例高于正常对照组(18%vs5%,p=0.007),meanspo2、nadirspo2均低于正常对照组(94%vs96%,p=0.011;89%vs92%,p=0.039)。④周期性肢体运动:病例组的周期性肢体运动次数明显高于正常对照组(20vs2,p=0.020)。有脑干和小脑病变的患者周期性肢体运动次数明显高于非幕下病变组(41vs3,p=0.001)。3.认知功能(1)nmosd患者比健康对照组mmse和moca得分显著降低(27.2vs28.3,p=0.014;24.2vs27.1,p=0.000)。nmosd患者认知功能障碍的发生率为39.4%。nmosd患者在以下认知功能方面显著受损:步伐听觉连续加法测试(pasat,p=0.002),符号数字转换测试(sdmt,p=0.000),california词语学习测验(totallearningofcvlt-ii,p=0.000),短延迟暗示回忆(sdcr,p=0.006),长延迟自由回忆(ldfr,p=0.005),长延迟暗示回忆(ldcr,p=0.010),简易视空间记忆测验(bvmt-r,p0.05),语义口语流畅性测验(p=0.000)。最常见认知障碍类型是记忆。(2)存在认知功能障碍的NMOSD患者与认知功能保留的NMOSD患者比较,年龄更大、教育水平更低(年龄:54.5±1.9 vs 42.5±3.0,P=0.002;受教育程度:8.4±1.1 vs 11.2±0.7,P=0.028)。结论1.NMOSD患者的疲劳发生率明显增高,既有躯体疲劳,又有脑力疲劳;存在疲劳的NMOSD患者日常生活能力下降;NMOSD患者的疲劳程度与抑郁程度、主观睡眠质量、SpO2相关。2.NMOSD患者的SE下降、WASO增加、REM及NREM-N1所占比例增加、NREM-N3所占比例减少、睡眠呼吸紊乱明显、SpO2降低、周期性肢体运动明显增多。存在幕下病变的NMOSD患者周期性肢体运动明显。3.NMOSD患者存在认知功能障碍,主要表现在短时、长时记忆功能,视觉及听觉信息处理速度等方面。NMOSD患者年龄越大、受教育越低,发生认知功能障碍的可能性越大。
[Abstract]:Objective to investigate the investigation of neuromyelitisoptica spectrum disorder (neuromyelitis optica spectrum disorder, NMOSD) in patients with systemic symptoms: fatigue, sleep disorders and cognitive impairment. To explore the factors related to the systemic symptoms, and learn more about the symptoms of patients with NMOSD, to deepen the understanding of NMO pathology damage, so as to provide a theoretical basis for better management of NMOSD 33 patients with clinically diagnosed NMOSD patients. The research contents and methods in September 2013 -2014 year in June were collected in General Hospital Affiliated to Tianjin Medical University from the Department of Neurology, 20 cases of healthy control. The two groups in age, gender, education matched records. Clinical analysis of image data; with series scale: Pittsburgh sleep quality index scale (Pittsburgh Sleep Quality Index, PSQI), EPPs Voss sleepiness scale (Epworth Sleepiness Scale, ESS), fatigue scale (Fatigue Quest Ionnaire, FQ), Beck Depression Scale (Beck Depression Inventory, BDI), ADL (Activities of Daily Living Scale, ADL), multiple sclerosis, simple cognitive function assessment scale (The Minimal Assessment of Cognitive Function in Multiple Sclerosis, MACFIMS); polysomnography (Figure polysomnography 24 hours PSG), packet monitoring. The data were analyzed with SPSS17.0 statistical software. Take a =0.05 level test, P0.05 had statistical significance. The research results of the 1. fatigue (1) survey results: fatigue fatigue occurred in NMOSD group was higher than that in the normal control group (64%vs 35%, P=0.043). The two group fatigue scale the total score, physical fatigue, mental fatigue scores were 6.4 vs 3.8 (P=0.001), 4.4 vs2.8 (P=0.002), 2 vs (1.1 P=0.007). According to the FQ score, the patients were divided into fatigue group (FQ = 4, n=21) and non fatigue group (FQ4, n=12) in patients with fatigue. The ability of daily life was significantly lower than the non fatigue group (ADL:31.9 vs 23.7, P=0.003), and the degree of fatigue was positively correlated with ADL scores (r=0.455, P=0.008). (2) in patients with nmosd related factors of fatigue analysis results: the two groups in clinical characteristics. No difference compared with non fatigue group, fatigue group BDI score increased (16.6vs7.3, p=0.016); fatigue group average, minimum oxygen concentration (meanspo2, nadirspo2) were decreased (90%vs94%, p=0.004; 87%vs93%, p=0.002). The fatigue group compared with non fatigue group, subjective sleep, sleepiness (psqi:9.2vs5.8, white Tianyi p=0.044; ess:7.3vs3.8, p=0.024); non REM N3 the proportion of lower (6.7%vs11.6%, p=0.033), the sleep period conversion times increased (131.3vs103.5, p=0.049). Correlation analysis showed that the fatigue degree and the degree of depression was positively correlated (r=0.599, p0.001); and meanspo2, nadirspo2 were negatively correlated (r=-0.457 P=0.007, r=-0.558, p=0.001);; there was a significant positive correlation with PSQI score (r=0.453, p=0.008) nmosd.2. PSG features of sleep disorders in patients with sleep: sleep efficiency (sleepefficiency, Se) decreased compared with normal control group, Se group were decreased (78%vs86%, p=0.034); then awake time increased 44 minutes after falling asleep (P0.0001). The sleep structure: compared with normal control group, patients in REM sleep, non REM stage N1 were increased by 4% (p=0.042) and 6% (p=0.001), non REM N3 phase decreased 12% (P0.0001), arousal index is lower than normal control group (6vs12, p=0.014) 3. Respiratory events: in the case group, the proportion of patients with sleep apnea is higher than the normal control group (18%vs5%, p=0.007), meanspo2, nadirspo2 were lower than the normal control group (94%vs96%, p=0.011; 89%vs92%, p=0.039). The periodic limb movement: periodic limb movement the number of cases was significantly higher than that of The normal control group (20vs2, p=0.020). The number of patients with periodic limb movement brainstem and cerebellar lesions were significantly higher than those in non subtentorial lesions group (41vs3, p=0.001).3. cognitive function (1) nmosd patients than in healthy control group MMSE and MOCA scores were significantly lower (27.2vs28.3, p=0.014; 24.2vs27.1, p=0.000).Nmosd patients with cognitive dysfunction the incidence of 39.4%.nmosd in patients with significantly impaired cognitive function in the following aspects: the pace of PASAT (PASAT, p=0.002), digital symbol conversion test (SDMT, p=0.000), California Verbal Learning Test (totallearningofcvlt-ii, p=0.000), short delay memory (sdcr, p=0.006) suggested that, long delayed free recall (ldfr, p=0.005), long delay memory (LdCr, p=0.010) suggests, simple visual spatial memory test (bvmt-r, P0.05), oral semantic fluency test (p=0.000). The most common type of cognitive impairment and memory. (2) cognitive function barrier Because of the comparison of NMOSD and cognitive function in patients with preserved NMOSD patients, older age, lower education levels (age: 54.5 + 1.9 vs 42.5 + 3, P=0.002; education level: 8.4 + 1.1 vs 11.2 + 0.7, P=0.028). Conclusion fatigue in patients with 1.NMOSD were significantly increased, both the body fatigue. And mental fatigue; there is a decrease of daily life ability of NMOSD patients with fatigue; fatigue degree in patients with NMOSD and depression, subjective sleep quality, SpO2 with.2.NMOSD SE decreased, WASO increased, REM and NREM-N1 increase in the proportion of NREM-N3, reduce the proportion of sleep disordered breathing, decreased SpO2, periodic limb the movement increased significantly. There are infratentorial lesions of NMOSD patients with periodic limb movement was.3.NMOSD patients have cognitive dysfunction, mainly in the short term, long memory, visual and auditory information processing speed with.NMOSD years The greater the age, the lower the education, the greater the possibility of cognitive impairment.

【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R744.52

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