急性脑梗死患者颈动脉粥样硬化斑块与H型高血压的相关性分析

发布时间：2018-03-12 15:05

本文选题：急性脑梗死　切入点：颈动脉粥样硬化斑块　出处：《山西医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：据现代流行病学研究，脑卒中是一种严重危害人类生命和健康的常见疾病，是目前我国人口三大死亡原因之一，具有高发病率、高死亡率、高致残率、预后差等特点，给家庭、社会及国家造成严重的经济负担和精神损失，其中以缺血性脑血管疾病即脑梗死多见。近几年研究，颈动脉粥样硬化是引起脑梗死的危险因素之一：颈动脉粥样硬化斑块形成，造成血管管腔狭窄、闭塞、血栓形成或者斑块脱落，为脑梗死的发生提供了病理基础。高血压和HHcy作为脑梗死发生、发展的两个独立危险因素，两者在心脑血管疾病的发生中具有协同作用。本文探讨急性脑梗死患者颈动脉粥样硬化斑块与H型高血压的相关性和急性脑梗死患者颈动脉粥样硬化斑块形成的危险因素；同时，颈动脉粥样硬化斑块作为脑梗死发生的重要危险因素之一，，为脑梗死的预防提供切实可行的科学依据。方法：收集山西医科大学第二医院神经内二科2011年2月1日至2013年1月31日的新发急性脑梗死住院患者115例，所有患者均符合1995年第四次全国脑血管病学术会议制定的各类脑血管疾病诊断标准，并经头颅CT和头颅核磁DWI确诊为急性脑梗死，病程小于72小时，年龄38-79岁，平均年龄56.80±9.69岁。所有病例均排除风湿性心脏病、心房颤动、严重心力衰竭、恶性肿瘤、全身严重感染、自身免疫性疾病、肝肾功能不全和近一月来服用叶酸和多种维生素及干扰同型半胱氨酸（tHcy）代谢的药物。步骤一：详细记录所有患者一般临床资料（性别、年龄、高血压病史、糖尿病史、吸烟史和饮酒史）和实验室指标结果（空腹血脂水平）；步骤二：应用山西医科大学第二医院超声科ATL5000型超声诊断仪，探头频率5-10Mhz，对所有患者沿颈动脉由下而上进行纵向和横向扫查，观察颈部动脉内中膜厚度、粥样硬化斑块有无，根据超声结果分为斑块组和对照组，并对各组进行一般资料和实验室指标方面的比较。步骤三：应用酶联免疫法(ELISA)测定tHcy，并根据tHcy检验结果和有无高血压病史，分为H型高血压组，单纯高血压组，HHcy组和两者均正常组（无高血压病史和tHcy正常）4个亚组，对斑块组和对照组进行4个亚组检出率方面的比较。所有数据均应用SPSS17.0软件进行统计学分析，计量资料单因素分析采用t检验，计数资料采用卡方检验，全部为双侧检测，以p0.05水平为差异具有统计学意义；以斑块组和对照组分组为因变量，对急性脑梗死患者颈动脉粥样硬化形成的可能危险因素设为自变量，进行多因素logistic回归分析；高血压和HHcy对急性脑梗死患者颈动脉粥样硬化斑块形成的联合作用采用交互作用分析相加模型。结果：1，斑块组与对照组各组危险因素分析：2组间年龄、高血压病史、吸烟史、tHcy、LDL差异有显著性，余危险因素间差异不明显；进一步行多因素logistic回归分析显示：年龄、高血压病史、LDL是急性脑梗死患者颈动脉粥样硬化斑块形成的独立危险因素。 2，斑块组内4个亚组的发生率：H型高血压发生率高血压发生率HHcy发生率两组均正常发生率。 3，交互作用分析：高血压、HHcy血症在急性脑梗死患者颈动脉粥样硬化斑块形成中起协同作用，起效应大于两者之和。结论：1，H型高血压在急性脑梗死患者颈动脉粥样硬化形成的危险性均大于高血压、高同型半胱氨酸血症和两者之和。 2，logistic回归分析显示：年龄、高血压病史、LDL是急性脑梗死患者颈动脉粥样硬化斑块形成的独立危险因素。
[Abstract]:Objective: according to the epidemiological study, stroke is a serious harm to human life and health of the common diseases, the population of our country is one of the three major causes of death at present, with high morbidity, high mortality, high disability rate, poor prognosis, to the family, society and country caused serious economic burden and mental loss among them, ischemic cerebrovascular disease cerebral infarction is rare. In recent years, carotid atherosclerosis is one of the risk factors of cerebral infarction, carotid atherosclerotic plaque, resulting in vascular stenosis, occlusion, or plaque off the formation of thrombus, provide the pathological basis for the occurrence of cerebral infarction. Hypertension and HHcy as cerebral infarction, two independent risk factors for the development, they have synergistic effect in the occurrence of cardiovascular and cerebrovascular diseases. This paper discusses the acute cerebral infarction patients with carotid atherosclerosis and H Correlation between type 2 hypertension and risk factors of carotid atherosclerotic plaques in patients with acute cerebral infarction. Meanwhile, carotid atherosclerotic plaques, as an important risk factor for cerebral infarction, provide a scientific basis for prevention of cerebral infarction.
Methods: new onset acute cerebral infarction collected nerve Second Hospital of Shanxi Medical University from February 1, 2011 to January 31, 2013 in two of 115 cases of patients, all patients were diagnosed with various cerebrovascular diseases standard in 1995 fourth national cerebrovascular disease conference established, and by brain CT and cranial DWI were diagnosed as acute cerebral infarction, duration less than 72 hours of age 38-79 years old, the average age of 56.80 + 9.69 years. All the cases were excluded from rheumatic heart disease, atrial fibrillation, severe heart failure, malignant tumor, severe systemic infection, autoimmune disease, liver and kidney dysfunction and nearly January to take folic acid and vitamins and interference of homocysteine (tHcy) metabolism of drugs. Step a detailed record of all patients with clinical data (gender, age, history of hypertension, history of diabetes, history of smoking and alcohol drinking) and laboratory index results. (fasting blood lipid levels); step two: the application of the second hospital of Shanxi Medical University Department of ultrasound ATL5000 type ultrasonic diagnostic instrument, probe frequency 5-10Mhz, all patients were from the carotid artery along the longitudinal and transverse scanning, observe the carotid artery intima-media thickness, atherosclerosis plaque or not, according to the ultrasound results were divided into plaque group and control group. And compare the general information and laboratory indicators of each group. Step three: using enzyme linked immunosorbent assay (ELISA) determination of tHcy and tHcy, according to the test result and there is no history of hypertension, divided into H type hypertension group, hypertension group, HHcy group and both normal group (without hypertension and normal tHcy) 4 subgroups of plaque group and the control group of 4 sub group detection rate comparison. All data were analyzed by SPSS17.0 statistical analysis, single factor analysis of measurement data using t test, counting. The material using a chi square test, all bilateral detection on the level of P0.05, the difference was statistically significant; plaque group and the control group as the dependent variable, the formation of carotid atherosclerosis in patients with acute cerebral infarction and the risk factors as independent variables, multivariate logistic regression analysis; the combined effect of HHcy on hypertension and carotid atherosclerosis plaque in patients with acute the formation of cerebral infarction the interaction analysis of additive model.
Results: 1. The analysis of plaque group and control group each group of risk factors between 2 groups of age, history of hypertension, smoking history, tHcy, LDL had significant difference between residual risk factors is not obvious; further multivariate logistic regression analysis showed that age, history of hypertension, LDL is an independent risk factor for patients with acute neck formation atherosclerosis of cerebral infarction.
2, the incidence of 4 subgroups in the plaque group: H type hypertension incidence rate of hypertension, the incidence of HHcy in two groups was normal.
3, the interaction analysis: hypertension, hyperlipidemia HHcy synergistic role in carotid atherosclerotic plaque in patients with acute cerebral infarction, which effect is greater than the sum of both. Conclusion: 1, the risk of H type hypertension in the formation of carotid atherosclerosis in patients with acute cerebral infarction were higher than that of high blood pressure, high homocysteine and the sum of both.
2, logistic regression analysis showed that age, history of hypertension, and LDL were independent risk factors for the formation of carotid atherosclerotic plaque in patients with acute cerebral infarction.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R743.33

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