Risk Factors of Vascular Dementia after Cerebral Infarction

目的:探讨影响脑梗死后血管性痴呆(VD)发病的危险因素.方法:对392例急性脑梗死患者进行随访研究,于发病第10天及第90天进行2次神经心理学测试,根据测试结果及美国国立神经系统疾病与卒中研究所和瑞士神经科学研究国际协会(NINDS-AIREN)VD诊断标准,将研究对象分为VD组和脑梗死后非痴呆组.分析患者的临床特征、血脂水平及影像学特征.采用多因素Logistic回归分析脑梗死后VD发病的危险因素.结果:84例患者诊断为VD(21.4％).单因素分析中,VD组与非痴呆组病灶的数目、部位、脑萎缩及脑白质病变(WMLs)差异有统计学意义,多因素分析中发现有左侧或双侧大脑半球病变、病灶的数目多和有脑萎缩为VD发病的独立危险因素,OR值分别为8.958、1.375和2.297.2组间年龄、性别、文化程度、高血压病史、糖尿病病史、冠心病病史、吸烟及饮酒史及血脂水平差异无统计学意义(P＞0.05).结论:脑梗死后VD很常见,小血管病变是VD的主要类型,应早期进行针对性的预防和治疗,以减少和延缓VD的发生.     

老年脑梗死后痴呆的危险因素分析

目的 对老年脑梗死后痴呆的相关因素进行探讨.方法 选取老年脑梗死患者143例,记录患者性别、年龄、受教育的程度,吸烟,饮酒情况及是否有高血压,冠心病,高脂血症,糖尿病,卒中病史,通过CT明确其病灶部位,病灶多少及大小,并对痴呆组和非痴呆组患者资料进行分析,探讨脑梗死后痴呆发生与以上各因素的关系.结论 33例确诊为VD,VD发生率为23.1％,VD组多见于高血压、糖尿病、多灶、双侧和大面积脑梗死及伴脑萎缩性脑梗死.结论 脑梗死后痴呆的发生率高,高血压、糖尿病、多灶、双侧和大面积脑梗死、脑萎缩与VD有关,可能是梗死后痴呆的独立危险因素.     

血管性痴呆危险因素及影像学表现临床分析

目的探讨血管性痴呆（VD）的危险因素、脑梗死部位、范围、以及和脑白质损害的关系。方法对80例VD患者进行危险因素、影像学分析。结果 VD的发生与高血压和糖尿病有关;影像学检查主要表现为基底节区梗死、多灶性梗死、脑萎缩及脑白质疏松。结论 VD与高血压、糖尿病、脑梗死部位、脑梗死次数及影像学改变等有密切关系。VD与脑梗死的发生及预后密切相关,预防危险因素及脑梗死的发生是防治VD的关键。     

低场MRI诊断阿尔茨海默病与血管性痴呆所致认知功能障碍的对比研究

目的：分析阿尔茨海默病（AD）和血管性痴呆（VD）的磁共振成像（MRI）表现,探讨MRI在鉴别诊断痴呆中作用。方法选取2011~2013年住院治疗的痴呆患者81例作为研究对象,其中AD 41例,VD 40例,对比分析两组患者MRI检查发现海马萎缩、脑萎缩、脑室改变、脑梗死、脑出血、脱髓鞘改变及无异常的发生比例。结果 AD组患者海马体积显著小于VD组,脑萎缩以颞、顶叶明显;VD可分为多发性脑梗死痴呆（MID）和皮层下动脉硬化性脑病（BD）,分别表现为双侧半卵圆中心、双侧基底节及脑室旁白质对称或不对称的片状脑白质病变,脑萎缩呈全脑萎缩或局限性脑萎缩。结论根据AD和VD不同的颅脑MRI影像学特点,结合临床病理资料有助于对2种痴呆的鉴别诊断。     

腔隙性脑梗死伴有认知障碍患者的头颅MRI表现

目的：探讨腔隙性脑梗死伴有认知障碍患者的头颅MRI表现。方法选择从2012年5月至2013年5月于我院就诊的45例腔隙性脑梗死患者,随机选取伴有认知障碍的23例患者为试验组,未伴有认知障碍的22例患者为对照组。所有入选患者均进行头颅 MRI 检查,对病灶部位进行测量,观察病灶数目、病灶体积,合并脑萎缩情况及伴有脑白质疏松情况。结果试验组的平均病灶数目和平均病灶体积均大于对照组（P<0.05）。试验组患者病灶部位位于侧脑室旁、额叶、丘脑较对照组明显增多（P<0.05）,试验组患者头颅MRI的哈氏值和侧脑室体部指数均高于对照组（P<0.05）;试验组患者伴有脑白质疏松发生率也高于对照组（χ2=5.02,P<0.05）。结论腔隙性脑梗死伴有认知障碍患者在头颅MRI中可见病灶数目明显增多,病灶体积较大,伴脑萎缩和脑白质疏松严重。     

脑血管性痴呆危险因素的临床分析

目的探讨脑血管性痴呆(vascular dementia,VD)的相关危险因素,制定相应的措施,预防VD的发生。方法收集我科3年来收治的VD患者共86例,回顾性分析患者的临床资料,多因素分析进行比较。结果高血压病、冠心病、糖尿病、高脂血症及吸烟、饮酒史均与VD发病相关,早期监控和治疗可控性的血管性因素有助于防止VD的发生。脑萎缩、脑白质疏松为VD的主要影象学改变,大灶脑梗死的痴呆发生率高。结论防治血管性痴呆,主要是防治危险因素及脑血管病的发生和发展。早期诊治,进行有效干预,可延缓和预防血管性痴呆的发生。     

老年人血管性痴呆的临床特点及危险因素分析

目的对老年人血管性痴呆的临床特点及危险因素进行探讨。方法对86例经确诊的脑血管老年患者进行血管性痴呆（VD）有关因素分析。结果老年人血管性痴呆在年龄组间差异有统计学意义（P〈0．01）,年龄增长与脑梗死数目增加可加重痴呆的发生。结论脑萎缩、高血压、糖尿病、冠心病是老年血管性痴呆的相关高危因素,应对老年血管性痴呆的危险因素进行干预,可降低血管性痴呆的发生率和致残率,以提高老年人的生存质量。     

42例脑梗死后痴呆临床分析

目的：分析42例脑梗死后痴呆的发病情况，探讨产生痴呆的影响因素。方法；所有病人在入院时及发病后3个月均进行临床和智能评估，入院时均行头颅CT/MRI检查，痴呆的诊断参照简明精神状态量表（MMSE）和美国精神病学会编《精神病诊断和治疗手册》第4版(DSM-IV).结果：3个月后随访有42例患者（15.8％）出现脑梗死后痴呆，痴呆的发生与高龄，文化程度低，高血压，糖尿病，脑梗死的部位、侧向、数目等有关。结论：脑梗死后痴呆比较常见，患者自身素质（如年龄、文化程度），导致动脉粥样硬化的血管因素（如高血压、糖尿病），以及脑梗死病灶的相关因素（如部位、侧向、数目）等在痴呆的发生上起一定作用。     

脑病变程度及部位不同血管性痴呆的发生率各异

目的：探讨脑病变程度及部位不同血管性痴呆（ VD）发病情况。方法对80例脑卒中史老年患者进行简易精神状（ MMSE）评定,根据是否患有VD分为VD组36例和非VD组44例,经颅脑CT分析脑病变程度和部位不同VD发病情况。结果 VD组中脑卒中史及多发性脑梗死比例均高于非VD组,差异均有统计学意义（ P＜0．05）。2组脑白质疏松比例差异无统计学意义（P＞0．05）。 VD组中额叶、颞叶、基底节脑梗死部位的发生率显著高于非VD组,差异有统计学意义（P＜0．05）。2组枕叶、顶叶、丘脑部位梗死发生率差异无统计学意义（P＞0．05）。结论脑卒中史,多发性脑梗死及颞叶、额叶、基底节部位病变使VD发病率增加,脑颅CT检测脑病变程度及部位对诊断VD有重要意义。     

不同年龄段急性心肌梗死的临床特点分析

目的分析不同年龄段急性心肌梗死（AMI）患者的临床特点和危险因素,为早期防治提供依据。方法回顾性分析本院收治的84例中青年AMI患者和同时期的40例老年AMI患者进行对比,从两组的危险因素、性别差异、起病诱因、临床表现、梗死部位和并发症等多方面进行比较。结果中青年组冠心病家族史、吸烟两项危险因素明显高于老年组（P〈0.05）;高血压、血脂水平显著低于老年组（P〈0.05）;C反应蛋白（CRP）中青年组明显高于老年组,高同型半胱氨酸（HCY）老年组明显高于中青年组,差异有统计学意义（P〈0.05）;中青年组患者发病多有明确诱因,临床表现典型,冠脉病变以单支病变为主,预后较好,并发症相对较少。结论不同年龄段AMI患者具有不同的临床表现、危险因素及梗死部位、病灶数目,临床诊断及治疗应结合患者特点,早诊断,早治疗。     

皮质下缺血性血管性痴呆的MRI相关高危因素研究

目的探索皮质下缺血性脑血管病MRI表现与血管性痴呆之间的关系。方法对比分析40例皮质下多发梗死痴呆患者和45例皮质下多发梗死非痴呆患者的MRI表现,采用Logistic回归分析皮质下缺血性血管性痴呆的影像学相关高危因素。结果经logistic多因素分析后,只有平均脑沟宽度（OR=2．740,P=0．017）、侧脑室指数（OR=1．767,P=0．012）和丘脑梗死的数目（OR=5．807,P=0．036）进入了方程。结论皮质下缺血性血管性痴呆可能与脑萎缩的程度和丘脑梗死的数目密切相关。     

血管性痴呆精神行为学症状的危险因素探讨

目的研究血管性痴呆（VD）精神行为学症状的危险因素。方法选择本院2011年6月～2012年6月收治的118例血管性痴呆患者作为观察对象（观察组）,选择同期收治的316例非痴呆患者为对照组,采用Logistic回归分析法对VD的相关临床因素进行调查分析。结果观察组中,文化程度、长期饮酒以及存在脑卒中等疾病病史的比例明显高于对照组。Logistic回归分析表明年龄、教育文化程度、既往脑卒中病史以及长期饮酒与VD密切相关,属于临床造成VD后行为异常的重要危险因素。结论年龄、文化程度、既往脑卒中病史是成VD的主要影响因素,脑卒中引发的精神行为学的异常是血管与脑卒中相互作用的结果。     

血管性痴呆有关因素的临床分析

目的 分析影响血管性痴呆（VD）发生的有关因素。方法 对121例经头颅CT确诊的脑血管病人进行血管性痴呆（VD）有关因素分析。其中脑梗死87例,脑出血32例,混和性中风2例。经痴呆量表检查诊断为VD者31例（25．61％）。结果 VD随年龄增长而增加。VD发生在脑梗死和脑出血中,两组间差异无显著意义（P＞0．05）。脑血管疾病患病次数与VD呈正相关（P＜0．01）。结论 预防血管性痴呆最重要的是预防和治疗脑血管疾病。     

The risk of pulmonary complication after surgery for gallstone disease

OBJECTIVES: To identify the risk factors of postoperative pulmonary complications (PPC) after surgery for gallstone disease. METHODS: A total of 544 patients undergoing open surgery for gallstone disease were retrospectively studied. Univariate and multivariate logistic regression were used to analyze each factor. RESULTS: There were 24 factors relating to PPC in univariate logistic analysis. And multivariate logistic analysis identified 5 independent risk factors associated with PPC, including perioperative aerosol therapy (OR = 5.906), duration of postoperative antacids therapy (OR = 1.145), duration of operation (OR = 1.011), preoperative serum albumin (OR = 0.689), postoperative analgesia (OR = 0.059), Logistic regression equation for predicting the risk of PPC was P(1) = 1/[1 + e-(- 9.803 + 1.776 x A + 0.135 x B + 0.011 x C - 0.372 x D - 2.835 x E)]. CONCLUSION: Perioperative aerosol therapy, duration of postoperative antacids therapy, duration of operation, preoperative serum albumin and postoperative analgesia were independent risk factors associated with PPC in patients undergoing surgery for gallstone disease.     

Poststroke dementia in the elderly

Risk of dementia increases after stroke, and poststroke dementia (PSD) is an important cause of disability in the elderly. The prevalence rates of PSD vary from 12.2% to 31.8% within 3 months to 1 year after stroke, depending on patient populations and the diagnostic criteria used in the numerous studies. Incidence rates of PSD increase with time after the stroke.Although vascular lesions and white matter changes can explain the cognitive disorders seen in stroke patients, an underlying neurodegenerative disorder may contribute to the development of PSD. Cognitive decline may pre-date the stroke and follow a progressive course after the stroke. The vascular and degenerative processes involved share common environmental and genetic risk factors. This review explains the mechanisms of dementia in stroke patients and identifies predictive factors for PSD. The following points are successively considered: (i) demographic characteristics of the patients, including age and level of education; (ii) prestroke cognitive decline; (iii) vascular risk factors, including diabetes mellitus and prior strokes; (iv) stroke characteristics, including severity and location of the vascular lesion; (v) co-morbid disorders; and (vi) abnormalities on brain imaging, including location, size and number of vascular lesions, white matter changes and cerebral atrophy. Older age, prestroke cognitive decline, stroke recurrence, hypoxic-ischaemic disorders, left-side infarcts, strategic infarcts and white matter lesions appear to be the main predictive factors of PSD. Prevention of stroke should reduce the morbidity and mortality associated with PSD. In addition, management of PSD with secondary prevention treatments could reduce occurrence of further strokes. Cholinesterase inhibitors may be beneficial not only in Alzheimer's disease associated with cerebrovascular lesions, but also for the treatment of cholinergic dysfunction arising from pure vascular dementia. Better knowledge of the risk factors for PSD, including environmental and genetic factors, should increase the effectiveness of preventive strategies in patients with this condition.     

阿尔茨海默病与血管性痴呆血脂水平及血管性疾病危险因素的研究

目的探讨阿尔茨海默病（AD）与血管性痴呆（VD）血脂水平及血管性疾病危险因素的差异。方法搜集25例AD患者（AD组）,30例VD患者（VD组）,另选取无痴呆患者30例作为对照组（CG组）,比较3组血脂水平及血管性疾病危险因素的差异。结果 AD组和VD组血浆总胆固醇、三酰甘油、低密度脂蛋白均高于CG组（P〈0.05或〈0.01）;AD组和VD组载脂蛋白A1低于CG组（P〈0.05或〈0.01）,VD组α-脂蛋白高于AD组和CG组（P〈0.05或〈0.01）,VD组高血压、糖尿病及冠状动脉粥样硬化性心脏病危险因素高于CG组（P〈0.05或〈0.01）。结论血浆总胆固醇、三酰甘油、低密度脂蛋白、α-脂蛋白增高,载脂蛋白A1降低可能与痴呆的发病有关,依据患者血管性疾病危险因素对临床医生更有效地诊断和鉴别诊断AD与VD有一定帮助。     

非肌层浸润性膀胱癌患者经尿道膀胱肿瘤电切术治疗后复发的现状及其危险因素分析

目的 分析非肌层浸润性膀胱癌(NMIBC)患者经尿道膀胱肿瘤电切术治疗后复发的现状及其危险因素.方法 选取2017年1月至2019年1月于山西焦煤汾西矿业总医院泌尿外科接受择期经尿道膀胱肿瘤电切术治疗的NMIBC患者130例的临床资料,根据患者术后2年是否复发可分为复发组(27例)、无复发组(103例).根据山西焦煤汾...     

2型糖尿病合并脑梗死相关危险因素分析

目的本文对糖尿病合并脑梗死的危险因素进行分析,为糖尿病患者预防脑梗死提供依据。方法住院糖尿病患者共200例,根据有无脑梗死分为单纯糖尿病组及糖尿病合并脑梗死组各100例。对研究因素进行单因素和多因素非条件Logistic回归分析。结果高血压（OR=8.257）、糖化血红蛋白（GHbA1c）（OR=1.382）、餐后血糖（PPBS）（OR=1.238）是糖尿病合并脑梗死的危险因素。结论糖尿病患者早期、积极有效的控制血压、血糖对减少大血管并发症的发生发展意义重大。     

Temporal Lobe Atrophy and White Matter Lesions are Related to Major Depression over 5 years in the Elderly

The influence of organic brain changes on the development of depression in the elderly is uncertain. Cross-sectional studies, most often from clinical samples, report associations with brain atrophy and cerebrovascular disease, while longitudinal population studies have given mixed results. Our aim was to investigate whether cortical atrophy and white matter lesions (WMLs) on computed tomography (CT) predict occurrence of depression in the elderly. This is a prospective population-based study with 5-year follow-up. The baseline sample included 525 elderly subjects, aged 70–86 years, without dementia or major depression, with a score on the Mini-Mental State Examination above 25, and without dementia at follow-up. Cortical atrophy and WMLs were evaluated at baseline using CT. The main outcome measure was development of major or minor depression at follow-up according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition, as evaluated using neuropsychiatric examinations and hospital discharge registers. Logistic regression was used to estimate risk. Over the period of 5 years, 20 individuals developed major and 63 minor depression. Presence of temporal lobe atrophy (odds ratio (OR)=2.81, 95% confidence interval (CI) 1.04–7.62) and moderate-to-severe WMLs (OR=3.21, 95% CI 1.00–10.26) independently predicted major, but not minor, depression after controlling for various confounders. Other brain changes did not predict occurrence of depression. Our findings suggest that temporal lobe atrophy and WMLs represent relatively independent and complementary pathways to major depression in the elderly. This may have implications for prevention, as both neurodegeneration and cerebrovascular disease have been related to preventable factors.