脑白质病变与糖尿病的相关性研究

发布时间：2018-05-19 14:18

本文选题：脑白质病变 + 糖化血红蛋白　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:探讨糖尿病(Diabetes Mellitus DM)对脑白质病变(white matter lesions WML)的严重程度有无影响,糖尿病与其他脑血管病危险因素在致脑白质病变上有无协同作用,应用认知功能评价脑白病变的严重程度是否准确。方法:选取2014年4月至2015年2月就诊于山西医科大学第二临床医学院神经内二科经颅脑MR检查明确有脑白质病变的住院患者150例,入选病例年龄均在55岁以上,65岁以下,均检验糖化血红蛋白,并收集一般病史资料,采用Fazekas影像评价量表进行影像学评分,蒙特利尔认知评估量表(Montreal Cognitive Assessment,Mo CA)进行认知评分。第一步,将所有患者进行影像学评分及认知功能评分,分别以A、B、C三组及A’、B’、C’三组代表轻、中、重度,分析两种评分系统间有无相关性。第二步,应用秩和检验,分析A、B、C三个不同层次的组间糖化血红蛋白、糖尿病年限有无差异。第三步,以影像学评分等级为应变量,以各种可能的危险因素作为自变量,进行多值有序的多重logistic回归分析,明确糖尿病是否为脑白质病变的危险因素。第四步,分析其他危险因素与糖尿病在对脑白间病变的影响上有无协同作用。结果:脑白质病变患者影像评分与认知评分有相关性(P0.05),但相关系数并不高(r=0.022809);经秩和检验,糖化血红蛋白与脑白质病变影像评分严重程度有相关性(P0.001),糖尿病年限与脑白质病变影像评分严重程度有相关性(P0.05);经多值有序的多重logistic回归分析,糖尿病使脑白质病变的危险增高3.728倍;合并糖尿病的脑白质病变患者组中高血压病致脑白质病变的危险系数为4.569,高于单纯脑白质病变组的2.671;合并糖尿病的脑白质病变患者组中高脂血症病致脑白质病变的危险系数为6.451,高于单纯脑白质病变组的5.500;合并糖尿病的脑白质病变患者组中高同型半胱氨酸血症致脑白质病变的危险系数为6.705,高于单纯脑白质病变组的5.124。结论:认知功能虽与脑白质病变的严重程度有相关性,但关系并不密切。糖尿病是脑白质病变的一个独立危险因素,在对脑白间病变的影响上,糖尿病与高血压病、高脂血症及高同型半胱氨酸血症有协同作用。
[Abstract]:Objective: to investigate whether diabetes mellitus (DM) has an effect on the severity of white matter lesions WML) in white matter lesions, and whether diabetes and other risk factors of cerebrovascular disease have synergistic effects on white matter lesions. Cognitive function was used to evaluate the severity of brain white lesions. Methods: from April 2014 to February 2015, 150 inpatients with white matter lesions were selected from the second Department of Neurology, second College of Clinical Medicine, Shanxi Medical University, who were diagnosed by craniocerebral Mr examination. The age of the patients were above 55 years old or below 65 years old. All patients were tested for glycosylated hemoglobin (HbA1c), and general medical history data were collected. The imaging scores were evaluated with the Fazekas image evaluation scale and the cognitive score with the Montreal Cognitive Assessment scale (Montreal Cognitive Assessment). In the first step, all the patients were scored by imaging and cognitive function. The patients were divided into three groups: group C and group C, which represented mild, moderate and severe, respectively. The correlation between the two scoring systems was analyzed. In the second step, the rank sum test was used to analyze the difference of glycosylated hemoglobin (HbA1c) in three different levels of AHBC and the duration of diabetes mellitus. In the third step, multiple logistic regression analysis was performed to determine whether diabetes was a risk factor for leukoencephalopathy, taking imaging score as dependent variable and various possible risk factors as independent variables. The fourth step is to analyze the synergistic effect of other risk factors and diabetes mellitus on the brain white-interleukopathy. Results: there was a correlation between image score and cognitive score in patients with leukoencephalopathy (P 0.05), but the correlation coefficient was not high (r = 0.022 2809). Glycosylated hemoglobin was correlated with the severity of white matter lesions (P 0.001), and the age of diabetes was correlated with the severity of white matter lesions (P 0.05). Diabetes increased the risk of white matter lesions by 3.728 times. The risk coefficient of white matter lesions caused by hypertension in patients with diabetes mellitus was 4.569, which was higher than that in patients with simple white matter disease 2.671, and that caused by hyperlipidemia in patients with diabetes mellitus was 4.569. The risk coefficient of hyperhomocysteinemia was 6.705, which was higher than that of pure white matter disease group (5.124%), and the risk coefficient of hyperhomocysteinemia group was 6.705, which was higher than that of pure white matter disease group (5.500%), and the risk coefficient of hyperhomocysteinemia group was 6.705 (P < 0.05). Conclusion: although cognitive function is correlated with the severity of leukoencephalopathy, it is not closely related. Diabetes is an independent risk factor for leukoencephalopathy. Diabetes has synergistic effects with hypertension, hyperlipidemia and hyperhomocysteinemia.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1;R741

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