【作者】 单颖；

【导师】 孙月吉；

【作者基本信息】 大连医科大学 ， 流行病与卫生统计学， 2007， 硕士

【摘要】 目的揭示缺血性丘脑卒中病人认知功能改变的特点及相关因素。研究方法2006年6月到2007年3月期间,连续收集大连大学附属中山医院及解放军210医院神经内科丘脑卒中住院患者23例为研究对象(观察组)。所有病例均符合1995年10月中华医学会第四届脑血管病学术研讨会通过的脑卒中诊断标准。按照病例:对照=1:2的原则,入选某社区健康老人46例作为健康对照组。采用了:1)在专家指导下自行设计的一般情况调查表; 2)韦氏成人智力量表( Wechsler Adult Intelligence Scale,WAIS)的词汇测试及数字符号分量表;3)韦氏记忆量表(Wechsler Memory Scale,WMS);4)威斯康星卡片(Wisconsion Card Sorting Test,WCST);5)工作记忆课题(Trail Making Test A and Trail Making Test B)等对患者的一般情况及20项认知功能进行测试。统计采用SPSS11.5软件系统对各项指标进行分析。结果1.丘脑卒中组与对照组的认知功能比较:丘脑卒中患者的词汇测试、执行完成分类数、执行错误应答数、执行非持续性错误数、连线作业A、连线作业B、经历、定向、视觉再认、图片回忆、视觉再生、联想学习、触觉记忆、理解记忆项目及顺背和倒背项目与对照组差异具有统计学意义(p<0.05);左侧丘脑卒中患者的词汇测试、执行功能(执行错误应答数、执行非持续性错误数)、连线作业A、连线作业B、视觉再认、图片回忆、视觉再生、触觉记忆、联想学习、理解记忆及顺背和倒背十四个认知指标与对照组差异具有统计学意义(P<0.05);右侧丘脑卒中患者的词汇测试、执行完成分类数、执行错误应答数、执行非持续性错误数、连线作业A、连线作业B、视觉再认、图片回忆、视觉再生、触觉记忆、联想学习及理解记忆十二项认知指标与对照组差异具有统计学意义(P<0.05);双侧丘脑卒中患者的词汇测试、执行完成分类数、执行错误应答数、执行非持续性错误数、连线作业A、视觉再认、图片回忆、视觉再生、触觉记忆、联想学习、顺背及倒背十二项认知指标上与对照组差异具有统计学意义(P<0.05)。以上结果表明丘脑卒中患者在言语智能、执行功能、记忆功能(工作记忆、长时记忆、短时记忆及瞬间记忆)方面与对照组具有统计学差异。2.不同部位丘脑卒中组组内认知功能比较:不同部位丘脑卒中患者在联想学习、触觉记忆及理解记忆三个项目上的差异具有统计学意义(P<0.05)。3.损伤体积与认知功能的相关分析:丘脑卒中组执行错误应答数及执行非持续性错误数与损伤体积呈正相关(rs >0,P<0.05),视觉再认与顺背与损伤体积呈负相关(rs <0,P<0.05);左侧卒中组执行错误应答数、执行非持续性错误数、视觉再生及触觉记忆与损伤体积呈正相关(rs >0,P<0.05);而右侧丘脑卒组执行错误应答数及执行非持续性错误数与损伤体积呈正相关(rs >0,P<0.05),图片回忆则表现出与损伤体积的负相关性(rs <0,P<0.05);双侧丘脑卒中组的数字符号与经历两项指标表现出与损伤体积的正相关性(rs >0,P<0.05)。结论丘脑卒中患者在言语智能、执行功能、记忆功能(长时记忆、短时记忆、瞬间记忆、工作记忆)方面有认知功能障碍;左右侧丘脑在短时记忆中可能发挥着不同的作用;认知功能障碍受丘脑损伤体积影响。损伤体积越大,认知障碍越明显。更多还原

【Abstract】 Aim To reveal the correlation factors of cognitive disorder after thalamic stroken.Methods and Objects There are 23 cases of thalamic stroke diagnosed on the basis of 1.5 tesla MRI. All patients are from department of neurology in the ZhongShan subsidiary Hospital of DaLian University and the Liberation Army 210 Hospital. In the same time, 46 cases health control are collected from community. All patients have been tested by Wechsler Adult Intelligence Scale (WAIS), Wechsler Memory Scale (WMS), Wisconsine Card Sorting Test (WCST), Trail Making Test A and Trail Making Test B. We have used t test, chi-square, two independent samples, spearmen correlation.Result There are no significant different in the sex, age and education degree between the two groups. 1) Group of thalamic stroken compare with health control for recognition index, there are significant different between the two groups at vocabulary, Executive complete number of categories, Executive erron responsive number, non Executive persist error number (nRpe), the trail making test A, the trail making test B, Visual recognition, Figure recall, Visual recall, Association thinking, the touch recognition and memory, and Inverse recite (P<0.05). 2) Comparation of cognition after different parts of thalamic stroke: Only three items of cognition have significant difference(P<0.05), those are Association thinking, touch recognition and memory and comprehensive memory. 3) Correlative analysis: Executive erron responsive number and non Executive persist error number have positive correlation with stroken volume (rs >0, P<0.05), but visual recognition and Inverse recite have negative correlation withstroken volume (rs <0, P<0.05).Conclusions Thalamic stroken can cause various cognition disorders, especially in vocabulary intelligence, executive function and working memory. The left and right thalamic stroken may have different effect on short-term memory. Stroken volume influence cognition.更多还原