急性轻中度脑梗死后认知功能障碍特点及血清SAA、A β与其相关性的研究

发布时间：2018-08-17 17:04

【摘要】：研究目的：分析不同部位急性轻中度脑梗死后的认知功能特点,并分析血清淀粉样蛋白A(serum amyloid A protein, SAA)、β-淀粉样蛋白(p-amyloid, Aβ)与急性轻中度脑梗后认知表现之间的关系,探究SAA及Ap在轻中度脑梗死急性期认知功能中的作用,为临床早期防治血管性认知功能障碍提供理论依据。研究方法：1.收集山东省立医院神经内科确诊为急性轻中度脑梗死的患者105例,无脑梗死对照30例。采用简易智能精神状态检查(Mini-Mental State Examination, MMSE)和蒙特利尔认知评估量表(Montreal Cognitive Assessment, MOCA)对其进行认知功能评估。首先,比较急性脑梗死组和无脑梗死对照组的一般资料和认知评分；其次,根据不同部位(包括右侧大脑半球、左侧大脑半球、额叶、顶叶、颞叶、枕叶、脑干、小脑、基底节区和丘脑)是否存在急性梗死依次进行分组,分别分为有和无两组,统计分析脑卒中危险因素对认知功能的影响、各组的认知功能特点及不同认知领域的损害特点。2.运用斯皮尔曼相关系数分析SAA、Aβ与所有影响因素之间的相关性,包括年龄、性别、受教育程度、α2-巨球蛋白2(a 2-macroglobulin, a 2-MG),吸烟和其他脑血管病危险因素(高血压、糖尿病、血脂异常、脑卒中家族史和脑卒中史)；运用广义线性回归分析探究SAA、Aβ与MMSE中各个认知域(包括时间和地点定向、即时记忆、计算力、短时记忆、语言和图形执行力)及MOCA中各个认知域(视空间与执行力、命名、记忆、注意力、计算力、语言、抽象和定向力)之间的相关性。结果：1.急性轻中度脑梗死患者中MMSE评分＜27分的有41例(43.8%)；急性脑梗死组的MMSE和MOCA的平均得分显著低于无脑梗死对照组(均p0.01),定向、短时记忆、语言、注意力等认知域得分显著降低(均p0.01)。105例急性脑梗死患者中,右侧大脑梗死者最多,有51(48.6%)例,其次为左侧大脑梗死40(38.1%)例和基底节区梗死31(29.5%)例。其中,额叶、顶叶和颞叶及基底节区部位梗死患者存在明显的认知功能下降(均P0.05)；按认知功能损害的不同领域分析,左侧大脑半球梗死患者的执行功能受损最明显(P=0.027),额叶梗死者语言功能、命名和注意力显著下降(均P0.05),顶叶梗死者的记忆、语言及视空间与执行能力受损明显(均P0.05),颞叶梗死者的注意力受损显著(P=0.043),基底节区梗死者的语言功能明显下降(均P0.05)。2.受教育年限小于6年的患者MMSE及MOCA,总分明显低于受教育年限不少于6年患者的MMSE及MOCA,总分；前、后循环均有梗死的患者认知障碍较单一循环系统梗死的认知受损明显,以定向障碍为著。斯皮尔曼系数相关性分析表明SAA与α2-MG之间正相关(0.29,P0.01)。SAA与MMSE中各认知领域之间的广义线性回归分析结果显示SAA对时间和地点定向力具有显著影响(控制了所有相关变量),在控制年龄、性别、受教育程度和a2-MG后,以及控制所有相关变量后SAA对计算力的影响明显；SAA与MOCA中各认知领域之间的广义线性回归分析结果显示SAA与认知无显著相关性。Aβ与MMSE中各认知领域之间的广义线性回归分析结果表明依次调整年龄、性别、受教育程度和a2-MG后,Aβ与短时记忆之间负相关,而调整以上变量及脑血管因素变量后Aβ与认知受损无相关性；Aβ与MOCA中各认知领域之间的广义线性回归分析结果显示Aβ与认知无显著相关性。结论：1.急性轻中度脑梗死患者普遍存在认知功能的下降,其发生率高达43.8%；而不同部位的认知功能障碍具有不同特点,为不同部位卒中患者制定早期、准确的认知康复方案提供理论支持。2.血清SAA升高可能与急性轻中度脑梗死后认知功能障碍相关,尤其是时间、地点定向和计算力(MMSE量表)；而Aβ与急性轻中度脑梗死后认知受损无明显相关性。但仍需更多的研究证实SAA与定向障碍的相关性,并进一步探究SAA的作用机制。
[Abstract]:Objective: To analyze the characteristics of cognitive function after acute mild to moderate cerebral infarction in different parts of the brain, and to analyze the relationship between serum amyloid A protein (SAA), amyloid beta protein (P-amyloid, Abeta) and cognitive performance after acute mild to moderate cerebral infarction, and to explore the role of SAA and A P in cognitive function in acute stage of mild to moderate cerebral infarction. Methods: 1. 105 patients with acute mild to moderate cerebral infarction and 30 controls without cerebral infarction were collected from Department of Neurology of Shandong Provincial Hospital. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment were used. The cognitive function was assessed with the Montreal Cognitive Assessment (MOCA). First, the general data and cognitive scores were compared between the acute cerebral infarction group and the control group without cerebral infarction. Second, according to different sites (including right cerebral hemisphere, left cerebral hemisphere, frontal lobe, parietal lobe, temporal lobe, occipital lobe, brain stem, cerebellum, basal ganglia and thalamus), the scores were Acute infarction was divided into two groups, with and without acute infarction. The influence of risk factors on cognitive function, characteristics of cognitive function and impairment characteristics in different cognitive fields were analyzed statistically. 2. Correlation between SAA, A beta and all influencing factors, including age, sex, and receipt, was analyzed by Spearman correlation coefficient. Education, alpha 2-macroglobulin 2 (a 2-MG), smoking, and other risk factors for cerebrovascular diseases (hypertension, diabetes, dyslipidemia, family history of stroke and stroke history); generalized linear regression analysis was used to explore the cognitive domains of SAA, A beta and MMSE (including time and place orientation, immediate memory, computational power, and short-term memory). Result: 1. 41 (43.8%) patients with acute mild to moderate cerebral infarction had MMSE score < 27; the average score of MMSE and MOCA in acute cerebral infarction group was significantly lower than that in acute cerebral infarction group. In the control group without cerebral infarction (all p0.01), the scores of orientation, short-term memory, language and attention were significantly decreased (all p0.01). Among 105 patients with acute cerebral infarction, 51 (48.6%) had right cerebral infarction, 40 (38.1%) had left cerebral infarction and 31 (29.5%) had basal ganglia infarction. There was significant cognitive impairment in patients with regional infarction (all P 0.05); according to different areas of cognitive impairment, the executive function of patients with left cerebral hemisphere infarction was most impaired (P = 0.027), the language function, naming and attention of patients with frontal infarction were significantly decreased (all P 0.05), memory, language, visual space and persistence of patients with parietal infarction. The patients with temporal lobe infarction had significantly impaired attention (P = 0.043) and language function in basal ganglia infarction (P = 0.05). 2. The total scores of MMSE and MOCA in patients with less than 6 years of education were significantly lower than those in patients with less than 6 years of education. Cognitive impairment was more pronounced in patients with cognitive impairment than in patients with single circulatory system infarction, especially directional impairment. Correlation analysis of Spearman coefficient showed that there was a positive correlation between SAA and alpha 2-MG (0.29, P 0.01). Generalized linear regression analysis between SAA and various cognitive domains in MMSE showed that SAA had a significant effect on time and place orientation (all of which were controlled). The results of generalized linear regression analysis showed that there was no significant correlation between SAA and cognition. The results showed that there was a negative correlation between Abeta and short-term memory after adjusting age, sex, education level and a2-MG, but no correlation between Abeta and cognitive impairment after adjusting the above variables and cerebrovascular factors. Generalized linear regression analysis showed that there was no significant correlation between Abeta and cognitive impairment in MOCA. Mild to moderate cerebral infarction patients generally have cognitive impairment, the incidence of which is as high as 43.8%. Different parts of cognitive impairment have different characteristics, providing theoretical support for different parts of stroke patients to formulate early and accurate cognitive rehabilitation program. 2. The increase of serum SAA may be associated with cognitive impairment after acute mild to moderate cerebral infarction. Guan, especially time, place orientation and computational power (MMSE), but Abeta was not significantly associated with cognitive impairment after acute mild to moderate cerebral infarction.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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