缺血性脑梗死合并2型糖尿病及其CISS分型与血脂的关系

发布时间：2018-04-10 15:03

本文选题：急性脑梗死 + 2型糖尿病　；参考：《兰州大学》2017年硕士论文

【摘要】：目的:对急性脑梗死合并2型糖尿病患者进行中国缺血性卒中亚型(China Ischemic Stroke Subclassification,CISS)分型,统计各亚型病因分型构成比以及不同的危险因素对各病因分型的影响;探讨总胆固醇水平与急性脑梗死合并2型糖尿病的相关性。方法:选择收入我院神经内科(2014年4月至2016年4月)发病72小时内且合并2型糖尿病的急性脑梗死患者376例,并进行CISS分型,单纯急性脑梗死292例,健康体检者389例,常规抽取空腹静脉血,检测包括尿酸、血同型半胱氨酸以及纤维蛋白原和血脂等在内的生化指标,并分析其与急性脑梗死合并2型糖尿病患者CISS分型的相关性。结果:急性脑梗死合并2型糖尿病患者的CISS分型中,大动脉粥样硬化性卒中(Large Artery Atherosclerosis,LAA)一共有191例(50.70%),病因不确定(Undetermined Etiology,UE)数量为103例(27.60%),其次分别为穿支动脉疾病(Penetrating Artery Disease,PAD)51例(13.50%),心源性脑卒中(Cardiogenic Stroke,CS)30例(8.00%)、其他原因所致缺血性卒中(Other Etiology,OE)1例(1.00%)。年龄、TG、LDL是LAA型的危险因素。CS的TC水平均低于其他4类亚型(P0.05),其余亚型两两比较无差异(P0.05),存在“胆固醇悖论”现象。年龄是CS型的危险因素。TC是PAD型的危险因素,PAD型高血压合并比例最高。饮酒是UE型的危险因素。TC水平降低与单纯脑梗死和急性脑梗塞合并2型糖尿病发病具有显著相关性。结论:急性脑梗死合并2型糖尿病患者中以LAA及UE为主;不同类型缺血性脑卒中与不同危险因素有关,LDL是LAA的危险因素,冠心病是CS的危险因素,饮酒是UE的危险因素;心源性脑卒中存在“胆固醇悖论”现象;急性脑梗死合并2型糖尿病患者存在“胆固醇悖论”现象。
[Abstract]:Objective: to classify the patients with acute cerebral infarction complicated with type 2 diabetes mellitus by China Ischemic Stroke subclassification CISS, and to calculate the proportion of the etiological classification of each subtype and the influence of different risk factors on the etiological classification.To investigate the correlation between total cholesterol level and type 2 diabetes mellitus with acute cerebral infarction.Methods: 376 patients with acute cerebral infarction within 72 hours of onset and complicated with type 2 diabetes were selected from neurology department of our hospital (from April 2014 to April 2016). CISS classification was performed in 292 patients with simple acute cerebral infarction and 389 healthy controls.Fasting venous blood was collected routinely to detect the biochemical indexes including uric acid, homocysteine, fibrinogen and blood lipids, and to analyze their correlation with CISS typing in patients with acute cerebral infarction and type 2 diabetes mellitus.Results: in the CISS classification of patients with acute cerebral infarction and type 2 diabetes,The level of TC in age group was lower than that in other four subtypes (P 0.05), but there was no difference in other subtypes (P 0.05), and there was a phenomenon of "cholesterol paradox".Age is the risk factor of CS type. TC is the risk factor of PAD type.Alcohol consumption was a risk factor of UE type. TC level decreased significantly with simple cerebral infarction and acute cerebral infarction with type 2 diabetes.Conclusion: LAA and UE are the main risk factors in patients with acute cerebral infarction and type 2 diabetes, and different types of ischemic stroke are associated with different risk factors. Coronary heart disease is the risk factor of CS, alcohol consumption is the risk factor of UE.There is "cholesterol paradox" in cardiogenic stroke and "cholesterol paradox" in patients with acute cerebral infarction and type 2 diabetes mellitus.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R587.1

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