合并脑白质病变脑梗死患者的危险因素研究

发布时间：2018-03-02 18:51

本文选题：脑白质病变　切入点：脑梗死　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的通过对合并脑白质病变脑梗死患者的危险因素的研究，，明确是否有促发因素使脑白质病变发生急性脑梗死或腔隙性脑梗死的风险增加，并探讨是否有促发因素使静息腔隙性梗死发生急性脑梗死的风险增加，从而为临床缺血性脑血管病的治疗和预防提供一定的依据。方法收集2012年3月至2013年12月山西医科大学第二临床医学院神经内科的缺血性脑血管病患者，共252例，依据头颅核磁共振成像和磁共振弥散成像技术表现分为脑白质病变组(WML,125例)、伴有脑白质病变的急性脑梗死组(aCI+WML,32例)、伴有脑白质病变的腔隙性梗死组(LI+WML,43例)、腔隙性梗死组(LI,28例)、伴有静息腔隙性梗死的急性脑梗死组(aCI+LI,24例)，了解患者的年龄、性别、吸烟、饮酒、糖尿病、高血压、H型高血压、胆固醇、低密度脂蛋白、高密度脂蛋白、甘油三脂的情况，利用卡方检验及二元Logistic回归模型对这些因素在WML组与aCI+WML组、WML组与LI+WML组、LI组与aCI+LI组进行组间的比较，分析危险因素对脑白质病变和腔隙性梗死发生脑梗死的影响情况；除外WML+LI共存的病例后，将以上病例分为急性脑梗死（aCI，56例）和非急性脑梗死（nCI，153例），通过卡方检验分析脑白质病变和腔隙性梗死在两组的分布情况；所有数据采用SPSS17.0软件进行统计分析，以P＜0.05为差异具有统计学意义。结果 1.WML组与aCI+WML组行卡方检验后发现，年龄、性别、高血压、H型高血压、胆固醇升高在两组间差别具有统计学意义（P＜0.05），行二元Logistic回归模型分析后发现，胆固醇、低密度脂蛋白升高在两组间差别具有统计学意义（P＜0.05）；胆固醇升高使脑白质病变发生急性梗死的风险增加12倍以上（OR=12.677）；低密度脂蛋白升高使脑白质病变发生急性脑梗死的风险增加3倍以上（OR=3.459）。 2.WML组与LI+WML组行卡方检验后发现，高血压、胆固醇升高在两组间的差别具有统计学意义（P＜0.05）；行二元Logistic回归模型分析后发现，高血压、胆固醇升高在两组间的差别具有统计学意义（P＜0.05），胆固醇使脑白质病变患者发生腔隙性脑梗死的风险增加18倍以上（OR=18.219），高血压使脑白质病变发生腔隙性脑梗死的风险增加7倍以上（OR=7.120）。 3.LI组与LI+aCI组行卡方检验和二元Logistic回归模型分析发现各危险因素在两组间的差别无统计学意义（P＞0.05）。 4.静息腔隙性梗死与脑白质病变在急性脑梗死和非急性脑梗死组的分布差别具有统计学意义（P＜0.05），静息腔隙性梗死发生急性脑梗死的风险更大，约为脑白质病变的3.348倍（OR=3.348）。结论：胆固醇升高是脑白质病变患者发生急性脑梗死和腔隙性梗死的独立危险因素，低密度脂蛋白升高是脑白质病变患者发生急性脑梗死的独立危险因素，高血压是脑白质病变患者发生腔隙性脑梗死的独立危险因素；与脑白质病变比较，静息腔隙性梗死与急性脑梗死的关系更为密切，发生急性梗死的风险越高。
[Abstract]:objective
By studying the risk to patients with cerebral white matter lesions of cerebral infarction, to determine whether a precipitating factor to increase the risk of cerebral white matter lesions in acute cerebral infarction or lacunar infarction, and to explore whether there is a risk factor to promote the rest of lacunar infarction occurred in the patients with acute cerebral infarction, so as to provide a basis for treatment and prevention and treatment of ischemic cerebrovascular disease.
Method
Department of Neurology, Clinical Medical College of Shanxi Medical University from March 2012 to December 2013, second patients with ischemic cerebrovascular disease, a total of 252 cases, on the basis of cranial magnetic resonance imaging and magnetic resonance diffusion imaging were divided into cerebral white matter lesions (group WML, 125 cases), acute cerebral infarction with cerebral white matter lesions (32 cases of aCI+WML). With cerebral white matter lesions in lacunar infarction group (LI+WML, n = 43), lacunar infarction group (LI, n = 28), acute cerebral infarction accompanied by resting lacunar infarction (aCI+LI, n = 24), understand the patient's age, gender, smoking, drinking, diabetes, hypertension, type H hypertension, cholesterol, low density lipoprotein, high density lipoprotein, glycerin three greases, using the chi square test and Logistic regression model of these two factors in WML group and aCI+WML group, WML group and LI+WML group, LI group and aCI+LI group were compared between the groups, analysis of risk factors for brain The effect of white matter lesions of cerebral infarction and lacunar infarction; except the coexistence of the WML+LI cases, the patients were divided into acute cerebral infarction (aCI, n = 56) and non acute cerebral infarction (nCI, n = 153), through the analysis of cerebral white matter lesions and lacunar infarction in the distribution in the two groups by chi square test; all data were analyzed by SPSS17.0 software, with P < 0.05, the difference was statistically significant.
Result
1.WML group and aCI+WML group were analyzed by chi square test revealed that age, gender, hypertension, type H hypertension, elevated cholesterol in a statistically significant difference between the two groups (P < 0.05), two Logistic regression model analysis showed that elevated cholesterol, low density lipoprotein in a statistically significant difference between the two groups (P < 0.05); cholesterol increased the risk of cerebral white matter lesions of acute infarction increases more than 12 times (OR=12.677); low density lipoprotein increased the risk of cerebral white matter lesions in acute cerebral infarction (OR=3.459) increased by more than 3 times.
2.WML group and LI+WML group were analyzed by chi square test revealed that high blood pressure, cholesterol levels between the two groups was statistically significant difference (P < 0.05); model analysis for two yuan Logistic regression showed that hypertension, cholesterol levels between the two groups was statistically significant difference (P < 0.05), the risk of brain cholesterol patients with white matter lesions of lacunar infarction (OR=18.219) increased by more than 18 times the risk of hypertension, cerebral white matter lesions occurred in lacunar infarction (OR=7.120) increased by more than 7 times.
The chi square test and two yuan Logistic regression model of group LI+aCI and group 3.LI found no significant difference in the difference between the two groups (P > 0.05).
4. there was a significant difference in the distribution of resting lacunar infarcts and white matter lesions in acute cerebral infarction and non acute cerebral infarction group (P < 0.05). The risk of acute cerebral infarction in resting lacunar infarction was greater than that in white matter lesions, which was 3.348 times higher than that in white matter lesions (OR=3.348).
Conclusion: cholesterol is an independent risk factor in patients with cerebral white matter lesions in acute cerebral infarction and lacunar infarction, elevated low density lipoprotein is an independent risk factor in patients with cerebral white matter lesions in acute cerebral infarction and hypertension were independent risk factors of cerebral white matter lesions in patients with lacunar cerebral infarction;
Compared with white matter lesions, the relationship between resting lacunar infarction and acute cerebral infarction is closer, and the risk of acute infarction is higher.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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