缺血性脑血管病脑动脉狭窄与ESSEN卒中风险评分及相关危险因素分析

发布时间：2018-03-25 16:25

本文选题：脑血管疾病　切入点：狭窄　出处：《大连医科大学》2014年硕士论文

【摘要】：目的：探讨缺血性脑血管病（Ischemic cerebral vascular disease，ICVD）患者脑动脉狭窄与ESSEN卒中危险评分(Essen stroke risk score,ESRS)及相关危险因素的相关性。方法：连续纳入482例行脑血管造影的症状性脑动脉狭窄患者，整理患者的临床资料（包括性别、年龄、高血压、糖尿病、既往心肌梗死、其它心脏病、吸烟、既往TIA或者卒中、外周动脉疾病、低密度脂蛋白、甘油三酯、胆固醇、高脂血症病史、同型半胱氨酸、C-反应蛋白、尿酸等）并对其进行ESRS评分,记录患者脑动脉狭窄的部位（前循环、后循环及颅内动脉、颅外动脉）。将血管狭窄度分为轻度狭窄10%～49%，中度狭窄50%～69%，重度狭窄＞70%～100%。如果是串联性狭窄则计算狭窄最严重处。按ESRS评分将患者分为卒中复发低危组（0～2分）及高危组（≥3分）。分析ESRS评分与脑血管狭窄程度及部位的相关性。以上各危险因素为自变量，，以血管狭窄为应变量，采用非条件Logistic回归分析相关变量。结果：482例缺血性脑血管病患者中，低危组198例(41.1%)，高危组284例（58.9%）。⑴高危组的年龄、高血压、糖尿病、心肌梗死病史、周围动脉疾病的比率高于低危组，差异有统计学意义（PO．05或PO.01）；而性别、吸烟的差异无统计学意义。⑵血管轻度狭窄64例(13.3%)，中度狭窄111例(23.0%)，重度狭窄或闭塞307例(63.7%)。Pearson直线相关分析显示，ESRS评分与血管狭窄度呈正相关（r=0.095，P=0.037）。说明血管的狭窄度与ESRS评分是相关的，脑血管的狭窄度越大，ESSEN分值越高。⑶482例中，前、后循环均有狭窄者占52.1%（251/482），前循环狭窄者占29.0%（140/482），后循环狭窄者占18.9%（91/482）。高危组前、后循环均有狭窄者占61.6%（175/284），高于低危组的38.4%（76/198）；而低危组的前循环狭窄患者较多占40.4%（80/198），差异有统计学意义（PO.01）。⑷482例缺血性脑血管病患者中，颅外动脉狭窄者占45.9%（91/482），颅内-外动脉均有狭窄着占90.5%（257/284），高于低危组的77.8%（154/198），差异有统计学意义（PO.01）。（5）以年龄、高血压、糖尿病、既往心肌梗死、其它心脏病、吸烟、既往TIA或者卒中、外周动脉疾病、低密度脂蛋白、甘油三酯、胆固醇、高脂血症病史、同型半胱氨酸、C-反应蛋白、尿酸等危险因素为自变量，以血管狭窄为应变量，采用非条件Logistic回归分析，逐步剔除了关系无显著性的变量，最后的回归模式剩下了有差异的变量为高血压、其它心脏病、高脂血症史、尿酸。高血压，其它心脏病(除外心肌梗死和心房纤颤)、高脂血症史、尿酸为脑血管狭窄的独立危险因素。结论：缺血性脑血管病患者脑动脉狭窄程度与ESRS评分相关，ESRS评分不同时脑动脉病变的部位分布有区别。高血压，其它心脏病(除外心肌梗死和心房纤颤)、高脂血症史、尿酸为脑血管狭窄的独立危险因素。
[Abstract]:Objective: to investigate the correlation between cerebral artery stenosis and ESSEN stroke risk score (Essen stroke risk score#en0#) and related risk factors in patients with ischemic cerebral vascular disease (ICVD). Methods: the clinical data of 482 patients with symptomatic cerebral artery stenosis, including sex, age, hypertension, diabetes, previous myocardial infarction, other heart disease, smoking, were analyzed. TIA or stroke, peripheral artery disease, low density lipoprotein, triglyceride, cholesterol, history of hyperlipidemia, homocysteine C-reactive protein, uric acid, etc. The sites of cerebral artery stenosis (anterior circulation, posterior circulation and intracranial artery) were recorded. Extracranial artery. The degree of stenosis is divided into mild stenosis and 49 degrees of stenosis, moderate stenosis of 50 to 69, severe stenosis of more than 70 to 100. If it is series stenosis, the most severe stenosis is calculated. According to ESRS score, patients are divided into two groups (0 ~ 2 points in low risk group of stroke recurrence) and high risk group (. The correlation between the ESRS score and the degree and location of cerebral vascular stenosis was analyzed. The above risk factors were independent variables. Vascular stenosis was used as dependent variable and non-conditional Logistic regression analysis was used. Results among 482 patients with ischemic cerebrovascular disease, 198 cases were in low risk group, and 284 cases in high risk group were 58.9% in age, hypertension, diabetes mellitus, myocardial infarction history, peripheral artery disease ratio was higher than that in low risk group. The difference was statistically significant, either PO.05 or PO.01. There was no significant difference in smoking between 64 cases with mild stenosis, 111 cases with moderate stenosis, and 307 cases with severe stenosis or occlusion. Pearson linear correlation analysis showed that there was a positive correlation between ESRS score and vascular stenosis. The greater the degree of cerebral vascular stenosis is, the higher the score of ESSEN is .3482 cases. In the patients with anterior and posterior circulation stenosis, the proportion of patients with stenosis of posterior circulation is 25.1 / 482U, the proportion of patients with anterior stenosis is 29.0 / 140 / 482N, and that of patients with posterior circulation stenosis is 18.9% / 4820.In the high risk group, The proportion of patients with stenosis of posterior circulation was 61.6 / 285, which was higher than that of low-risk group (38.4%), while that of low-risk group was 40.4 / 80 / 1980.The difference was statistically significant in patients with ischemic cerebrovascular diseases. The number of patients with extracranial artery stenosis was 45.9 / 482, and the intracranial / external artery stenosis was 90.5 / 257 / 284, which was higher than that in the low-risk group (77.8 / 154.The difference was statistically significant (P < 0.05).) Age, hypertension, diabetes, past myocardial infarction, other heart disease, smoking, past TIA or stroke, Peripheral artery disease, low density lipoprotein, triglyceride, cholesterol, hyperlipidemia history, homocysteine C-reactive protein, uric acid and other risk factors were independent variables, vascular stenosis as dependent variables, non-conditional Logistic regression analysis. The variables that had no significant relationship were gradually excluded, and the final regression model was left with the variables of hypertension, other heart disease, history of hyperlipidemia, uric acid, hypertension, Other heart diseases (excluding myocardial infarction and atrial fibrillation, history of hyperlipidemia and uric acid were independent risk factors for cerebrovascular stenosis. Conclusion: the degree of cerebral artery stenosis in patients with ischemic cerebrovascular disease is different from the distribution of cerebral artery lesions in the same time as ESRS scores. Hypertension, other heart diseases (except myocardial infarction and atrial fibrillation, history of hyperlipidemia), Uric acid is an independent risk factor for cerebrovascular stenosis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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