皮质下缺血性血管病患者平均血小板体积水平变化及其意义

发布时间：2017-12-31 08:04

本文关键词：皮质下缺血性血管病患者平均血小板体积水平变化及其意义　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景与目的随着社会人口老龄化的加速与脑血管疾病危险因素的高发,皮质下缺血性血管病(SIVD)日益增多。SIVD发病隐匿,容易被患者、家庭以及医务工作者所忽视,但是其有发展成脑卒中和痴呆的风险,会使患者的生活质量明显降低并给家庭以及社会带来繁重的负担。近年来,血小板功能与各种疾病的关系也日益引起重视,平均血小板体积(MPV)的异常作为很多疾病一种可能的新生危险因素,越来越受到研究者的青睐。既往研究显示,MPV变化与脑卒中、阿尔茨海默病(AD)、糖尿病、冠心病等多种疾病密切相关,而目前有关SIVD和MPV关系的研究较少。本研究通过检测SIVD患者MPV水平的大小,目的在于探讨SIVD患者MPV水平的变化及其临床意义。材料与方法选取340例SIVD患者(SIVD组)和同期健康体检者(对照组)160例,根据头颅磁共振(MRI)将SIVD组分为多发性腔隙性脑梗死(LI)组(n=124)和脑白质疏松(LA)组(n=216),按照Fazekas的评分标准将LA组脑白质疏松严重程度分为3级;采用血液分析仪检测所有受试者MPV值,比较SIVD组及其亚组与正常照组之间MPV水平的变化,并分析MPV与脑白质疏松程度的相关性。结果 SIVD组年龄较对照组大、高血压比例较对照组高,差异有统计学意义(P0.01);SIVD组MPV、血小板分布宽度(PDW)水平显著高于对照组,血小板计数(PLT)水平显著低于对照组,差异有统计学意义(P0.01)。在校正年龄因素后,LI组和LA组MPV、PDW水平均显著高于对照组,PLT均显著低于正常对照组,差异有统计学意义(P0.01);且LA组MPV、PDW水平显著高于LI组,差异有统计学意义(P0.05)。将LA组进一步分组后发现,LA等级越高者,MPV水平越高(1级、2级、3级MPV分别为11.06±0.76fl、12.13±0.88fl、12.64±1.02fl),差异具有统计学意义(P0.01);相关分析显示,MPV水平与LA等级成显著正相关性(rs=0.596,P0.01)。将年龄、性别、高血压、糖尿病、冠状动脉粥样硬化性心脏病、吸烟、饮酒及MPV水平等作为自变量,是否SIVD作为因变量进行多元Logistic回归分析发现,在控制各项因素后MPV水平的增高仍是SIVD的危险因素。(OR=3.461,95%CI:2.653-4.515,P0.01)。结论 SIVD患者MPV水平显著高于健康人群,MPV的增高可能是SIVD发生的一项重要的独立危险因素,且与脑白质病变的等级有着密切的联系。MPV的升高可以通过多种机制导致SIVD的发生,但是对于大体积血小板如何产生的机制目前尚不十分明确,有待于相关的基础和临床研究来进一步明确。在SIVD的临床诊治过程中,应重视MPV水平的检测,并积极应用抗血小板药物,以改善患者的预后。SIVD患者MPV水平显著增高,是SIVD尤其是脑白质疏松的重要危险因素,其升高水平与脑白质疏松的程度存在显著正相关。临床上应重视观察MPV的变化,积极应用抗血小板药物可能改善SIVD患者预后。
[Abstract]:Background and objective: with the risk of accelerated aging of population and the risk factors of cerebrovascular disease, subcortical ischemic vascular disease (SIVD) increased.SIVD incidence of occult, easy to be ignored by the patients, families and medical workers, but the development of stroke and dementia risk, will make the life quality of patients obviously reduce and bring heavy burden to the family and society. In recent years, the relationship between platelet function and various diseases are caused by the growing importance of mean platelet volume (MPV) anomaly as many diseases may be a new risk factor, more and more favored by researchers. Previous studies showed that the change of MPV and stroke, Alzheimer's disease (AD), diabetes mellitus, coronary heart disease and other diseases are closely related, and the current research about the relationship between MPV and SIVD is less. This study size by the level of MPV in patients with SIVD detection, purpose To investigate the changes of MPV level in SIVD patients and its clinical significance. Materials and methods 340 cases of SIVD patients (SIVD group) and healthy people (control group) 160 cases, according to the magnetic resonance imaging (MRI) of SIVD were divided into multiple lacunar infarction (LI) group (n=124) and white osteoporosis (LA) group (n=216), in accordance with the standard for evaluation of Fazekas LA group the severity of leukoaraiosis is divided into 3 levels; all subjects were detected by MPV blood analyzer, SIVD group and sub group and normal control group MPV level changes, and to analyze the correlation between MPV and cerebral white matter the degree of osteoporosis. Results the age of the SIVD group compared with the control group, the proportion of hypertension was higher than that in control group, the difference was statistically significant (P0.01); group SIVD MPV, platelet distribution width (PDW) were significantly higher than the control group, the platelet count (PLT) was significantly lower than that of control group, the difference was statistically significant (P0.01). In After adjustment for age, LI group and LA group MPV, PDW levels were significantly higher than the control group, PLT was significantly lower than the normal control group, the difference was statistically significant (P0.01); group LA and MPV, the level of PDW was significantly higher than that in LI group, the difference was statistically significant (P0.05). The LA group was further grouped after that the higher the LA level, the higher the MPV level (1 grade, 2 grade, 3 grade MPV were 11.06 + 0.76fl, 12.13 + 0.88fl, 12.64 + 1.02fl), the difference was statistically significant (P0.01); correlation analysis showed that the MPV level and LA level significantly positive correlation (rs=0.596, P0.01). The age, gender, hypertension, diabetes, coronary heart disease, smoking, alcohol drinking and MPV level as the independent variables, whether SIVD as the dependent variable, multivariate Logistic regression analysis showed that the factors in risk control after the increase of MPV level is still a factor of SIVD. (OR=3.461,95%CI:2.653-4.515, P0.01) conclusion. The level of MPV in patients with SIVD were significantly higher than that of healthy people, the increase of MPV may be an important independent risk factors of SIVD, and the level of cerebral white matter lesions are closely related to elevated.MPV can lead to the occurrence of SIVD through a variety of mechanisms, but the mechanism for the large volume of blood in how it is not very clear, need to be related to the basic and clinical research to further clarify the clinical diagnosis and treatment. In the process of SIVD, we should pay attention to detect the level of MPV, and the positive application of antiplatelet drugs, to improve the level of MPV in patients with the prognosis of patients with.SIVD significantly increased, especially SIVD is an important risk factor for leukoaraiosis, there was a significant positive the increasing level of leukoaraiosis. Clinical attention should be paid to observe the change of MPV, the positive application of antiplatelet drugs may improve the prognosis of patients with SIVD.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743

【参考文献】