H型高血压与急性脑梗死关系的研究

发布时间：2017-12-27 14:00

本文关键词：H型高血压与急性脑梗死关系的研究　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:近年来,我国心脑血管疾病发病连年攀升,此中脑血管病增加更为突出。流行病学调查显示,与欧美发达国家相比,我国脑卒中较心脏病更为高发,而欧美国家心脏病发病较为突出。针对此,学者们调查发现欧美国家高血压人群多合并高脂血症,而我国患者高血压人群多合并高同型半胱氨酸血症,其所占比例高达3/4,这可能为我国与欧美国家心脑血管病发病截然不同的原因。我国高血压患者合并同型半胱氨酸增高具有广泛性,为此,我国学者为突出两者的关系,将此类情况定义为H型高血压。相关研究表明,H型高血压促进急性脑梗死形成的作用远大于单纯高同型半胱氨酸血症或单纯高血压。本研究从多个方面研究分析H型高血压与急性脑梗死之间的关系,论述其在急性脑梗死形成中的作用和相互关系。方法:选取在吉林大学第二医院住院治疗的缺血性脑卒中患者319例,分为急性脑梗死组和短暂性脑缺血发作组,对两组进行病例对照研究(急性脑梗死组为观察组,短暂性脑缺血发作组为对照组)。采集患者的一般情况(年龄、性别、既往史、吸烟饮酒史)。记录其入院后化验(同型半胱氨酸水平、低密度脂蛋白、高密度脂蛋白、总胆固醇、甘油三酯)。按照是否患有高血压及入院后所测Hcy水平将急性脑梗死和TIA组均分成H型高血压组、单纯高血压组、单纯高同型半胱氨酸组、全部正常组。应用SPSS13.0统计分析软件,应用t-检验、X2-检验进行单因素分析,应用非条件Logistic回归分析进行多因素分析。结果:(1)将缺血性脑卒中按性别分为男性组和女性组,男性H型高血压发生率(57.36%)明显高于女性(45.08%),差异有统计学意义(P0.05)。男性同型半胱氨酸水平(22.53±11.27)umol/L明显高于女性组(13.50±8.07)umol/L,具有统计学意义(t=-7.711 P0.01)。(2)TIA组同型半胱氨酸水平(17.29±11.88)umol/L明显低于急性脑梗死组(20.34±10.30)umol/L,两组具有统计学意义(t=2.447 P0.05)。(3)将急性脑梗死和TIA组患者均分成H型高血压、总高血压、总同型半胱氨酸组三个亚组,两组患者亚组发生率的关系均为总同型半胱氨酸血症总H型高血压总高血压。两组间相比总高血压发生率急性脑梗死组(66.3%)大于TIA组(56.1%),但无明显不同(X2=3.453 P0.05)。总体H型高血压的发生率具有明显差异(X2=14.143 P0.05),急性脑梗死组(61.5%)高于TIA组(40.2%)。总体高同型半胱氨酸血症的发生率也有显著差异(X2=17.232 P0.05),急性脑梗死组(91.4%)高于TIA组(74.2%)。(4)急性脑梗死组H型高血压115例,发生率为61.5%,明显高于TIA组H型高血压发生率(40.2%),差异有统计学意义(X2=14.143 P0.05)。而对于单纯高血压发生率,TIA组有21例,占15.9%,明显高于急性脑梗死组(4.9%),差异有统计学意义(X2=11.183 P0.05)。急性脑梗死组单纯Hcy发生率为29.9%,略小于TIA组(34.1%),统计学无明显差别(X2=0.614P0.05)。急性脑梗死组两者均正常7例,所占比例3.7%,少于TIA组(9.8%),具有统计学差别(X2=4.908 P0.05)。(5)急性脑梗死四个亚组发生率的顺序是H型高血压(61.5%)单纯高Hcy(29.9%)单纯高血压(4.9%)正常组(3.7%)。对四个亚组进行两两比较,正常组与单纯高血压组相差不大,没有统计学意义(X2=0.261 P0.05)。单纯高Hcy56例,占29.9%,明显高于正常组(X2=45.831 P0.05)及单纯高血压组(X2=41.133 P0.05)。H型高血压共计115例,占全部脑梗死61.5%,明显高于单纯高Hcy(X2=37.505 P0.05)、单纯高血压(X2=135.557 P0.05)、正常(X2=141.892 P0.05)。(6)将急性脑梗死组分成H型高血压组和非H型高血压组,H型高血压组共计115例,内膜正常者4例,内膜斑块形成111例。非H型高血压共72例,内膜正常者13例,斑块形成59例,H型高血压组颈动脉斑块发生率(96.64%)明显高于非H型高血压组(81.94%)。H型高血压组复发性脑梗死发生率为49.56%,明显高于非H型高血压组(26.397%)。(7)根据NIHSS评分将急性脑梗死四个亚组均分成进展性卒中和非进展性卒中,四个亚组进展性卒中发生率的排序是H型高血压(46.96%)高Hcy(26.79%)单纯高血压组(11.11%)正常组(0%)。对四个亚组进展性卒中发生率进行两两对照,单纯高血压组与正常组对比无明显差别,HHcy组与单纯高血压组、正常组相比也无明显差别。H型高血压均高于其他三组,有统计学差别。(8)多因素分析示:H型高血压(OR=2.644),95.0%CI(1.297-5.390)和Hcy(OR=1.744),95.0%CI(1.047-2.903)为急性脑梗死的独立危险因素,H型高血压的回归系数β(0.972)Hcy(0.556)。结论:1、缺血性脑卒中患者中男性的H型高血压发生率及同型半胱氨酸水平均较女性高。2、急性脑梗死患者的同型半胱氨酸水平较TIA组的高。3、H型高血压可能促进脑卒中的进展和脑梗死复发。4、H型高血压在脑梗死中发生率高,可能是急性脑梗死形成的独立危险因素。5、高血压与高同型半胱氨酸血症对急性脑梗死形成具有协同作用。
[Abstract]:Objective: in recent years, the incidence of cardiovascular and cerebrovascular diseases in China has been increased year after year, and the increase of cerebrovascular disease is more prominent. Epidemiological survey shows that compared with developed countries in Europe and America, cerebral apoplexy in China is more high than that of heart disease, while the heart disease of European and American countries is more prominent. For this, the scholars survey found that hypertension in Europe and the United States more complicated with hyperlipemia, and hypertension in China patients with hyperhomocysteinemia, the proportion of up to 3/4, which may be the reason of cardiovascular and cerebrovascular disease in China and different countries in Europe and america. Hypertension and homocysteine increase is widespread in China. For this reason, Chinese scholars define the relationship between them as H hypertension. Related studies have shown that the role of H type hypertension in the formation of acute cerebral infarction is much greater than that of simple hyperhomocysteinemia or simple hypertension. In this study, the relationship between H type hypertension and acute cerebral infarction was analyzed from several aspects, and its role and relationship in the formation of acute cerebral infarction were discussed. Methods: 319 patients with ischemic stroke hospitalized in the second hospital of Jilin University were selected and divided into acute cerebral infarction group and transient ischemic attack group. Case control study in two groups (acute cerebral infarction group as observation group and transient ischemic attack group as control group). The general situation of the patients (age, sex, history, history of smoking and drinking) was collected. They were recorded after admission (homocysteine level, low density lipoprotein, high density lipoprotein, total cholesterol, triglyceride). Acute cerebral infarction and TIA group were divided into H hypertension group, simple hypertension group, Dan Chungao homocysteine group and all normal group according to whether they had hypertension or Hcy level after admission. SPSS13.0 statistical analysis software was used, single factor analysis was used by t- test and X2- test, and multi factor analysis was carried out by non conditional Logistic regression analysis. Results: (1) according to gender, ischemic stroke was divided into male group and female group. The incidence of male type H hypertension (57.36%) was significantly higher than that of female (45.08%), the difference was statistically significant (P0.05). The level of male homocysteine (22.53 + 11.27) umol/L was significantly higher than that of the female group (13.50 + 8.07) umol/L, which was statistically significant (t=-7.711 P0.01). (2) the level of homocysteine in TIA group (17.29 + 11.88) umol/L was significantly lower than that in the acute cerebral infarction group (20.34 + 10.30) umol/L, and the two group was statistically significant (t=2.447 P0.05). (3) patients with acute cerebral infarction and TIA were divided into three subgroups of H type hypertension, total hypertension and total homocysteine group. The incidence of subgroup in two groups was homocysteinemia, total H type hypertension and total hypertension. The incidence of acute cerebral infarction in the two groups (66.3%) was greater than that in the TIA group (56.1%), but there was no significant difference (X2=3.453 P0.05). The incidence of total H type hypertension was significantly different (X2=14.143 P0.05), and the group of acute cerebral infarction (61.5%) was higher than that in group TIA (40.2%). The overall incidence of hyperhomocysteinemia was also significantly different (X2=17.232 P0.05), and in the acute cerebral infarction group (91.4%) was higher than that in the TIA group (74.2%). (4) 115 cases of type H hypertension in acute cerebral infarction group, the incidence rate was 61.5%, which was significantly higher than that in group TIA (40.2%), and the difference was statistically significant (X2=14.143 P0.05). The incidence of H hypertension in acute cerebral infarction group was significantly higher than that in group A (40.2%). For the incidence of simple hypertension, there were 21 cases in group TIA, which accounted for 15.9%, which was significantly higher than that in the acute cerebral infarction group (4.9%), and the difference was statistically significant (X2=11.183 P0.05). The incidence of simple Hcy in acute cerebral infarction group was 29.9%, slightly less than that in group TIA (34.1%), and there was no significant difference (X2=0.614P0.05). In the acute cerebral infarction group, both of the 7 cases were normal, the proportion of which was 3.7%, less than group TIA (9.8%), with statistical difference (X2=4.908 P0.05). (5) the incidence of four subgroups in acute cerebral infarction was H type hypertension (61.5%) simple high Hcy (29.9%) simple hypertension (4.9%) normal group (3.7%). Compared to the four subgroups, there was no difference between the normal group and the high blood pressure group, and there was no significant difference between the four subgroups (X2=0.261 P0.05). The simple high Hcy56 cases, accounting for 29.9%, was significantly higher than the normal group (X2=45.831 P0.05) and the simple hypertension group (X2=41.133 P0.05). There were 115 cases of type H hypertension, accounting for 61.5% of total cerebral infarction, which was significantly higher than that of high Hcy (X2=37.505 P0.05), simple hypertension (X2=135.557 P0.05), and normal (X2=141.892 P0.05). (6) the group of acute cerebral infarction was divided into H type hypertension group and non H type hypertension group. There were 115 cases of H type hypertension group, 4 cases with normal endometrium and 111 cases of intima plaque formation. There were 72 cases of non H hypertension, 13 cases of normal endometrium, and 59 cases of plaque formation. The incidence of carotid plaques in type H hypertension group (96.64%) was significantly higher than that in non H hypertension group (81.94%). The incidence of recurrent cerebral infarction in H type hypertension group was 49.56%, which was significantly higher than that of non H hypertension group (26.397%). (7) according to the NIHSS score, four subgroups of acute cerebral infarction were divided into progressive stroke and non progressive stroke. The incidence of progressive stroke in four subgroups was H hypertension (46.96%), high Hcy (26.79%), simple hypertension group (11.11%), and normal group (0%). The incidence of progressive stroke in the four subgroups was 22. There was no significant difference between the simple hypertension group and the normal group. There was no significant difference between the HHcy group and the simple hypertension group or the normal group. Type H hypertension was higher than that of the other three groups, with a statistically significant difference. (8) multivariate analysis showed that H type hypertension (OR=2.644), 95.0%CI (1.297-5.390) and Hcy (OR=1.744) and 95.0%CI (1.047-2.903) were independent risk factors for acute cerebral infarction, and the regression coefficient of H type hypertension was 0.972 (0.556) Hcy. Conclusion: 1. The incidence of H type hypertension and the level of homocysteine in the male patients with ischemic stroke are higher than that of the female. 2. The level of homocysteine in patients with acute cerebral infarction is higher than that in group TIA. Type 3, H type hypertension may promote cerebral apoplexy
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R743.33

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