首发脑梗死后认知障碍与病灶部位及责任动脉的相关性分析

发布时间：2018-06-24 07:07

本文选题：脑梗死 + 认知障碍　；参考：《南华大学》2015年硕士论文

【摘要】：目的:分析首发脑梗死后患者认知障碍的影响因素;探讨不同病灶部位首发脑梗死患者认知障碍发生率及认知域损害的特点,观察病灶部位与认知障碍之间的关系;探讨首发脑梗死后责任动脉与认知障碍之间的关系。方法:收集2013年2月~2014年10月入住我院神经内科的206例首发脑梗死患者,按病灶部位分为额叶28例,颞叶24例,顶叶23例,枕叶5例,基底节73例,丘脑14例,小脑20例,脑干19例。按责任动脉分为大脑前动脉(ACA)组18例、大脑中动脉(MCA)组109例、脉络膜前动脉(ACh A)组15例、大脑后动脉(PCA)组25例和椎基底动脉(VBA)组39例。采用中文版蒙特利尔认知评估量表(Mo CA)对患者进行认知功能评估。记录所有入选病例的性别、年龄、受教育年限、吸烟史、饮酒史、影像学资料、高血压病病史、2型糖尿病病史,入院第二日清晨空腹抽外周静脉血检查血糖、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)。结果:1、认知障碍组和非认知障碍组性别、年龄、受教育年限、吸烟史、饮酒史、高血压病病史、总胆固醇、甘油三脂、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇等比较,差异无统计学意义(均P0.05);2型糖尿病病史比较,差异有统计学意义(P0.05)。2、不同病灶部位受损的首发脑梗死患者,其认知障碍的发生率,差异有统计学意义(P0.05),额叶组认知障碍发生率最高,达92%以上;其次为丘脑组,达85%以上;再次为颞叶组,达75%以上;小脑组及脑干组最低,约30%左右。3、额叶组在视空间与执行功能、注意力认知域均低于其他各组(P0.05);丘脑组在视空间与执行功能、记忆、注意力、语言、定向力认知域均低于其他各组(P0.05);颞叶组在命名、记忆认知域分值低于其他各组(P0.05);三组Mo CA总分分值均低于其他各组,差异有统计学意义(P0.05)。4、责任动脉阻塞致首发脑梗死后认知障碍发生率差异有统计学意义(P0.05),MCA供血区梗死认知障碍发生率最高,达70%以上。结论:1、2型糖尿病病史是首发脑梗死后认知障碍的影响因素之一;2、首发脑梗死后认知障碍的发生与病灶部位有关,不同病灶部位脑梗死损害的认知域也不同;3、责任动脉阻塞致首发脑梗死后认知障碍发生率不同,MCA供血区梗死认知障碍发生率最高。
[Abstract]:Objective: to analyze the influencing factors of cognitive impairment in patients with initial cerebral infarction, to explore the incidence of cognitive impairment and the characteristics of cognitive domain damage in patients with initial cerebral infarction, and to observe the relationship between lesion location and cognitive impairment. To explore the relationship between the responsible artery and cognitive impairment after initial cerebral infarction. Methods: 206 patients with initial cerebral infarction admitted to our hospital from February 2013 to October 2014 were divided into frontal lobe (n = 28), temporal lobe (n = 24), parietal lobe (n = 23), occipital lobe (n = 5), basal ganglia (n = 73), thalamus (n = 14) and cerebellum (n = 20). Brain stem 19 cases. According to the responsible artery, there were 18 cases in the anterior cerebral artery (ACA) group, 109 cases in the middle cerebral artery (MCA) group, 15 cases in the anterior choroidal artery (ach A) group, 25 cases in the posterior cerebral artery (PCA) group and 39 cases in the vertebrobasilar artery (VBA) group. Chinese Montreal Cognitive Assessment scale (MOCA) was used to evaluate the cognitive function of patients. Sex, age, years of education, smoking history, drinking history, imaging data, history of hypertension and type 2 diabetes mellitus were recorded. Total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C). Results: sex, age, years of education, smoking history, drinking history, history of hypertension, total cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol were compared between the cognitive disorder group and the non-cognitive disorder group, such as sex, age, years of education, history of smoking, history of drinking alcohol, history of hypertension, total cholesterol, triglyceride, low density lipoprotein cholesterol and high density lipoprotein cholesterol. There was no significant difference in the history of type 2 diabetes mellitus (P0.05), the difference was statistically significant (P0.05) .2.The incidence of cognitive impairment in patients with first cerebral infarction with different lesion sites was significant. The difference was statistically significant (P0.05). The incidence of cognitive impairment was the highest in frontal lobe group (92%), followed by thalamus group (85%), temporal lobe group (75%), cerebellar group and brainstem group (75%). About 30%, frontal lobe group in visual space and executive function, attention cognitive domain were lower than other groups (P0.05); thalamus group in visual space and executive function, memory, attention, language, orientation cognitive field were lower than other groups (P0.05); temporal lobe group in naming, The scores of memory cognitive domain were lower than those of other groups (P0.05), the total scores of Mo CA in three groups were lower than those in other groups. The difference was statistically significant (P0.05). 4. The incidence of cognitive impairment after primary cerebral infarction caused by responsible artery occlusion was significantly different (P0.05) the incidence of cognitive impairment in MCA supplying area was the highest (over 70%). Conclusion the history of type 2 diabetes mellitus is one of the influencing factors of cognitive impairment after initial cerebral infarction. The occurrence of cognitive impairment after initial cerebral infarction is related to the location of the lesion. The cognitive domain of cerebral infarction damage was also different in different lesions. The incidence of cognitive impairment in MCA supplying area was the highest after the first cerebral infarction caused by responsible artery occlusion.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3

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