卒中后淡漠的危险因素及其与基于弥散张量成像脑白质结构网络关系的研究

发布时间：2019-06-13 12:43

【摘要】：【背景与目的】淡漠是卒中后常见精神症状之一，然而，卒中后出现淡漠的危险因素及结构基础尚不明确。本研究目的在于探究缺血性脑卒中后淡漠的危险因素及可能的结构基础。【对象与方法】（1）连续入组于2012年12月至2013年6月期间在广州市第一人民医院神经内科住院的缺血性脑卒中患者85例（起病2周以内），按照淡漠的临床评定标准将上述患者分为淡漠组及非淡漠组。登记患者的基本人口资料，包括年龄、性别、受教育年限，记录患者是否存在高血压病、II型糖尿病、脑血管病等基础病史，是否存在吸烟、饮酒史，记录入院时患者的血压、血糖、血脂水平及NIHSS神经功能缺损评分；根据磁共振扫描T2和Flair序列上的显示，登记病灶位置；并在起病1月内采用MMSE、MOCA、HAMD量表对其认知功能、抑郁程度进行评价。应用组间比较对各因素进行单因素分析，并采用二元多因素Logistic回归模型查找独立危险因素。（2）85例患者中共有56例完成DTI检查，我们采用DTI纤维束追踪术构建脑白质结构网络，并应用图论分析来研究该网络的拓扑属性。根据节点分析结果，构建淡漠相关及淡漠非相关子网络，分析各子网络与淡漠的关系；应用二元多因素Logistic回归分析，分析各部分网络与淡漠之间的关系。【结果】（1）85例入组患者中，28例（32.9%）被评定为患有淡漠。年龄、受教育年限、脑血管病史、认知功能、抑郁及额叶、基底节位置病灶与淡漠有关，而MMSE评分降低（OR：0.76,95%CI：0.65-0.88，P0.01)及有脑血管病史（OR：10.27,95%CI：2.61-40.44，P0.01）可作为卒中后出现淡漠的独立危险因素。（2）全脑网络局部效率（r=-0.39, P0.01）及全局效率（r=-0.44, P0.01）与AES-C评分显著相关，且全局效率在淡漠组降低（P=0.04）。共发现34个节点的效率在淡漠组降低或与AES-C评分相关，其中额叶节点20个，包括双侧中央前回、双侧背外侧额上回、双侧额中回、双侧岛盖部额下回、双侧三角部额下回、双侧眼眶部额下回、双侧补充活动区、双侧内侧额上回及右侧眶部额上回、右侧眶部额中回、右侧罗兰多壳盖、左侧内侧眶部额上回；岛叶区节点两个，即双侧岛叶；顶叶节点6个，，包括双侧中央后回、双侧缘上回、双侧旁中央小叶；基底节区节点2个，为双侧尾状核；颞叶节点6个，包括双侧颞上极及双侧海马。此34个节点组成淡漠相关网络的局部效率（P=0.05）及全局效率（P0.01）在淡漠组降低，且该局部效率（r=-0.28，P=0.04）与全局效率（r=-0.59，P0.01）均与AES-C评分相关，而淡漠非相关网络与淡漠无关。此外，二者之间纤维连接强度在淡漠组降低（P0.01），且与AES-C评分相关（r=-0.52，P0.01）。多因素分析中，淡漠相关网络全局效率的降低（OR：0.00，95%CI：0.00-0.07，P=0.01）及既往有脑血管病史（OR：6.41，95%CI：1.32-31.15，P=0.02）在本研究中成为卒中后淡漠的独立危险因素。【结论】（1）卒中后淡漠与年龄、受教育年限、脑血管病史、认知功能、抑郁、及额叶、基底节位置病灶有关，MMSE评分的下降及既往有脑血管病史可作为卒中后淡漠的独立危险因素。（2）淡漠是一种与白质结构完整性破坏有关的症状，其发生的结构基础复杂，可能与额叶-皮质下环路内及部分顶叶、边缘系统之间纤维连接的破坏有关。我们所发现的淡漠相关网络可作为卒中后淡漠的独立危险因素。
[Abstract]:[Background and Purpose] The light desert is one of the common mental symptoms of the stroke. However, the risk factors and the structural foundation of the apathy after stroke are not clear. The purpose of this study is to explore the risk factors and possible structural groups of the apathy after the ischemic stroke. A.[Object [Methods] (1) In the period from December 2012 to June 2013,85 patients (within 2 weeks of onset) of the ischemic stroke in the Department of Neurology of the First People's Hospital of Guangzhou were divided into a mild group and a non-indifferent group. The basic population data of the patients, including age, sex and age of education, recorded whether the patient had the basic medical history of hypertension, type II diabetes, cerebrovascular disease and other basic medical history, whether there was a smoking or drinking history, and recorded the blood pressure, blood sugar, blood lipid level and NIHSS nerve function defect score of the patient at the time of admission; according to the display of the magnetic resonance scan T2 and the Flair sequence, the position of the lesion was registered; and the cognitive function and the degree of depression were evaluated by means of MMSE, MOCA and HAMD in the first month of the disease. To set up the risk factors. (2) In the total of 85 patients,56 cases of DTI were completed. We used the DTI fiber bundle tracing technique to construct the network of the white matter structure, and the graph theory analysis was applied to study the topological properties of the network. According to the results of the node analysis, the relationship between the subnetworks and the apathy was analyzed according to the results of the node analysis, the relation between the subnetworks and the apathy was analyzed, and the network and the apathy of each part were analyzed by using the multi-factor logistic regression analysis. off-to-point The results] (1) Among the 85 enrolled patients,28 (32.9%) were assessed as having a mild condition. The age, age of education, history of cerebrovascular disease, cognitive function, depression and frontal and basal ganglia were related to the apathy, while the MMSE score decreased (OR: 0.76,95% CI: 0.65-0.88, P0.01) and the history of cerebrovascular disease (OR: 10.27,95% CI: 2.61-40.44, P0.01). The local efficiency of the whole brain network (r =-0.39, P0.01) and global efficiency (r =-0.44, P0.01) were significantly correlated with the AES-C score, and the global efficiency decreased in the indifferent group (P = 0.04). The efficiency of 34 nodes was found to be lower in the indifferent group or related to the AES-C score. Among them,20 of the frontal nodes, including the bilateral central frontal gyrus, the bilateral dorsolateral frontal gyrus, the bilateral frontal gyrus, the bilateral complementary active region, the lower back of the bilateral triangular part, the lower back of the two-sided orbital part, the double-sided supplementary active region, the upper back of the bilateral medial frontal and the right orbital part, the bilateral island lobe, the top leaf node,6, including the bilateral central back, the back of the bilateral margin, the double-side central leaflets; 52, P0.01). In the multi-factor analysis, the decrease in global efficiency of the indifferent network (OR: 0.00,95% CI: 0.00-0.07, P = 0.01) and the history of prior cerebrovascular disease (OR: 6.41,95% CI: 1.32-31.15, P = 0.02) became a stroke in this study. The only one in the desert. Risky factors.[Conclusion] (1) The age, duration of education, history of cerebrovascular disease, cognitive function, depression, and frontal and basal ganglia are related to the history of stroke, cognitive function, depression, and frontal and basal ganglia, and the decline of MMSE score and the history of previous cerebrovascular diseases An independent risk factor for the apathy in the post-stroke. (2) The apathy is a symptom associated with the destruction of the structural integrity of the white matter, the complex structure of which may be related to the destruction of the fiber connection between the frontal-subcortical loop and some of the parietal and limbic systems. The apathy-related network we have found may
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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