【摘要】：研究目的：分析不同部位急性輕中度腦梗死后的認(rèn)知功能特點(diǎn),并分析血清淀粉樣蛋白A(serum amyloid A protein, SAA)、β-淀粉樣蛋白(p-amyloid, Aβ)與急性輕中度腦梗后認(rèn)知表現(xiàn)之間的關(guān)系,探究SAA及Ap在輕中度腦梗死急性期認(rèn)知功能中的作用,為臨床早期防治血管性認(rèn)知功能障礙提供理論依據(jù)。研究方法：1.收集山東省立醫(yī)院神經(jīng)內(nèi)科確診為急性輕中度腦梗死的患者105例,無腦梗死對照30例。采用簡易智能精神狀態(tài)檢查(Mini-Mental State Examination, MMSE)和蒙特利爾認(rèn)知評估量表(Montreal Cognitive Assessment, MOCA)對其進(jìn)行認(rèn)知功能評估。首先,比較急性腦梗死組和無腦梗死對照組的一般資料和認(rèn)知評分；其次,根據(jù)不同部位(包括右側(cè)大腦半球、左側(cè)大腦半球、額葉、頂葉、顳葉、枕葉、腦干、小腦、基底節(jié)區(qū)和丘腦)是否存在急性梗死依次進(jìn)行分組,分別分為有和無兩組,統(tǒng)計(jì)分析腦卒中危險因素對認(rèn)知功能的影響、各組的認(rèn)知功能特點(diǎn)及不同認(rèn)知領(lǐng)域的損害特點(diǎn)。2.運(yùn)用斯皮爾曼相關(guān)系數(shù)分析SAA、Aβ與所有影響因素之間的相關(guān)性,包括年齡、性別、受教育程度、α2-巨球蛋白2(a 2-macroglobulin, a 2-MG),吸煙和其他腦血管病危險因素(高血壓、糖尿病、血脂異常、腦卒中家族史和腦卒中史)；運(yùn)用廣義線性回歸分析探究SAA、Aβ與MMSE中各個認(rèn)知域(包括時間和地點(diǎn)定向、即時記憶、計(jì)算力、短時記憶、語言和圖形執(zhí)行力)及MOCA中各個認(rèn)知域(視空間與執(zhí)行力、命名、記憶、注意力、計(jì)算力、語言、抽象和定向力)之間的相關(guān)性。結(jié)果：1.急性輕中度腦梗死患者中MMSE評分＜27分的有41例(43.8%)；急性腦梗死組的MMSE和MOCA的平均得分顯著低于無腦梗死對照組(均p0.01),定向、短時記憶、語言、注意力等認(rèn)知域得分顯著降低(均p0.01)。105例急性腦梗死患者中,右側(cè)大腦梗死者最多,有51(48.6%)例,其次為左側(cè)大腦梗死40(38.1%)例和基底節(jié)區(qū)梗死31(29.5%)例。其中,額葉、頂葉和顳葉及基底節(jié)區(qū)部位梗死患者存在明顯的認(rèn)知功能下降(均P0.05)；按認(rèn)知功能損害的不同領(lǐng)域分析,左側(cè)大腦半球梗死患者的執(zhí)行功能受損最明顯(P=0.027),額葉梗死者語言功能、命名和注意力顯著下降(均P0.05),頂葉梗死者的記憶、語言及視空間與執(zhí)行能力受損明顯(均P0.05),顳葉梗死者的注意力受損顯著(P=0.043),基底節(jié)區(qū)梗死者的語言功能明顯下降(均P0.05)。2.受教育年限小于6年的患者M(jìn)MSE及MOCA,總分明顯低于受教育年限不少于6年患者的MMSE及MOCA,總分；前、后循環(huán)均有梗死的患者認(rèn)知障礙較單一循環(huán)系統(tǒng)梗死的認(rèn)知受損明顯,以定向障礙為著。斯皮爾曼系數(shù)相關(guān)性分析表明SAA與α2-MG之間正相關(guān)(0.29,P0.01)。SAA與MMSE中各認(rèn)知領(lǐng)域之間的廣義線性回歸分析結(jié)果顯示SAA對時間和地點(diǎn)定向力具有顯著影響(控制了所有相關(guān)變量),在控制年齡、性別、受教育程度和a2-MG后,以及控制所有相關(guān)變量后SAA對計(jì)算力的影響明顯；SAA與MOCA中各認(rèn)知領(lǐng)域之間的廣義線性回歸分析結(jié)果顯示SAA與認(rèn)知無顯著相關(guān)性。Aβ與MMSE中各認(rèn)知領(lǐng)域之間的廣義線性回歸分析結(jié)果表明依次調(diào)整年齡、性別、受教育程度和a2-MG后,Aβ與短時記憶之間負(fù)相關(guān),而調(diào)整以上變量及腦血管因素變量后Aβ與認(rèn)知受損無相關(guān)性；Aβ與MOCA中各認(rèn)知領(lǐng)域之間的廣義線性回歸分析結(jié)果顯示Aβ與認(rèn)知無顯著相關(guān)性。結(jié)論：1.急性輕中度腦梗死患者普遍存在認(rèn)知功能的下降,其發(fā)生率高達(dá)43.8%；而不同部位的認(rèn)知功能障礙具有不同特點(diǎn),為不同部位卒中患者制定早期、準(zhǔn)確的認(rèn)知康復(fù)方案提供理論支持。2.血清SAA升高可能與急性輕中度腦梗死后認(rèn)知功能障礙相關(guān),尤其是時間、地點(diǎn)定向和計(jì)算力(MMSE量表)；而Aβ與急性輕中度腦梗死后認(rèn)知受損無明顯相關(guān)性。但仍需更多的研究證實(shí)SAA與定向障礙的相關(guān)性,并進(jìn)一步探究SAA的作用機(jī)制。
[Abstract]:Objective: To analyze the characteristics of cognitive function after acute mild to moderate cerebral infarction in different parts of the brain, and to analyze the relationship between serum amyloid A protein (SAA), amyloid beta protein (P-amyloid, Abeta) and cognitive performance after acute mild to moderate cerebral infarction, and to explore the role of SAA and A P in cognitive function in acute stage of mild to moderate cerebral infarction. Methods: 1. 105 patients with acute mild to moderate cerebral infarction and 30 controls without cerebral infarction were collected from Department of Neurology of Shandong Provincial Hospital. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment were used. The cognitive function was assessed with the Montreal Cognitive Assessment (MOCA). First, the general data and cognitive scores were compared between the acute cerebral infarction group and the control group without cerebral infarction. Second, according to different sites (including right cerebral hemisphere, left cerebral hemisphere, frontal lobe, parietal lobe, temporal lobe, occipital lobe, brain stem, cerebellum, basal ganglia and thalamus), the scores were Acute infarction was divided into two groups, with and without acute infarction. The influence of risk factors on cognitive function, characteristics of cognitive function and impairment characteristics in different cognitive fields were analyzed statistically. 2. Correlation between SAA, A beta and all influencing factors, including age, sex, and receipt, was analyzed by Spearman correlation coefficient. Education, alpha 2-macroglobulin 2 (a 2-MG), smoking, and other risk factors for cerebrovascular diseases (hypertension, diabetes, dyslipidemia, family history of stroke and stroke history); generalized linear regression analysis was used to explore the cognitive domains of SAA, A beta and MMSE (including time and place orientation, immediate memory, computational power, and short-term memory). Result: 1. 41 (43.8%) patients with acute mild to moderate cerebral infarction had MMSE score < 27; the average score of MMSE and MOCA in acute cerebral infarction group was significantly lower than that in acute cerebral infarction group. In the control group without cerebral infarction (all p0.01), the scores of orientation, short-term memory, language and attention were significantly decreased (all p0.01). Among 105 patients with acute cerebral infarction, 51 (48.6%) had right cerebral infarction, 40 (38.1%) had left cerebral infarction and 31 (29.5%) had basal ganglia infarction. There was significant cognitive impairment in patients with regional infarction (all P 0.05); according to different areas of cognitive impairment, the executive function of patients with left cerebral hemisphere infarction was most impaired (P = 0.027), the language function, naming and attention of patients with frontal infarction were significantly decreased (all P 0.05), memory, language, visual space and persistence of patients with parietal infarction. The patients with temporal lobe infarction had significantly impaired attention (P = 0.043) and language function in basal ganglia infarction (P = 0.05). 2. The total scores of MMSE and MOCA in patients with less than 6 years of education were significantly lower than those in patients with less than 6 years of education. Cognitive impairment was more pronounced in patients with cognitive impairment than in patients with single circulatory system infarction, especially directional impairment. Correlation analysis of Spearman coefficient showed that there was a positive correlation between SAA and alpha 2-MG (0.29, P 0.01). Generalized linear regression analysis between SAA and various cognitive domains in MMSE showed that SAA had a significant effect on time and place orientation (all of which were controlled). The results of generalized linear regression analysis showed that there was no significant correlation between SAA and cognition. The results showed that there was a negative correlation between Abeta and short-term memory after adjusting age, sex, education level and a2-MG, but no correlation between Abeta and cognitive impairment after adjusting the above variables and cerebrovascular factors. Generalized linear regression analysis showed that there was no significant correlation between Abeta and cognitive impairment in MOCA. Mild to moderate cerebral infarction patients generally have cognitive impairment, the incidence of which is as high as 43.8%. Different parts of cognitive impairment have different characteristics, providing theoretical support for different parts of stroke patients to formulate early and accurate cognitive rehabilitation program. 2. The increase of serum SAA may be associated with cognitive impairment after acute mild to moderate cerebral infarction. Guan, especially time, place orientation and computational power (MMSE), but Abeta was not significantly associated with cognitive impairment after acute mild to moderate cerebral infarction.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R743.3

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