脑血管病患者脑微出血危险因素分析及与认知功能的关系

发布时间：2018-09-02 05:28

【摘要】：第一部分脑血管病患者脑微出血危险因素分析目的:探讨脑血管病患者脑微出血(cerebral microbleeds,CMBs)的相关危险因素,为CMBs的防治提供理论依据。方法:连续收集2015年1月至2017年1月于河北医科大学第二医院神经内科住院的脑血管病患者。记录入组患者一般人口学资料、个人史、既往史、检查结果等信息。对所有患者行头颅MRI检查(包括:T1WI、T2WI、FLAIR、DWI、MRA、SWI)并依据MARS量表记录CMBs的部位及数目,依据Fazekas评分评估脑白质稀疏的严重程度。根据SWI是否检出CMBs将入组患者分为阳性组和阴性组,分析CMBs的危险因素、CMBs的数目分别与Fazekas评分及腔隙性脑梗死数目间的关系。依据CMBs的发生部位将阳性组患者分为单纯脑叶CMBs组、脑深部及幕下CMBs组及混合CMBs组,分析不同部位CMBs危险因素的差异。结果:1基本资料:共纳入164例脑血管病患者,CMBs阳性组98例(59.8%),CMBs阴性组66例(40.2%)。CMBs在非急性脑血管病、急性脑梗死、急性脑出血、急性脑梗死出血性转化患者中的检出率分别为43.3%、63.9%、85.7%、100%。CMBs在脑叶、脑深部、幕下的发生率分别为46.3%、38.4%、15.3%。2 CMBs危险因素分析:年龄(OR=1.069,95%CI:1.008-1.133)、高血压(OR=3.472,95%CI:1.243-9.696)、脑白质稀疏(OR=2.235,95%CI:1.345-3.715)、腔隙性脑梗死(OR=1.589,95%CI:1.01-2.499)为CMBs独立的危险因素。3 CMBs分别与脑白质稀疏及腔隙性脑梗死的相关性分析:CMBs的数目与脑白质稀疏的严重程度(r=0.564,P0.001)及腔隙性梗死灶的数目(r=0.762,P0.001)均成正相关关系。4不同部位CMBs危险因素的差异:单纯脑叶CMBs组患者的年龄最大,腔隙性脑梗死灶数目最多;脑深部及幕下CMBs组患者高血压史比例最高;混合CMBs组Fazekas评分最大。结论:高龄、高血压、脑白质疏松及腔隙性脑梗死为CMBs独立的危险因素,CMBs的严重程度与脑白质稀疏及腔隙性脑梗死的严重程度均呈正相关关系。第二部分脑血管病患者脑微出血与认知功能的关系目的:探讨脑血管病患者CMBs对认知功能的影响。方法:从第一部分脑血管病患者中选取基线资料(年龄、性别、受教育程度、脑白质稀疏严重程度、腔隙性脑梗死数目等)相匹配的患者为研究对象。采用简易精神状态检查表(Mini-Mental State Examination,MMSE)及蒙特利尔认知评估量表(Montreal Cognitive Assessment,Mo CA)对所有入组患者进行认知功能评估。对比CMBs阴性组与CMBs阳性组总体认知功能评分、各领域认知功能评分及痴呆比例的差异;分析不同部位CMBs对总体认知功能及各领域认知功能的影响。结果:1基线资料:共纳入96例基线资料匹配的脑血管病患者,CMBs阳性组51例(53.1%),CMBs阴性组45例(46.9%)。2 CMBs与认知功能的关系:CMBs阳性组Mo CA评分及在视空间及执行功能、注意、延迟回忆3个认知领域的评分均低于CMBs阴性组,痴呆比例高于CMBs阴性组,差异均有统计学意义(P0.05)。3不同部位CMBs对认知功能的影响:单纯脑叶CMBs组Mo CA评分及在各认知领域的评分均低于非单纯脑叶CMBs组,差异有统计学意义(P0.05)。而深部及幕下CMBs组Mo CA评分及在各认知领域的评分与对照组的差异无统计学意义(P0.05)。结论:在脑血管病患者中,CMBs(尤其是单纯脑叶CMBs)会导致全面认知功能下降甚至痴呆,且与视空间及执行功能、注意、延迟回忆3个领域的认知功能关系最密切。
[Abstract]:Objective: To explore the risk factors of cerebral microbleeds (CMBs) in patients with cerebrovascular diseases, and to provide theoretical basis for the prevention and treatment of CMBs. Patients. General demographic data, personal history, past history, examination results, etc. were recorded. All patients were examined with cranial MRI (including T1WI, T2WI, FLAIR, DWI, MRA, SWI) and the location and number of CMBs were recorded according to the MARS scale. The severity of leukoaraiosis was assessed according to Fazekas score. The patients were divided into positive group and negative group, the risk factors of CMBs were analyzed, and the relationship between the number of CMBs and Fazekas score and lacunar infarction was analyzed. Data: A total of 164 patients with cerebrovascular diseases were enrolled in this study, 98 (59.8%) were CMBs positive and 66 (40.2%) were CMBs negative. The detection rates of CMBs in patients with non-acute cerebrovascular diseases, acute cerebral infarction, acute cerebral hemorrhage and hemorrhagic transformation of acute cerebral infarction were 43.3%, 63.9%, 85.7% and 100%, respectively. Risk factors for CMBs: age (OR = 1.069, 95% CI: 1.008-1.133), hypertension (OR = 3.472, 95% CI: 1.243-9.696), leukoaraiosis (OR = 2.235, 95% CI: 1.345-3.715), lacunar infarction (OR = 1.589, 95% CI: 1.01-2.499) were independent risk factors for CMBs. 3 CMBs were associated with leukoaraiosis and lacunar infarction, respectively. The number of S was positively correlated with the severity of leukoaraiosis (r = 0.564, P 0.001) and the number of lacunar infarcts (r = 0.762, P 0.001). Conclusion: Age, hypertension, leukoaraiosis and lacunar infarction are independent risk factors for CMBs. The severity of CMBs is positively correlated with the severity of leukoaraiosis and lacunar infarction. Part II The relationship between cerebral microhemorrhage and cognitive function in patients with cerebrovascular disease. Methods: The baseline data (age, sex, education, degree of leukoaraiosis, number of lacunar infarctions, etc.) matched patients with cerebrovascular disease were selected from the first part of the study. Mini-Mental State Examination (MMSE) and Mini-Mental State Examination (MMSE) were used. The Montreal Cognitive Assessment (Mo CA) was used to assess the cognitive function of all the patients. The differences of the overall cognitive function score, cognitive function score and dementia ratio between CMBs negative group and CMBs positive group were compared. The effects of different parts of CMBs on the overall cognitive function and cognitive function in different fields were analyzed. Results: 1 Baseline data: A total of 96 patients with cerebrovascular disease matched with baseline data were included, 51 patients (53.1%) were CMBs positive group, 45 patients (46.9%) were CMBs negative group. 2 Relationship between CMBs and cognitive function: The scores of Mo CA and visual space and executive function, attention and delayed recall in CMBs positive group were lower than those in CMBs negative group. In the CMBs negative group, the difference was statistically significant (P Conclusion: In patients with cerebrovascular diseases, CMBs (especially simple lobe CMBs) can lead to the decline of overall cognitive function, even dementia, and are most closely related to visual space and executive function, attention and delayed recall.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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