认知损害、尿酸水平与视神经脊髓炎及其疾病谱临床特征的相关性分析

发布时间：2018-06-13 23:24

本文选题：视神经脊髓炎 + NMO疾病谱　；参考：《福建医科大学》2014年硕士论文

【摘要】：目的：了解视神经脊髓炎（NMO）及其疾病谱(NMOSD)患者认知功能损害的特点及其影响因素；对视神经脊髓炎及其谱系疾病的尿酸水平进行分析。方法：对2012.9.1～2014.3.31期间于福建医科大学附属第一医院神经内科入院确诊为视神经脊髓炎及其疾病谱的44例患者的临床资料进行回顾性分析。其中30例病例组和相应的对照组采用重复性成套神经心理状态测验（RBANS）量表进行认知功能评估，采用扩展残疾状态量表（EDSS）评估残疾状态、予汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)进行评估焦虑抑郁状态评估,进行横断面分析。采用双侧T检验进行参数检验,卡方精确概率法进行非参数检验,采用logistic回归分析的方法，探讨NMO及NMOSD患者认知障碍评分与EDSS评分、临床特点以及情绪等因素的相关性。采用Spearman相关分析血清AQP4抗体水平与EDSS评分、脊髓受累节段数、复发次数、年龄、颅内病灶的相关性。使用T检验进行病例组与对照组、性别、EDSS评分组间的尿酸水平的差异比较。结果：⑴病程中出现单眼或双眼视神经炎占86%,长节段横贯性脊髓炎占69.2%,主要发生在颈髓和胸髓。接受AQP4检验的患者中阳性者占64.3%。AQP4抗体滴度水平与复发次数、病程有着明显的正相关的关系，但与发病年龄、损害脊髓节段长度、EDSS评分无明显相关性。不同部位的颅内病灶AQP4抗体滴度不同，在延髓者AQP4滴度较高，病灶在丘脑部位者滴度最低。⑵病例组与对照组比较，RBANS评分明显降低（分别为72.00±16.609和89.40±19.253），，差别具有统计学意义（P0.001）；RBANS五项认知评分中有三个项目的评分下降具有统计学意义，分别为视觉广度(P0.001)、注意(P0.001)、延迟记忆(P值=0.017)。NMO认知损害的严重程度与NMOSD比较，两组之间差异无统计学意义（P=0.825）。RBANS评分与HAMA、HAMD评分及受教育程度具有相关性（Pearson相关系数分别为：-0.541，-0.510，1.563；P值分别为0.01，0.01，p=0.0390.05），而与性别、年龄、病程、复发次数以及是否存在颅脑病灶之间无明显相关性。⑶NMO及NMO疾病谱患者尿酸水平低于对照组。结论：1、NMO及其疾病谱患者中认知损害和情绪障碍较常见；2、认知障碍严重程度与教育程度、情绪异常存在相关性，与病程、躯体残障程度、年龄、临床类型、脑部可见病灶无关；3、NMO及NMO疾病谱患者尿酸水平降低。
[Abstract]:Objective: to investigate the characteristics and influencing factors of cognitive impairment in patients with optic neuromyelitis (NMO) and its disease spectrum (NMOSD), and to analyze the level of uric acid in optic neuromyelitis and its lineage diseases. Methods: the clinical data of 44 patients with optic neuromyelitis and its disease spectrum who were admitted to the Department of Neurology of the first affiliated Hospital of Fujian Medical University on March 31, 2012.1,2014.were retrospectively analyzed. The cognitive function of 30 cases and corresponding control group were evaluated by repetitive neuropsychological state test (RBANS), and the disability status was evaluated by extended disability status scale (EDSS). Hamilton Depression scale (Hamd) and Hamilton anxiety scale (Hama) were used to evaluate anxiety and depression status. Bilateral T test was used for parameter test, chi-square accurate probability method for non-parametric test, and logistic regression analysis method to investigate the correlation between cognitive impairment score and EDSs score, clinical characteristics and emotion in NMO-NMOSD patients. Spearman correlation was used to analyze the correlation between serum AQP4 antibody level and EDSS score, number of spinal cord involvement, recurrence times, age and intracranial lesions. T-test was used to compare the uric acid levels between the patients and the control group and the gender EDSS score group. Results the incidence of monocular or binocular optic neuritis was 86% in the disease course and 69.2% in the long segment transverse myelitis which mainly occurred in the cervical spinal cord and thoracic spinal cord. There was a positive correlation between the antibody titer of 64.3. AQP4 and the number of relapse and the course of disease, but there was no significant correlation with the age of onset and the length of spinal cord injury and EDSS score. The titer of AQP4 antibody in the medulla oblongata was higher than that in the control group (72.00 卤16.609 vs 89.40 卤19.253, P 0.001). In the group with the lowest titer of the lesion in the thalamus, the score of AQP4 antibody was significantly lower than that in the control group (72.00 卤16.609 and 89.40 卤19.253, respectively). The scores of three of the five cognitive scores of RBANS were significantly lower than those of NMOSD, which were visual span (P 0.001), attention (P 0.001), delayed memory (P < 0.017) and NMO (P = 0.017). There was no significant difference between the two groups (P < 0. 825). RBANS score was correlated with Hamad score and education level. Pearson's correlation coefficient was 0. 01% -0. 541% -0. 510 0. 563 (P = 0. 01 0. 01), but 0. 039 0. 05% with sex, age, course of disease. There was no significant correlation between recurrence times and brain lesions. 3 the uric acid levels in patients with NMO and NMO disease spectrum were lower than those in the control group. Conclusion Cognitive impairment and emotional disorder are more common in patients with NMO and its disease spectrum. The severity of cognitive impairment is correlated with education level, emotional abnormality, and course of disease, physical disability, age, clinical type. The level of uric acid was decreased in patients with NMO and NMO disease spectrum.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R744.52

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