中老年高血压患者脑微出血与认知功能的相关性研究

发布时间：2018-03-23 03:08

本文选题：高血压病　切入点：脑微出血　出处：《延安大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:1.以脑微出血(CMBs)作为生物标志物,通过对认知正常与认知障碍中老年高血压患者的比较,探讨CMBs对认知功能的影响。2.对高血压CMBs的分布情况进行分析,研究其好发部位及区域分布特点。3.通过分析CMBs与高血压、CMBs与认知功能之间的关系,研究三者间的相关性。方法:收集延安大学附属医院东关分院神经内科2015年11月-2016年10月收住院,并经Mo CA量表认定为认知功能损害的高血压病患者50例,及年龄、性别、吸烟史、饮酒史、受教育年限等相匹配的Mo CA量表认定为无认知功能损害的高血压病患者50例。100例患者中有8例因MRI、CT及血管超声等检查发现明显脑白质疏松经、颈动脉狭窄及脑梗死灶予以剔除。经排除后最终入组92例,其中高血压认知正常组48例,高血压认知障碍组44例。收集每位入组患者的空腹血糖、血脂、Mo CA值总分及各分项值,行SWI扫描,根据SWI检测到CMBs与否,分为CMBs阳性组和阴性组,并在SWI上记录每位CMBs患者的病灶个数,按出血灶多少分为4个等级。统计每位CMBs患者大脑半球深部、皮质/皮质下、脑干/小脑区域微出血阳性例数和病灶个数,汇总总的出血例数及总的病灶个数。采用SPSS20.0软件对数据进行处理。研究方法如下:1.分析比较认知功能正常组和认知功能障碍组间CMBs阳性率是否有差异,并比较两组患者相同区域间CMBs阳性率是否有差异;2.分析比较所有CMBs患者区域与区域之间出血阳性率以及病灶数构成比是否有差异;3.分析比较CMBs严重程度分级与高血压不同等级之间是否有相关性;4.分析比较CMBs与Mo CA总值及各分项值之间是否有相关性。结果:1.两组患者一般临床资料比较:年龄、性别、吸烟、饮酒、受教育年限、血糖、总胆固醇(TC)、低密度脂蛋白(LDL-C)等比较,结果无统计学差异(P0.05)。2.认知正常组与认知障碍组CMBs阳性率比较,结果有统计学差异(P0.05)。3.认知正常组与认知障碍组相同区域间CMBs阳性率比较,结果均有统计学差异(P0.05)。4.CMBs阳性组内区域与区域间病灶数构成比的比较,大脑半球深部与皮质/皮质下区域之间比较,结果无统计学差异(P0.05);其余两组比较,均有统计学差异(P0.05)。5.CMBs阳性组内区域与区域间CMBs阳性率比较,结果均有统计学差异(P0.05)。6.CMBs严重程度分级与高血压不同等级的相关性研究发现,两者呈正相关(r=0.348)。7.CMBs严重程度分级与相应Mo CA值之间相关性研究发现,两者呈负相关(r=-0.645)。8.CMBs病灶个数与认知功能各项评分的相关性研究发现,CMBs病灶个数与Mo CA总分、视空间和执行功能、记忆力、注意力、语言、定向力及抽象思维评分呈负相关,与命名能力无相关。结论:1.认知障碍组CMBs阳性率明显高于认知正常组。2.高血压患者CMBs灶主要分布于大脑半球深部及皮质/皮质下区域。3.CMBs严重程度分级与不同等级高血压之间呈正相关,认为血压越高CMBs越严重,微出血病灶越多。4.CMBs病灶个数与Mo CA评分呈负相关,认为CMBs数目越多患者的认知功能损害越严重。
[Abstract]:Objective: 1. to cerebral microbleeds (CMBs) as a biomarker, through the comparison of elderly hypertensive patients with normal cognition and cognitive disorders, to investigate the effect of CMBs on cognitive function of.2. on blood pressure distribution of CMBs were analyzed, to study its predilection site and regional distribution characteristics of.3. through the analysis of CMBs and hypertension, relationship between CMBs and cognitive function. The correlation between the three. Methods: from Dongguan Branch Department of Neurology Affiliated Hospital of Yan'an University in November 2015 -2016 year in October admitted to the hospital, and the Mo CA scale as the cognitive impairment in patients with high blood pressure in 50 cases, and age, gender, smoking history, drinking history, education etc. to match the Mo CA scale identified as no cognitive impairment in patients with hypertension and 50 cases of.100 patients in 8 cases of MRI, CT and vascular ultrasound examination revealed obvious leukoaraiosis, cerebral and carotid artery stenosis The infarction be removed. After exclusion finally enrolled 92 patients, the cognition of hypertension in 48 cases of normal group, hypertension and cognitive impairment group 44 cases. Each group were collected in the fasting blood glucose, blood lipid, Mo value of CA total score and each item value, SWI scan, according to SWI CMBs is detected or not, divided into CMBs positive and negative groups, and record the number of lesions per CMBs in patients with SWI, according to the number of hemorrhage is divided into 4 grades. The deep statistics of each CMBs in patients with cerebral hemisphere, cortical / subcortical and brainstem cerebellar / regional micro hemorrhage and the number of positive cases of lesion number, the total number of cases of blood collection and the total number of lesions. The data were analyzed by SPSS20.0 software. The research methods are as follows: 1.. Analysis and comparison of the normal cognitive group and cognitive impairment group between the positive rate of CMBs whether there are differences, and compare the two groups of patients in the same region between the positive rate of CMBs whether there are differences between the 2. are analyzed; Between region and region in patients with bleeding CMBs positive rate and the number of lesions which have difference than whether; whether there is a correlation between the 3. analysis and comparison of CMBs severity grading and hypertension in different grades; whether there is a correlation between CMBs and Mo CA analysis and comparison of 4. gross and each item value. Results: 1. comparison of two groups of patients with clinical data. Age, sex, smoking, drinking, years of education, blood glucose, total cholesterol (TC), low density lipoprotein (LDL-C) comparison, showed no statistically significant difference (P0.05) positive rate comparison between normal group and cognitive impairment group CMBs cognitive.2., the results were statistically significant difference (P0.05) compared with normal group and.3. cognitive disorders the same regional cognitive group CMBs positive rate, the difference was statistically significant (P0.05) which compared the number of lesions between regions of.4.CMBs positive group, deep brain hemisphere and cortical / subcortical regions between the comparison results Statistical difference (P0.05); the remaining two groups had significant difference (P0.05) between.5.CMBs positive group in the region and the region between the positive rate of CMBs, the results were statistically significant difference (P0.05) classification and correlation of different grades of hypertension found a positive correlation between the severity of.6.CMBs (r=0.348).7.CMBs severity grading and the corresponding Mo CA the correlation between the value of the study found that there is a negative correlation (r=-0.645) correlation between.8.CMBs lesion number and cognitive function of the score, the number of Mo and CMBs lesions CA score, visual space and executive function, memory, attention, language, abstract thinking and orientation score was negatively correlated with no naming ability. Conclusion: 1. cognitive impairment group CMBs positive rate was significantly higher than that of normal cognitive group.2. in patients with essential hypertension CMBs foci are mainly distributed in deep cerebrum cortex and cortex / regional.3.CMBs severity There was a positive correlation between grading and different grades of hypertension. The higher the blood pressure is, the more severe the CMBs is. The more the micro hemorrhage is, the more the number of.4.CMBs lesions is negatively correlated with the Mo CA score. The more the number of CMBs is, the more serious the cognitive impairment is.

【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R743.34

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