脑分水岭梗死与病灶侧血管狭窄及颈动脉斑块关系分析

发布时间：2018-03-01 13:28

本文关键词： 脑分水岭梗死危险因素病灶侧血管狭窄不稳定斑块　出处：《河北联合大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探讨脑分水岭梗死（CWI）发生的相关危险因素，分析不同亚型间病灶侧颈动脉斑块性质、病灶侧责任血管及其狭窄程度差异，为临床的个体化治疗及二级预防提供理论依据。方法收集我院经核磁共振弥散加权成像（DWI）检查明确诊断的急性脑梗死患者403例，依据影像学特点分为脑分水岭梗死组与非分水岭梗死组，分析脑分水岭梗死患者的临床特点，并依据经典的Bogousslavsky分类将CWI分为3种亚型，观察病灶侧颈部斑块性质及颈内动脉、大脑中动脉血管狭窄程度在亚型间差异。结果1脑分水岭梗死组与非分水岭梗死组相比，两组间性别、年龄、吸烟史、饮酒史、卒中史、高血压病史、糖尿病病史、冠心病病史、血脂异常、WBC、RBC、HGB、PLT、FIB、UA、GLU、病灶侧颈动脉斑块性质及ACA、PCA狭窄程度间差异无显著性（P0.05），入院时收缩压、舒张压、平均动脉压、NIHSS评分以及病灶侧颈动脉斑块检出率、ICA、MCA狭窄程度及病灶侧病变血管支数间比较，两组间差异存在统计学意义（P0.05）。2经多因素Logistic回归分析得到结果显示入院时平均动脉压（OR=0.976，95%CI0.958~0.994，P=0.010）为CWI保护因素；病灶侧ICA重度狭窄（OR=6.415，95%CI3.096~13.291，P0.001）、病灶侧MCA重度狭窄（OR=2.954，95%CI1.615~5.404，P0.001）及病灶侧多支（OR=3.142，95%CI1.709~5.775， P0.001）为CWI危险因素。3185例CWI中皮质型45例、皮质下型107例、混合型33例，各亚型所占比例分别为24.3%、57.8%、17.9%。4CWI3亚型间入院时收缩压、舒张压、平均动脉压间无差异（P0.05）。3亚型在病灶侧ICA及MCA狭窄程度间差异存在统计学意义（P0.05）。皮质型分水岭梗死ICA狭窄程度重于其他两型（P=0.041），皮质下型梗死者MCA狭窄程度较重（P=0.034）；伴有严重病灶侧ICA狭窄的3亚型颈动脉斑块性质比较，存在差异（P0.05），26例皮质型分水岭梗死患者多伴颈动脉不稳定斑块（80.8%）；3亚型在病变血管支数间比较差异存在统计学意义（P=0.019），混合型多伴有多支血管病变。结论1CWI多伴有病灶侧严重的血管狭窄，尤其与ICA或MCA重度狭窄有关。2皮质型分水岭梗死ICA狭窄较重，，皮质下型分水岭梗死以MCA狭窄程度较重；伴严重血管狭窄的皮质型分水岭梗死颈动脉以不稳定斑块常见多见；混合型多伴有病灶侧多支血管病变。3CWI患者入院时血压低于非分水岭脑梗死，且神经功能缺损症状较轻，患者入院后血压偏高对CWI为有利因素。
[Abstract]:Objective to investigate the risk factors associated with CWI in cerebral watershed infarction, and to analyze the characteristics of carotid plaques, responsible vessels and the degree of stenosis between different subtypes of the lesions, so as to provide a theoretical basis for individualized treatment and secondary prevention. Methods 403 patients with acute cerebral infarction diagnosed by diffusion weighted imaging (DWI) were divided into watershed infarction group and non-watershed infarction group according to their imaging characteristics. The clinical features of cerebral watershed infarction patients were analyzed. According to the classical Bogousslavsky classification, CWI was divided into three subtypes. The characteristics of plaque and internal carotid artery were observed. The degree of stenosis of middle cerebral artery was different among the subtypes. Results 1 gender, age, smoking history, drinking history, stroke history, hypertension history, diabetes history, coronary heart disease history were compared between the cerebral watershed infarction group and the non-watershed infarction group. There was no significant difference in the character of carotid plaques and the stenosis degree of ACAA PCA in the lesion side. The systolic blood pressure and diastolic blood pressure at admission were not significantly different between the patients with dyslipidemia and the patients with dyslipidemia. The mean arterial pressure and NIHSS scores and the detection rate of carotid plaques in the lesion side were compared between the stenosis degree of ICA and MCA and the number of vessel branches in the lesion side. The difference between the two groups was statistically significant. The results of multivariate Logistic regression analysis showed that the mean arterial pressure at admission was 0.97695 CI 0.958 and 0.994Pao 0.010) as a protective factor for CWI. There were 45 cases of cortical type, 107 cases of subcortical type, 33 cases of mixed type and 24.37.817.97.97.97.99.4CWI3 subtype of ICA in the lesion side. The risk factors of CWI were 6.415995 CI3.0969CI13.291t P 0.001g, 2.954-95CI1.6155.404p0.001) and the risk factors of CWI were 45 cases of cortical type, 107 cases of subcortical type and 33 cases of mixed type. The proportion of each subtype was 24.37.817.917.9. 4CWI3 subtype had systolic blood pressure on admission, and 3185 cases of CWI were classified as cortical type, subcortical type and mixed type, and the proportion of each subtype was 24.37.817.99.4CWI3. Diastolic pressure, There was no significant difference in the mean arterial pressure between the subtypes of P0.05. 3 and the degree of stenosis of MCA and ICA. The degree of ICA stenosis in cortical watershed infarction was more serious than that in the other two types, and the degree of MCA stenosis in patients with subcortical infarction was more severe than that in patients with subcortical infarction. The characteristics of carotid plaques in three subtypes with severe lesion side ICA stenosis were compared. In 26 patients with cortical watershed infarction, there was a significant difference in the number of diseased vessels between the two subtypes, and the mixed type was associated with multiple vessel lesions. Conclusion 1CWI is usually accompanied by severe stenosis in the lesion side, especially in patients with severe stenosis of ICA or MCA. The severity of ICA stenosis in cortical watershed infarction is more serious than that in subcortical watershed infarction, and the degree of MCA stenosis is more severe in subcortical watershed infarction. The carotid artery of cortical watershed infarction with severe vascular stenosis is more common in unstable plaque, and the blood pressure of patients with mixed type is lower than that of non-watershed cerebral infarction on admission, and the symptom of nerve function defect is mild, and the blood pressure of mixed type patients is lower than that of non-watershed cerebral infarction on admission. High blood pressure was a favorable factor for CWI after admission.
【学位授予单位】：河北联合大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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