皮质下缺血性血管病患者神经精神症状及其与皮质下脑损害间相关性

发布时间：2018-06-17 18:16

本文选题：皮质下缺血性血管病 + 轻度认知功能损害　；参考：《安徽医科大学》2014年硕士论文

【摘要】：目的探讨皮质下缺血性血管病（subcortical ischemic vascular disease, SIVD）患者神经精神症状（neuropsychiatric symptoms,NPS）的临床特征。方法采用中文版神经精神科问卷（Chinese version of the neuropsychiatricinventory,CNPI）对50例正常健康老年人（normal controls,NC）、101例SIVD患者，其中51例皮质下血管性轻度认知功能损害（subcortical vascular mild cognitiveimpairment, SVMCI）及50例皮质下血管性痴呆患者（subcortical vascular dementia,SVaD）进行评定，比较各组间NPS的特征以及SVMCI和SVaD组之间NPS的发生率。结果3组间CNPI总分有显著性差异，SVMCI组CNPI得分显著高于NC组且低于SVaD组，差异有统计学意义（P0.01）。SVaD组与NC组比较在激越、心境恶劣、焦虑、情感淡漠、易激惹、睡眠行为及进食障碍等症状得分方面差异有统计学意义（P0.05）；SVMCI组与NC组比较在激越、情感淡漠、易激惹症状得分方面差异有统计学意义（P0.05）。从NPS发生率来看，SVaD组情感淡漠、睡眠行为、心境恶劣、进食障碍、异常行为发生率均显著高于SVMCI组，且差异有统计学意义（χ2=10.99，P=0.001; χ2=8.72. P=0.003; χ2=4.32，P=0.037; χ2=4.0，P=0.045;χ2=5.66.P=0.017）。结论NPS是SIVD患者常见的临床症状；情感淡漠等症状是SIVD患者特征性的NPS表现，且随着认知损害的加重而愈加明显。目的探讨皮质下缺血性血管病(subcortical ischemic vascular disease, SIVD)患者皮质下缺血性损害（subcortical ischemic lesions, SIL）与神经精神症状（neuropsychiatricsymptoms, NPS）之间的相关性。方法选择144例SIVD患者，，其中认知功能正常59例，轻度认知损害患者49例，痴呆患者36例，使用MRI半定量量表评价SIL情况，头颅MRI线性脑萎缩测量法测量脑萎缩指标；采用简明精神状态量表（Mini-mental StateExamination,MMSE）评价总体认知功能，神经精神科问卷中文版（Chinese versionof the neuropsychiatric inventory, CNPI）评价NPS，二元Logistic回归分析SIL与NPS间的相关性。结果在控制性别、年龄、总体认知功能、脑萎缩等情况下，侧脑室旁白质病变与焦虑密切相关（OR2.21,95%CI1.13-4.32），脑室旁白质病变总分与睡眠行为异常相关（OR1.41,95%CI1.02-1.96）；基底节区白质病变总分与情感淡漠显著相关（OR1.23,95%CI1.07-1.41）；基底节区腔隙性梗死与脱抑制密切相关（OR3.37,95%CI1.06-10.71）；颞叶白质病变与欣快显著相关（OR1.73,95%CI1.08-2.77）。结论SIVD患者SIL与NPS密切相关，特定部位的皮质下损害可导致相应NPS的发生。
[Abstract]:Objective to investigate the clinical features of neuropsychiatric symptoms in patients with subcortical ischemic vascular disease, SIVD. Methods the Chinese version of the neuropsychiatric inventory (CNPI) was used in the study of 50 healthy elderly patients with normal control normal NCU, 101 patients with SIVD. Among them, 51 cases of subcortical vascular mild cognitiveimpairment, with mild cognitive impairment and 50 cases of subcortical vascular dementia (SVaD) were evaluated. The characteristics of NPS and the incidence rate of SVMCI and SVaD were compared. Results there was significant difference in the total scores of CNPI between the three groups. The CNPI score of SVMCI group was significantly higher than that of NC group and lower than that of SVaD group. The difference was statistically significant compared with NC group. There were significant differences in the scores of sleep behavior and eating disorders between SVMCI group and NC group in terms of agitation, apathy and irritability (P 0.05). The incidence of NPS in SVaD group was significantly higher than that in SVMCI group (蠂 2 + 10.99% P0. 001; 蠂 2 + 8. 72 2). The incidence of emotional indifference, sleep behavior, bad mood, eating disorder and abnormal behavior in SVaD group were significantly higher than those in SVMCI group. P0. 003; 蠂 2: 4. 32, P0. 037; 蠂 2, 0. 0, P0. 045; 蠂 2, 5. 66. P0. 017. Conclusion NPS is a common clinical symptom in patients with SIVD, and emotional apathy is a characteristic manifestation of NPS in patients with SIVD, and it becomes more and more obvious with the aggravation of cognitive impairment. Objective to investigate the relationship between subcortical ischemic lesions (sil) and neuropsychedelic disorders (NPSs) in subcortical ischemic vascular disease, patients. Methods 144 patients with SIVD were selected, including 59 patients with normal cognitive function, 49 patients with mild cognitive impairment and 36 patients with dementia. The sil was evaluated with MRI semi-quantitative scale. Brain atrophy was measured by linear brain MRI. The total cognitive function was evaluated by Mini-Mental Mental examination scale (MMSE), the Chinese versionof the neuropsychiatric inventory, CNPI was evaluated by Chinese Psychiatry questionnaire, and the correlation between sil and NPS was analyzed by binary Logistic regression analysis. Results under the condition of controlling sex, age, total cognitive function and brain atrophy, there was a close correlation between paraventricular white matter lesion and anxiety. The total score of ventricular white matter lesion was correlated with sleep behavior abnormality. The total score of white matter lesions in basal ganglia was significantly correlated with affective apathy (OR 1.2395 CI 1.07-1.41); basal ganglia lacunar infarction was closely related to depressor activity; OR3.37 ~ 95CI1.06-10.71; and temporal white matter lesion was significantly correlated with OR 1.7395CI1.08-2.77. Conclusion sil is closely related to NPS in patients with SIVD, and subcortical damage in specific sites may lead to the occurrence of NPS.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

【共引文献】