脑小血管病中脑微出血与认知功能障碍关系的研究

发布时间：2019-07-04 09:34

【摘要】：目的:本研究旨在探讨脑小血管病人群中CMBs与认知功能障碍的关系,查找CMBs的相关危险因素。脑小血管病在老年人群中很常见,按有无症状来分,可以分为症状性脑小血管病和非症状性脑小血管病。脑小血管病的影像学诊断包括腔隙性梗死与腔隙灶、脑白质疏松、脑微出血及脑萎缩脑,它们很少引起神经系统功能障碍,所以临床医生对此关注较少,而认知功能障碍,早期更是难以发现,诊断率很低,导致后期治疗效果差,严重影响患者的生活质量,为家庭以及社会带来沉重负担。随着磁敏感加权成像序列的广泛使用,脑微出血的检出率越来越频繁,引发了神经内科医师的高度重视,CMBs与知功能障碍之间的关系更是成为目前的研究热点。本文通过探讨脑微出血的相关危险因素及其对认知功能的影响,能尽早对其危险因素进行有效的干预和防治,有着十分重大的临床意义。因此,本研究选择脑小血管病患者为研究对象,探讨脑微出血的相关危险因素及其对认知功能的影响。方法:从2015年1月至2016年12月连续选取96例皖南医学院第一附属医院神经内科,无神经系统缺损症状的非急性卒中患者。采集患者入院时的年龄、性别、入院时的收缩压、舒张压、空腹血糖、糖化血红蛋白、总甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白等,详细询问患者既往病史,如冠心病病史、高血压病病史、糖尿病病史等;对符合条件者行头颅MRI+MRA+SWI,根据CMBs的有无分为脑微出血阳性组和脑微出血阴性组,将脑微出血的发生例数、每例发生的数目、部位等记录下来,再分别记录每例腔隙性脑梗死数目、脑白质疏松程度、脑萎缩严重程度等状况,应用MMSE量表测试认知功能。所有数据用SPSSl9.0进行统计分析。结果:1.21例参与者存在至少1个以上CMBs灶(26.3%),阳性组与阴性组在年龄,性别,高脂血症,冠心病,糖尿病上无差异,其在MMSE评分上差异有统计学意义(P0.05),CMBs阳性组MMSE评分显著低于阴性组。2.CMBs阳性组与阴性组两组在血压分级上差异无统计学意义(P0.05),而两组在腔梗分级、脑白质疏松程度分级上有统计学意义(P0.05),阳性组在腔梗分级及脑白质疏松严重程度上高于阴性组;Sperman等级相关检验结果显示CMBs与腔梗分级、脑白质疏松程度分级存在正相关(P0.05),即腔隙性脑梗死数目越多,脑白质疏松程度越重,越容易出现CMBs。3.CMBs阳性组与阴性组在MMSE评分中各项认知领域的得分比较显示,两组在定向力和注意计算力上差异无统计学意义(P0.05),而在瞬时记忆、延时回忆、语言能力上差异有统计学意义(P0.05)。4.MMSE得分正常组的平均年龄小于低分组,有统计学意义(P0.05),但MMSE得分正常组与低分组在性别、高脂血症、冠心病、糖尿病病史方面无差异(P0.05)。5.MMSE得分与腔隙性脑梗塞分级及脑白质疏松程度分级上比较,显示差异有统计学意义(P0.05),且MMSE得分与腔梗分级、脑白质疏松程度分级存在负相关(P0.05),即腔隙性脑梗塞与脑白质疏松程度越严重,MMSE得分越低。6.多因素Logistic回归分析表明年龄、脑微出血、脑白质疏松是认知功能障碍独立危险因素。结论:1.CMBs是认知功能损害的独立危险因素。2.CMBs与MMSE得分显著相关,尤其是与MMSE单项认知领域中的瞬时记忆、延时回忆、语言能力下降密切相关。
[Abstract]:Objective: The purpose of this study is to explore the relationship between the CBRs and cognitive dysfunction in the small-sized brain, and to find the relevant risk factors of the CMBs. The small brain is common in the elderly population, and can be divided into symptomatic and non-symptomatic brain subscales according to the presence or absence of symptoms. The imaging diagnosis of the small brain tumor includes the lacunar infarction and the lacunar, the leukoaraiosis, the cerebral microhemorrhage and the brain atrophy, which rarely cause the dysfunction of the nervous system, so the clinical doctor is less concerned, and the cognitive function, the early stage is difficult to find, the diagnosis rate is very low, Leading to poor treatment effect in the later period, seriously affecting the quality of life of the patient, and placing a heavy burden on the family and the society. With the wide use of the magnetic sensitive weighted imaging sequence, the detection rate of cerebral microhemorrhage is becoming more and more frequent. The related risk factors of cerebral microhemorrhage and its effect on cognitive function are discussed in this paper. It is of great significance to intervene and control the risk factors as soon as possible. Therefore, the study on the risk factors of cerebral microhemorrhage and its effect on cognitive function were discussed in this study. Methods:96 patients with neurology and non-acute stroke in the first Affiliated Hospital of Anhui Medical College were selected from January 2015 to December 2016. the age, sex, systolic blood pressure, diastolic blood pressure, fasting blood sugar, glycosylated hemoglobin, total triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein and the like at the time of admission of the patient are collected, and the prior medical history of the patient, such as the medical history of the coronary heart disease, the medical history of the hypertension, The medical history of diabetes and the like; the head MRI + MRA + SWI was divided into the positive group of the cerebral microhemorrhage and the negative group of the micro-hemorrhage of the brain according to the presence or absence of the condition; the number of the cerebral microhemorrhage, the number of each occurrence, the position and the like were recorded, and the number of each lacunar cerebral infarction was recorded separately, The cognitive function was tested by MMSE scale, such as the degree of leukoaraiosis and the severity of the atrophy of the brain. All data were statistically analyzed with SPSSl92.0. Results: 1.21 participants had at least one CBRs (26.3%), and the positive and negative groups had no difference in the age, sex, hyperlipidemia, coronary heart disease and diabetes. The MMSE score of the positive group of CMBs was significantly lower than that of the negative group.2. There was no significant difference between the two groups in the control group (P0.05). The positive group was higher than that of the negative group in the stage of infarction and the degree of leukoaraiosis was significantly higher in the positive group than in the negative group (P <0.05). The more the number of lacunar cerebral infarction and the greater the degree of leukoaraiosis, the more the number of lacunar cerebral infarction. The more easily the CMBs.3. The score of the CMBs positive group and the negative group in the cognitive domain of the MMSE score showed that the two groups had no significant difference in the directional force and the attention calculation force (P0.05), and in the instant memory, the time-delay memory, In that mean age of the normal group, the mean age of the normal group was less than that of the low group (P0.05), but the normal group of the MMSE score and the low group were in the form of sex, hyperlipidemia, and coronary heart disease. There was no difference in the history of diabetes (P0.05). The more serious the degree of lacunar infarction and leukoaraiosis, the lower the MMSE score. Logistic regression analysis of multiple factors showed that age, cerebral microhemorrhage and leukoaraiosis were independent risk factors of cognitive impairment. Conclusion:1. CMBs are independent risk factors of cognitive impairment.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.34

【参考文献】