缺血性脑白质病变情感淡漠发生情况及与认知障碍研究
发布时间：2019-05-29 21:45
【摘要】：目的:探讨缺血性脑白质病变患者血清同型半胱氨酸和特定炎性细胞因子(IL-6、CRP、TNF-α)水平的表达,并分析缺血性脑白质病变患者情感淡漠发生情况及与认知障碍关系。方法:1、选取西南医科大学附属医院神经内科以头昏头痛为主诉并通过影像学证实存在缺血性脑白质病变(white matter lesions,WMLs)的患者44例为观察组,同期住院病人中头颅影像学未见明显异常者44例为对照组,两组性别、饮酒、吸烟、心脏病、受教育程度、脑血管病危险因素(年龄、高血压病、糖尿病、血脂水平等)资料比较无差异。2、所有病例根据修订版情感淡漠评定量表(modified apathy evaluation scale,MAES)进行评分,比较WMLs组与对照组情感淡漠发生率,并以此将WMLs患者分为情感淡漠组和非情感淡漠组(MAES评分大于14分定义为情感淡漠)。3、入院次日所有入组病例抽取空腹肘正中静脉血测定并比较WMLs组与对照组及WMLs伴情感淡漠与不伴情感淡漠组间血清炎性细胞因子(IL-6、TNF-α、CRP)及血清同型半胱氨酸(total Homocysteine,tHcy)水平差异。4、采用简易精神状态检查表(mini mental state examination,MMSE)及蒙特利尔认知量表(Montreal Cognitive Assessment,MoCA)评价WMLs伴情感淡漠及不伴情感淡漠组患者总体认知功能,选用连线测验及Stroop色词实验对其执行功能进行进一步测试。最后整理、统计、分析所有收集资料。结果:1、WMLs患者情感淡漠发生率(36.4%)明显高于正常对照组(15.9%),中/重度WMLs患者情感淡漠发生率(54.5%)明显高于轻度WMLs患者(18.2%),差异具有统计学意义。2、wmls患者血清thcy(11.82±3.17μmol/l)、il-6(99.92±18.43ng/ml)和tnf-α(233.99±84.35ng/ml)水平高于对照组thcy(8.46±1.52μmol/l)、il-6(37.87±6.40ng/ml)和tnf-α(34.51±6.33ng/ml)水平,差异均有统计学意义;中重度wmls患者血清thcy(13.48±2.73μmol/l)及il-6(111.90±11.13ng/ml)水平显著高于轻度wmls患者thcy(10.16±2.78μmol/l)及il-6(95.86±20.36ng/ml)水平,差异均有统计学意义。3、wmls伴情感淡漠患者血清il-6(106.34±11.68ng/ml)、crp(5.13±4.29mg/l)和thcy(13.77±3.18μmol/ml)水平高于不伴情感淡漠患者il-6(76.63±34.08ng/ml)、crp(1.68±2.47mg/l)和thcy(10.51±2.58μmol/ml)水平,差异具有统计学意义。多元线性回归分析提示il-6(标准化偏回归系数b’=0.638,p=0.000)与crp(标准化偏回归系数b’=0.341,p=0.004)可显著影响maes评分,il-6、crp水平越高,情感淡漠越重。4、wmls伴情感淡漠患者mmse得分(18.00±7.16)低于不伴情感淡漠患者(25.75±4.24),wmls伴情感淡漠患者moca得分(13.00±5.89)低于不伴情感淡漠患者(18.80±4.74),差异具有统计学意义。pearson相关分析提示mmse与moca得分与maes评分呈负相关。5、wmls伴情感淡漠患者stroop测验任务c反应时、stroop干扰效应、连线测验a和b完成时、连线测验干扰量均大于不伴情感淡漠者,wmls伴情感淡漠患者连线测验a错误数多于不伴情感淡漠者,上述差异均具有统计学意义。pearson相关分析提示stroop干扰效应反应时、连线测验干扰量均与maes评分呈正相关,即情感淡漠愈重,执行功能障碍愈明显。结论:1、情感淡漠是缺血性脑白质病变患者的常见伴发症状,且白质病变程度越重情感淡漠发生率越高;2、血清tHcy、IL-6、TNF-α水平与缺血性脑白质病变的发生密切相关,其中tHcy、IL-6水平越高,脑白质病变程度越重;3、IL-6、CRP、tHcy水平与缺血性脑白质病变伴发情感淡漠相关,其中IL-6和CRP与情感淡漠严重程度呈正相关,IL-6、CRP水平越高,情感淡漠越重;4、脑白质病变伴情感淡漠患者较非情感淡漠患者有着更为严重的认知功能障碍及执行功能损害。
[Abstract]:Objective: To study the expression of serum homocysteine and specific inflammatory cytokines (IL-6, CRP, TNF-1) in patients with ischemic white matter lesions, and to analyze the relationship between the occurrence and the cognitive disorder of the patients with ischemic white matter lesions. Methods:1. The neurology department of the Affiliated Hospital of Southwest Medical University was selected as the main body of head and head, and 44 cases of patients with ischemic white matter disease (WMLs) were confirmed by imaging. There was no difference between the two groups of sex, drinking, smoking, heart disease, the degree of education, the risk factors of cerebrovascular disease (age, hypertension, diabetes, blood lipid level, etc.). The incidence of the emotion of WMLs group and the control group was compared, and the patients with WMLs were divided into two groups:1. The levels of serum inflammatory cytokines (IL-6, TNF-1, CRP) and serum homocysteine (tHcy) were measured in all enrolled cases on the following day of admission and compared with the control group and the control group and the WMLs, and the levels of serum inflammatory cytokines (IL-6, TNF-1, CRP) and serum homocysteine (tHcy) were different. The general cognitive function of WMLs with the condition of mild state examination (MMSE) and the Montreal Cognitive Scale (MoCA) was used to evaluate the overall cognitive function of WMLs with the indifferent and indifferent group. The function of the executive function of WMLs was further tested by using the connection test and the Stroop color word experiment. And finally, arranging, counting and analyzing all the collected data. Results:1. The incidence of affective apathy (36.4%) in the patients with WMLs was significantly higher than that in the normal control group (15.9%), and the incidence of the moderate/ severe WMLs (54.5%) was significantly higher than that of the patients with mild WMLs (18.2%). The level of il-6 (99.92-18.43 ng/ ml) and tnf-1 (233.99-84.35 ng/ ml) was higher than that of control group thcy (8.46-1.52. mu.mol/ l), il-6 (37.87-6.40 ng/ ml) and tnf-1 (34.51-6.33 ng/ ml). The serum thcy (13.48-2.73. mu.mol/ l) and il-6 (11.90-11.13 ng/ ml) in patients with moderate to severe wmls were significantly higher than those in mild wmls (10.16-2.78. mu.mol/ l) and il-6 (95.86-20.36 ng/ ml). The levels of crp (5.13-4.29 mg/ l) and thcy (13.77-3.18. mu.mol/ ml) were higher than those in the non-affective apathy patients (76.63-34.08 ng/ ml), crp (1.68-2.47 mg/ l) and thcy (10.51-2.58. mu.mol/ ml). The multivariate linear regression analysis suggested that il-6 (normalized partial regression coefficient b '= 0.638, p = 0.000) and crp (normalized partial regression coefficient b' = 0.341, p = 0.004) could significantly affect the maes score, il-6, the higher the crp level, the more severe the feeling. The mse score (18.00-7.16) in wmls with the apathy patients was lower than that of the non-affective patients (25.75-4.24), and the mcoa score (13.00-5.89) in wmls with the apathy patients was lower than that of the non-affective patients (18.80-4.74), and the difference was of statistical significance. The correlation analysis showed that the mse and moca scores were negatively correlated with the maes score. The above-mentioned difference is of statistical significance in wmls with the number of connected test a and the number of connected test a. The correlation analysis of pearson suggested that the amount of the interference in the connection test was positively correlated with the maes score, i. e. the less the feeling and the more obvious the performance of the dysfunction. Conclusion:1. The higher the incidence of the common concomitant symptoms in the patients with ischemic and white matter lesions, the higher the incidence of the degree of the white matter lesions, the higher the level of the serum tHcy, IL-6, and TNF-1, and the higher the level of tHcy and IL-6. The higher the degree of white matter lesions, the higher the level of IL-6, CRP and tHcy was associated with the apathy of the ischemic white matter lesions, where IL-6 and CRP were positively related to the severity of the mood, the higher the level of IL-6 and CRP, the more severe the feeling of emotion, and 4, The patients with the white matter lesion and the apathy have more serious cognitive impairment and functional damage than the non-affective patients.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743
本文编号：2488248
[Abstract]:Objective: To study the expression of serum homocysteine and specific inflammatory cytokines (IL-6, CRP, TNF-1) in patients with ischemic white matter lesions, and to analyze the relationship between the occurrence and the cognitive disorder of the patients with ischemic white matter lesions. Methods:1. The neurology department of the Affiliated Hospital of Southwest Medical University was selected as the main body of head and head, and 44 cases of patients with ischemic white matter disease (WMLs) were confirmed by imaging. There was no difference between the two groups of sex, drinking, smoking, heart disease, the degree of education, the risk factors of cerebrovascular disease (age, hypertension, diabetes, blood lipid level, etc.). The incidence of the emotion of WMLs group and the control group was compared, and the patients with WMLs were divided into two groups:1. The levels of serum inflammatory cytokines (IL-6, TNF-1, CRP) and serum homocysteine (tHcy) were measured in all enrolled cases on the following day of admission and compared with the control group and the control group and the WMLs, and the levels of serum inflammatory cytokines (IL-6, TNF-1, CRP) and serum homocysteine (tHcy) were different. The general cognitive function of WMLs with the condition of mild state examination (MMSE) and the Montreal Cognitive Scale (MoCA) was used to evaluate the overall cognitive function of WMLs with the indifferent and indifferent group. The function of the executive function of WMLs was further tested by using the connection test and the Stroop color word experiment. And finally, arranging, counting and analyzing all the collected data. Results:1. The incidence of affective apathy (36.4%) in the patients with WMLs was significantly higher than that in the normal control group (15.9%), and the incidence of the moderate/ severe WMLs (54.5%) was significantly higher than that of the patients with mild WMLs (18.2%). The level of il-6 (99.92-18.43 ng/ ml) and tnf-1 (233.99-84.35 ng/ ml) was higher than that of control group thcy (8.46-1.52. mu.mol/ l), il-6 (37.87-6.40 ng/ ml) and tnf-1 (34.51-6.33 ng/ ml). The serum thcy (13.48-2.73. mu.mol/ l) and il-6 (11.90-11.13 ng/ ml) in patients with moderate to severe wmls were significantly higher than those in mild wmls (10.16-2.78. mu.mol/ l) and il-6 (95.86-20.36 ng/ ml). The levels of crp (5.13-4.29 mg/ l) and thcy (13.77-3.18. mu.mol/ ml) were higher than those in the non-affective apathy patients (76.63-34.08 ng/ ml), crp (1.68-2.47 mg/ l) and thcy (10.51-2.58. mu.mol/ ml). The multivariate linear regression analysis suggested that il-6 (normalized partial regression coefficient b '= 0.638, p = 0.000) and crp (normalized partial regression coefficient b' = 0.341, p = 0.004) could significantly affect the maes score, il-6, the higher the crp level, the more severe the feeling. The mse score (18.00-7.16) in wmls with the apathy patients was lower than that of the non-affective patients (25.75-4.24), and the mcoa score (13.00-5.89) in wmls with the apathy patients was lower than that of the non-affective patients (18.80-4.74), and the difference was of statistical significance. The correlation analysis showed that the mse and moca scores were negatively correlated with the maes score. The above-mentioned difference is of statistical significance in wmls with the number of connected test a and the number of connected test a. The correlation analysis of pearson suggested that the amount of the interference in the connection test was positively correlated with the maes score, i. e. the less the feeling and the more obvious the performance of the dysfunction. Conclusion:1. The higher the incidence of the common concomitant symptoms in the patients with ischemic and white matter lesions, the higher the incidence of the degree of the white matter lesions, the higher the level of the serum tHcy, IL-6, and TNF-1, and the higher the level of tHcy and IL-6. The higher the degree of white matter lesions, the higher the level of IL-6, CRP and tHcy was associated with the apathy of the ischemic white matter lesions, where IL-6 and CRP were positively related to the severity of the mood, the higher the level of IL-6 and CRP, the more severe the feeling of emotion, and 4, The patients with the white matter lesion and the apathy have more serious cognitive impairment and functional damage than the non-affective patients.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743
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相关期刊论文 前3条
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