急性脑梗死患者颈动脉粥样硬化斑块易损性与H型高血压相关性研究

发布时间：2018-03-27 22:33

本文选题：急性脑梗死　切入点：高同型半胱氨酸血症　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:颈动脉易损斑块是脑梗死的重要病理基础,高血压和高同型半胱氨酸血症是脑梗死发生、发展的两个独立危险因子。H型高血压与脑梗死及动脉粥样硬化斑块性质的关系逐渐成为研究的热点。本课题主要探讨急性脑梗死患者颈动脉粥样硬化斑块易损性与H型高血压的相关性。方法:收集2014年12月~2016年12月忻州市人民医院符合纳入标准的230例急性脑梗死患者,根据颈动脉彩色超声检查结果将患者分为易损斑块组和非易损斑块组,比较两组血浆同型半胱氨酸水平和相关指标的差异。将所有入选对象根据同型半胱氨酸检查结果和有无高血压病史分为四组,H型高血压组、单纯高血压组、高同型半胱氨酸组和正常组(血压和同型半胱氨酸均正常),观察4个亚组颈动脉易损斑块的发生率,比较H型高血压组和其余三组颈动脉易损斑块发生率的差异,进一步分析高血压和高同型半胱氨酸血症在急性脑梗死患者颈动脉易损斑块形成中的相互作用。结果:1.易损斑块组与非易损斑块组一般资料及实验室指标对比显示:两组间高血压、同型半胱氨酸、CRP、LDL-C、HDL-C、ApoA等方面差异有统计学意义,其他危险因素(年龄、性别、糖尿病、吸烟史、饮酒史、TC、TG、ApoB、FIB)差异无统计学意义。2.以颈动脉易损斑块为因变量,单因素分析中差异明显的指标为自变量,进行多因素logistic回归分析,结果显示:高血压、高同型半胱氨酸血症、LDL-C是颈动脉易损斑块形成的独立危险因素,HDL-C是独立保护因素。3.四个亚组颈动脉易损斑块的发生率:H型高血压组单纯高血压组HHcy组正常组。4.相互作用分析:高血压和高同型半胱氨酸血症在急性脑梗死患者颈动脉易损斑块形成中起协同作用(S=71),其中63.2%的急性脑梗死患者颈动脉易损斑块是由高血压和高同型半胱氨酸血症相互作用引起。结论:1.高血压及高同型半胱氨酸血症与急性脑梗死患者颈动脉易损斑块的形成密切相关。2.H型高血压更易导致颈动脉易损斑块的发生,高血压和高同型半胱氨酸血症在颈动脉易损斑块形成中起协同作用。
[Abstract]:Objective: carotid artery plaque is an important pathological basis of cerebral infarction, hypertension and hyperhomocysteinemia is the occurrence of cerebral infarction, the relationship between the development of two independent risk factors of.H type hypertension and cerebral infarction and atherosclerosis plaque has become a hot research topic. This thesis mainly discuss the relationship between acute cerebral infarction patients with carotid atherosclerotic plaque vulnerability and type H hypertension. Methods: the collection of Xinzhou City People's Hospital in December 2014 ~2016 year in December with 230 cases of acute cerebral infarction were included in the standard, according to the carotid artery color Doppler ultrasound examination results were divided into plaque group and non plaque group, the difference between the two groups of plasma homocysteine levels and related indicators. All subjects were according to the homocysteine examination results and have no history of hypertension were divided into four groups, H type hypertension group, hypertension Group, high homocysteine group and normal group (blood pressure and homocysteine were normal), observe 4 groups of vulnerable carotid plaque incidence, H type hypertension group and other three groups of vulnerable carotid artery plaque incidence rate difference, further analysis of interaction between hypertension and hyperhomocysteinemia in vulnerable plaque formation Gao Tongxing the carotid artery in patients with acute cerebral infarction. Results: comparison of 1. vulnerable plaque group and the group of general information and laboratory index of non vulnerable plaque between two groups of hypertension, homocysteine, CRP, LDL-C, HDL-C, ApoA was significantly higher in other aspects, other risk factors (age, gender, diabetes, smoking history. The history of drinking, TC, TG, ApoB, FIB) there was no significant difference between.2. with carotid artery plaque as the dependent variable, the single factor index analysis in difference as independent variables, multivariate logistic regression analysis, the results show Show: hypertension, high homocysteine, LDL-C are independent risk factors for the formation of carotid artery atherosclerotic plaque, HDL-C was an independent protective factor.3. four subgroup of carotid artery atherosclerotic plaque incidence: H type hypertension group, hypertension group HHcy group normal group.4. interaction analysis: hypertension and hyperhomocysteinemia in in the synergistic effect of vulnerable atherosclerotic plaque of carotid artery in patients with acute cerebral infarction (S=71), the vulnerable plaque of carotid artery in patients with acute cerebral infarction in 63.2% is caused by hypertension and hyperhomocysteinemia interaction. Conclusion:.2.H is closely related to hypertension are more likely to result in the occurrence of carotid artery plaque formation of vulnerable plaque of carotid artery in patients with hypertension and 1. hyperhomocysteinemia and acute cerebral infarction, hypertension and hyperhomocysteinemia play a synergistic role in the carotid artery atherosclerotic plaque formation.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R544.1

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