白质疏松与短暂性脑缺血发作的关系

发布时间：2018-04-18 18:18

本文选题：短暂性脑缺血发作 + 白质疏松　；参考：《南京医科大学》2017年博士论文

【摘要】：[目的]白质疏松在头颅磁共振上是常见的影像表现,越来越多文献报道缺血性卒中患者白质疏松发生率高,程度严重;白质疏松是缺血性卒中发生的独立危险因素,且与卒中病情轻重、进展、治疗及预后明显相关。但白质疏松与短暂性脑缺血发作之间的相关性尚不明确,短暂性脑缺血发作是神经科急症,发生致死、致残性血管事件比例高,本研究的目的是测定白质疏松对短暂性脑缺血发作患者的临床重要性,以指导临床进行个体化治疗。[方法]连续入组2010年8月至2015年12月住院首发的症状发生48h之内的短暂性脑缺血发作患者,入院后行头颅磁共振检查评估白质疏松,合并白质疏松患者采用MRIcro软件定量测定白质疏松体积并以全脑体积标准化,后给予四分位数分层。采集患者临床资料,入院后给予患者抗栓、他汀类药物及控制危险因素治疗,随访1年观察血管事件发生情况。单变量研究有统计学意义的变量进入多元logistic回归,以P0.05为差异具有统计学意义;分析短暂性脑缺血发作患者白质疏松发生及严重程度的相关危险因素,以及白质疏松与再发血管事件之间的相关性。[结果](1)共181例短暂性脑缺血发作患者被纳入本研究,其中104例(57.5%)患者磁共振检查发现白质疏松,单因素分析显示年龄、高血压病、高脂血症、ABCD2评分及沉默性脑梗死与白质疏松发生相关,而性别、糖尿病史、吸烟、心房颤动、冠心病、临床表现、症状持续时间及病变定位等与白质疏松发生无关。多元回归分析显示年龄(OR,1.12;95%CI,1.08-1.17;P=0.000)和高血压病(OR,2.11;95%CI,1.06-4.21;P=0.034)为白质疏松发生的独立危险因素。(2)104例合并白质疏松患者标准化白质疏松体积范围为0.95～49.13 mL,中位数5.00 mL,按四分位数分层后单变量及多变量分析发现年龄(OR,1.07;95%CI,1.03-1.11;P=0.001)和高血压病(OR,2.21;95%Cl,1.06-4.60;P=0.034)与白质疏松体积密切相关。(3)发病后随访一年发现共26例(14.4%)患者再发血管事件,单因素分析发现年龄、高血压病、糖尿病、高脂血症、ABCD2评分和白质疏松与再发血管事件有关。多元回归分析显示年龄(OR,1.05;95%CI,1.00-1.11;P=0.040)、糖尿病(OR,2.92;95%CI,1.13-7.57;P=0.027)、高脂血症(OR,4.19;95%CI,1.60-11.03;P=0.004)和白质疏松(OR,3.71;95%CI,1.09-12.60;P=0.036)与血管事件发生独立相关。合并白质疏松患者及不合并白质疏松患者血管事件发生率分别为21.15%(22/104)和5.19%(4/77),合并白质疏松患者发生血管事件的风险是不合并白质疏松患者的3倍多(OR,3.71;95%CI,1.09-12.60;P=0.036)。(4)合并白质疏松患者白质疏松体积和高脂血症(OR,5.38;95%CI,1.73-16.79;P=0.004)是血管事件发生的独立危险因素,且白质疏松体积第四四分位发生血管事件的风险为第一四分位的26倍多(P=0.009)。[结论]短暂性脑缺血发作患者白质疏松发生率高,年龄和高血压病是白质疏松的发生及严重程度的独立危险因素。白质疏松的发生及严重程度与一年内再发血管事件密切有关,白质疏松可用来作为评估短暂性脑缺血发作的预后指标。严重白质疏松与临床结局有关,因此,对白质疏松的研究不仅评估其发生,对其严重程度的识别更显重要,积极治疗白质疏松可调节的危险因素如高血压等有望延缓白质疏松的发生和发展,改善短暂性脑缺血发作患者预后。
[Abstract]:[Objective] leukoaraiosis is common imaging findings in magnetic resonance imaging, more and more reports of ischemic stroke patients with leukoaraiosis in high incidence and severity of leukoaraiosis; is the independent risk factor for ischemic stroke, and with the progress of stroke severity, treatment and prognosis, but the correlation between the significant correlation. Leukoaraiosis and transient ischemic attack is not clear, transient ischemic attack is a neurological emergency, fatal, disabling cerebrovascular events in a high proportion, the purpose of this study is to determine the clinical importance of leukoaraiosis in patients with transient ischemic attack, in order to guide the clinical individualized treatment method. Continuous group in August 2010 to December 2015 were the first symptoms of 48h in patients with transient ischemic attack, the patient underwent MRI evaluation of leukoaraiosis patients with leukoaraiosis. Determination of leukoaraiosis volume and whole brain volume standardized by MRIcro software quantitative, given after the four percentile stratification. The clinical data of patients were collected after admission, patients were given anticoagulant, statins and control of risk factors for the occurrence of 1 years of follow-up, observation of vascular events. The single variable was statistically significant amount of variables into multivariate logistic regression with P0.05 difference was statistically significant; analysis of the risk and severity of leukoaraiosis in patients with the risk factors of transient ischemic attack, as well as between leukoaraiosis and recurrent vascular events related. Results (1) a total of 181 patients with transient ischemic attack were enrolled in this study. Of which 104 cases (57.5%) patients with MRI found leukoaraiosis, univariate analysis showed that age, hypertension, hyperlipidemia, ABCD2 score and silent cerebral infarction and leukoaraiosis occurred, and gender And the history of diabetes, smoking, atrial fibrillation, coronary heart disease, clinical manifestation, symptom duration and lesion location and leukoaraiosis occurred. Multiple regression analysis showed that age (OR, 1.12; 95%CI, 1.08-1.17; P=0.000) and hypertension (OR, 2.11; 95%CI, 1.06-4.21; P=0.034) were the independent risk of leukoaraiosis the factors. (2) of 104 patients with leukoaraiosis in patients with standardized leukoaraiosis volume ranged from 0.95 to 49.13 mL, median 5 mL, according to the analysis of univariate and multivariate quantile stratified four age (OR, 1.07; 95%CI, 1.03-1.11; P=0.001) and hypertension (OR, 2.21; 95%Cl, 1.06-4.60; P=0.034) is closely associated with leukoaraiosis volume. (3) after the onset of one year of follow-up were found in 26 cases (14.4%) of patients with recurrent vascular events, univariate analysis showed that age, hypertension, diabetes, hyperlipidemia, ABCD2 score and leukoaraiosis associated with multiple recurrent vascular events. Regression analysis showed that age (OR, 1.05; 95%CI, 1.00-1.11; P=0.040), diabetes (OR, 2.92; 95%CI, 1.13-7.57; P=0.027), hyperlipidemia (OR, 4.19; 95%CI, 1.60-11.03; P=0.004) and leukoaraiosis (OR, 3.71; 95%CI, 1.09-12.60; P=0.036) and blood vessels occurred independently related. With leukoaraiosis patients and patients without leukoaraiosis in patients with vascular events were 21.15% (22/104) and 5.19% (4/77), with the risk of leukoaraiosis in patients with vascular events is not associated with leukoaraiosis in patients with more than 3 times (OR, 3.71; 95%CI, 1.09-12.60; (P=0.036). 4) with leukoaraiosis in patients with leukoaraiosis volume and hyperlipidemia (OR, 5.38; 95%CI, 1.73-16.79; P=0.004) is an independent risk factor for vascular events, and leukoaraiosis volume the 44 percentile risk for vascular events occurred more than 26 times the first four points (P=0.009) patients. Conclusion: transient ischemic attack The high incidence of osteoporosis, age and hypertension were independent risk factors and severity of leukoaraiosis. Occurrence and severity of leukoaraiosis occurred within one year of recurrent vascular events related to leukoaraiosis may be used as a prognostic indicator in patients with transient ischemic attack. Severe leukoaraiosis related therefore, with the clinical outcome of osteoporosis, with not only the evaluation, more important to recognize the severity of the risk factors of aggressive treatment of leukoaraiosis can be adjusted such as the occurrence and development of hypertension is expected to delay the leukoaraiosis, improve the prognosis of patients with transient ischemic attack.

【学位授予单位】：南京医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R743.3

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