急性后循环腔隙性脑梗死病情进展的危险因素研究

发布时间：2018-05-13 17:03

本文选题：急性后循环腔隙性脑梗死 + 病情进展　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:随着医学的发展,对于脑梗死这一疾病的认识发生了巨大的变化。近年来研究发现,后循环腔隙性脑梗死作为缺血性脑卒中的一种类型,在各种缺血性脑卒中中造成的损伤和死亡尤为突出。迄今为止,急性后循环腔隙性脑梗死病情进展的主要危险因素研究结果存在争议。为进一步探讨造成急性后循环腔隙性脑梗死病情加重的主要因素,本研究回顾性观察了195例急性后循环腔隙性脑梗死患者的临床特征及预后,分析了急性后循环腔隙性脑梗死患者病情进展的危险因素,以求对患者的病情进展作出早期预测,及时采取有效治疗措施,最大程度改善预后降低致残率和死亡率,提高患者的生活质量。方法:2014年8月~2015年7月期间于我院神经内科住院治疗的脑梗死患者635例,经磁共振成像(magnetic resonance imaging,MRI)扫描及弥散加权成像(diffuse weighted imaging,DWI)序列扫描,证实为急性后循环腔隙性脑梗死,严格按照入选标准及排除标准纳入研究对象,收集可能引起急性后循环腔隙性脑梗死患者病情进展加重的因素如:年龄、性别、入院时血压、就诊时间及既往史中可能引起病情进展的危险因素(包括高血压病史、糖尿病病史、冠心病病史、脑梗死病史、短暂性脑缺血发作病史、脑出血病史),记录患者的胆固醇、低密度脂蛋白、同型半胱氨酸、糖化血红蛋白、血红蛋白、平均红细胞体积、红细胞分布宽度等化验检查结果,行颈部动脉超声检测以观察患者后循环动脉斑块及内膜增厚情况,采用头颅MRI检查判断患者是否存在脑白质疏松及明确患者病灶部位。应用标准化方法对患者进行详细查体并记录患者是否存在吞咽功能障碍,评估患者入院时以及入院7天NIHSS评分,以确定脑梗死病情是否进展。将入院7天NIHSS评分增加2分及以上的患者纳入进展组,余为非进展组。所有患者均接受相同治疗方案,即抗血小板以及调血脂、调血糖、调血压、改善心脑循环等。使用SPSS软件分析可能造成急性后循环腔隙性脑梗死病情进展加重的因素及各因素的临界值。男性124例,女性71例。年龄最小者27岁,最大者91岁,平均年龄(64.8±11.2)岁;进展组39例(20%),非进展组156例(80%)。单因素分析显示:两组性别比较差异无统计学意义(χ2=3.189,P=0.074)。将所有患者年龄分为6个年龄段组,分别是50岁、50~59岁、60~69岁、70~74岁、75~80岁、80岁,两组患者年龄段比较无显著差异(χ2=1.865,P=0.868),均以60岁组比例最多。进展组就诊时间为16(12,24)h,非进展组就诊时间为16(8,24)h,两组患者就诊时间呈非正态性分布,两组患者就诊时间经秩和检验差异无统计学差异(Z=0.053,P=0.615)。两组患者慢性病史高血压病史、糖尿病史、冠心病史、脑梗死病史、TIA病史、脑出血病史发生率比较差异无统计学意义(P0.05)。吞咽功能障碍、收缩压、舒张压两组比较无显著差异(P0.05)。进展组入院时NIHSS评分为4(2,7)分,非进展组为3(1.25,5.00)分,两组患者入院时NIHSS评分比较差异有统计学意义(P=0.023,P0.05),总胆固醇、低密度脂蛋白、同型半胱氨酸、糖化血红蛋白、血红蛋白、平均红细胞体积、红细胞分布宽度比较差异无统计学意义(P0.05)。进展组脑白质疏松20例(51.28%),非进展组53例(33.97%),进展组脑白质疏松率明显高于非进展组(P=0.046)。进展组动脉斑块24例(61.54%),非进展组66例(42.31%),两组动脉斑块情况比较差异有统计学意义(P=0.031)。两组患者内膜增厚比较差异无显著差异。两组患者病灶部位脑干、丘脑、枕叶、小脑、部位多发比较差异无统计学意义(P0.05)。将单因素P0.1的变量纳入多因素分析,赋值方法如下:性别1=男,2=女;入院时NIHSS评分原值代入;脑白质疏松0=否,1=是;动脉斑块0=否,1=是。以是否进展为因变量,单因素分析P0.1的变量“性别”、“入院时NIHSS评分”、“脑白质疏松”、“动脉斑块”为自变量,采用全部进入法进行二分类多因素logistic回归分析,最终进入方程的有“入院时NIHSS评分”和“动脉斑块”,提示入院时NIHSS评分是急性后循环腔隙性脑梗死进展的危险因素,有动脉斑块急性后循环腔隙性脑梗死患者病情进展危险性是无动脉斑块患者的2.311倍。受试者工作特征曲线(ROC曲线)分析发现,计算受试者工作特征曲线下面积,入院时NIHSS评分的计算所得为0.617,误差为0.051,95%CI结果:本研究最终纳入急性后循环腔隙性脑梗死患者共195例,其中为0.518~0.716,临界值为7.5分。结论:急性后循环腔隙性脑梗死患者入院时NIHSS评分和后循环动脉斑块是病情进展的危险因素,存在后循环动脉斑块者发生进展危险性是无后循环动脉斑块患者的2.311倍。对存在后循环动脉斑块及入院时NIHSS评分7.5分的患者,需密切关注其病情变化,及时针对患者的病因给予合理有效的治疗,以最大程度改善预后。
[Abstract]:Objective: with the development of medicine, great changes have taken place in the knowledge of cerebral infarction. In recent years, it has been found that posterior circulating lacunar cerebral infarction is a type of ischemic stroke, and the injury and death in various ischemic stroke are particularly prominent. So far, acute posterior circulation lacunar cerebral infarction In order to further explore the main factors contributing to the exacerbation of acute posterior circulating lacunar infarction, this study reviewed the clinical features and prognosis of 195 patients with acute posterior lacunar cerebral infarction and analyzed the progress of patients with acute posterior lacunar cerebral infarction. Risk factors, in order to make early prediction of the patient's progress, take effective treatment measures in time, improve the prognosis to reduce the rate of disability and mortality, and improve the quality of life. Methods: 635 patients with cerebral infarction hospitalized in the neurology department of our hospital during July ~2015 years, by magnetic resonance imaging (magnetic reso) Nance imaging, MRI) scanning and diffusion weighted imaging (diffuse weighted imaging, DWI) sequence scan proved to be an acute posterior circulating lacunar cerebral infarction, strictly according to the criteria and exclusion criteria, to collect factors that may cause the progression of acute posterior lacunar infarction, such as age, sex, admission. Blood pressure, time of visit and the risk factors that may cause progress in the past history (including history of hypertension, diabetes history, history of coronary heart disease, history of cerebral infarction, history of transient ischemic attack, history of cerebral hemorrhage), records of patients' cholesterol, low density lipoprotein, homocysteine, glycosylated hemoglobin, hemoglobin, Ping Junhong The results of cell volume, red cell distribution and other tests were performed to observe the plaque and intima thickening of the posterior circulation artery by ultrasonic examination of the neck artery. The MRI examination was used to determine the presence of leukoaraiosis and the specific location of the patients. There was dysphagia, assessed the patient's admission and NIHSS score at 7 days to determine whether the disease was progressing. The patients who had increased the NIHSS score of 2 and above 7 days were included in the progression group, and the other was the non progressing group. All the patients received the same treatment, that is, anti blood plate and blood lipid modulation, blood glucose regulation, blood pressure regulation and improvement of the heart. SPSS software was used to analyze the factors and critical values of the progression of acute posterior circulating lacunar infarction. 124 males and 71 females. The youngest was 27 years old, the largest was 91 years, the average age was (64.8 + 11.2) years, 39 cases (20%) and 156 (80%) in the non progressing group (80%). Single factor analysis showed two sex. The difference was not statistically significant (x 2=3.189, P=0.074). The age of all patients was divided into 6 age groups, 50 years old, 50~59 years old, 60~69 years old, 70~74 years old, 75~80 years old and 80 years old. The age segments of the two groups were not significantly different (x 2=1.865, P=0.868), all in the 60 year old group. The time for the treatment of the progress group was 16 (12,24) h, and the time for non progression group visits. For 16 (8,24) h, the time of treatment in the two groups was non normal distribution, and there was no statistical difference between the two groups of patients by rank sum test (Z=0.053, P=0.615). There was no statistical difference between the two groups of patients with chronic history of hypertension, diabetes, coronary heart disease, cerebral infarction, TIA, and the history of cerebral hemorrhage (P0.05). There was no significant difference in the two groups of pharynx dysfunction, systolic pressure and diastolic pressure (P0.05). The NIHSS score of the progressive group was 4 (2,7), and the non progressive group was 3 (1.25,5.00). The difference in the NIHSS score of the two groups was statistically significant (P=0.023, P0.05), total cholesterol, low density lipoprotein, homocysteine, glycosylated hemoglobin, blood red. There was no significant difference in the protein, average red cell volume and red cell distribution width (P0.05). There were 20 cases of leukoaraiosis in the progressive group (51.28%), 53 cases in non progressive group (33.97%), the rate of leukoaraiosis in the progressive group was significantly higher than that in the non progressing group (P=0.046). 24 cases (61.54%), 66 cases (42.31%) in the non progressing group and two group of atherosclerotic plaques in the progress group. The difference was statistically significant (P=0.031). There was no significant difference in intimal thickening between the two groups. There were no significant differences between the two groups of brain stem, thalamus, occipital lobe, cerebellum and location (P0.05). The variables of single factor P0.1 were divided into multiple factors, and the methods of assignment were as follows: sex 1= men, 2= women; and NIHSS score at admission. The original value was replaced; the leukoplasm was loose 0= or 1=; the atherosclerotic plaque 0= was not, the 1= was. By the variable, the single factor analysis of the P0.1 variable "sex", "the admission NIHSS score", "the leukoaraiosis", "arterial plaque" as the independent variable, the two classification multiple factor Logistic regression analysis was used in all the entry methods, and finally into the equation. Finally the equation entered the equation. There were "admission NIHSS scores" and "arterial plaque", suggesting that the NIHSS score at admission was a risk factor for the progression of acute posterior circulating lacunar infarction. The risk of progressive posterior circulation lacunar infarction in patients with atherosclerotic atherosclerotic cerebral infarction was 2.311 times as high as that of the patients without atherosclerotic plaques. The ROC curve analysis of the subjects was found to be found. The calculation of the area under the characteristic curve of the subjects was 0.617 and the error was 0.051,95%CI results. The results were included in this study, which included 195 cases of acute posterior lacunar cerebral infarction, including 0.518~0.716, and the critical value of 7.5. Conclusion: the acute posterior lacunar cerebral infarction patients were enrolled in the NIHSS score and after admission to the hospital. The plaque of the circulatory artery is a risk factor for the progression of the disease. The risk of the progression of the posterior circulatory artery plaque is 2.311 times as high as that of the patients without the posterior circulation artery. The patients with the posterior circulation artery plaque and the NIHSS score of 7.5 in the hospital need to pay close attention to the change of the disease, and to give a reasonable and effective treatment to the cause of the patient's cause. To improve the prognosis to the greatest extent.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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