脑血管反应性与不同程度脑白质疏松的相关性研究

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1、贵阳医学院2012届硕士论文目录摘要„„„„„„„„„„„„„„„„„„„„„„02略缩词表„„„„„„„„„„„„„„„„„„„„„03前言„„„„„„„„„„„„„„„„„„„„„„04材料与方法„„„„„„„„„„„„„„„„„„„„05结果„„„„„„„„„„„„„„„„„„„„„„07讨论„„„„„„„„„„„„„„„„„„„„„„12参考文献„„„„„„„„„„„„„„„„„„„„„16致谢„„„„„„„„„„„„„„„„„„„„„„20英文摘要„„„„„„„„„„„„„„„„„„„„„21附录„„„„„„„„„„„„„„„„„„„„„„„23论文原创性声明„„„„„„„„„„„

2、„„„„„„„24综述„„„„„„„„„„„„„„„„„„„„„„25附：临床能力考核有关材料：临床轮转考核表(按时间顺序)学术活动情况表(按时间顺序)临床能力考试及学位答辩情况表1贵阳医学院2012届硕士论文脑血管反应性与不同程度脑白质疏松的相关性研究专业名称：神经病学研究生：陈娟导师：杨雪霞摘要背景和目的：脑白质疏松(LA)被认为是一种小血管病，并与认知功能下降、卒中和抑郁相关；经颅多普勒(TCD)屏气指数(BHI)能反映脑血管反应性。本研究主要目的是通过检测大脑中动脉屏气指数（MCA-BHI）来评价脑血管反应性与头颅MRI大脑半球LA严重程度及其危险因素的相关性。方法：收集2011年5

3、月-2011年12月在贵阳医学院附属医院神经内科住院并完成头颅MRI等检查的确诊患者，根据Kinkel等的方法将头颅MRIT2WI脑白质疏松严重程度分为5级，不同等级的病例各收取40例，共200例，记录患者的年龄、性别，全自动生化分析仪测定其空腹血糖、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇等生化指标，检查患者的血压等危险因素情况，经颅多普勒超声检测脑血流动力学变化，并记录相关参数值，计算屏气指数，应用SPSS19.0软件进行分析。结果：脑白质疏松组BHI水平显著低于正常对照组，各种不同程度的LA患者之间BHI值有显著差异，LA程度越重的患者BHI下降越明显；年龄、高血压、

4、高胆固醇与LA及其等级相关；高血压、高胆固醇与BHI相关。结论：1、脑血管反应性的降低与脑白质疏松的发生及发展有密切相关性,TCD-BHI能反映LA的严重程度。2、高血压、老龄、高胆固醇是脑白质疏松的危险因素，高血压、高胆固醇与脑血管反应性降低有关。关键词：经颅多普勒；屏气指数；磁共振成像；白质疏松2贵阳医学院2012届硕士论文英文缩略词表英文缩略词英文全称中文全称ACZacetazolamide乙酰唑胺BHIBreath-holdindex屏气指数CBFCerebralbloodflow脑血流量CHOLcholesterol总胆固醇CVRcerebrovascularreactivity脑

5、血管反应性DWIdiffusionweightedimagine弥散加权成像FLAIRfluidattenuatedinversionrecovery液体衰减反转恢复序列成像HDLhighdensitylipoproteins高密度脂蛋白LA1eukoaraiosis白质疏松LDLlowdensitylipoproteins低密度脂蛋白MCAmiddlecerebralartery大脑中动脉MRAmagneticresonanceangiography磁共振血管造影MRImagneticresonanceimaging核磁共振成像rCBFRegionalcerebralbloodflow局部

6、的脑血流量SPECTsinglephotonemissioncomputedtomography单光子发射扫描T1WITlweightedimagingTl加权成像T2WIT2weightedimagingT2加权成像TCDtranscranialdoppler经颅多普勒TGtriglyceride甘油三酯3贵阳医学院2012届硕士论文前言白质疏松(leukoaraiosis，LA)是1987年由加拿大神经病学家Hachinski提出，这是一个影像诊断学术语，用于描述脑白质，特别是位于半卵圆中心，边界[1]不清的斑片状或融合的信号改变。LA在CT上表现为低密度影，MRI的T1加权成像(Tlw

7、eightedimaging，T1WI)显示为等信号或者稍低信号，T2加权成像(T2weightedimaging，T2WI)及液体衰减反转恢复序列成像(fluidattenuatedinversionrecovery，FLAIR)可显示为高信号(如图1)。LA是一个影像学概念和术语，而不是临床疾病的概念，它是很多种类疾病的相同或相似的影像学改变。LA可出现在智能正常的老年人中，它的临床表现差异很大，轻者临床