非心源性缺血性脑卒中患者踝臂指数（ABI）与动脉粥样硬化多血管床损害

发布时间：2018-03-26 21:41

本文选题：非心源性缺血性脑卒中　切入点：ABI　出处：《大连医科大学》2014年硕士论文

【摘要】：目的：了解踝臂指数（ankle-brachial index，ABI）与非心源性缺血性脑卒中患者动脉粥样硬化多血管床损害及其危险因素的关系方法：选择进行ABI评价的非心源性缺血性脑卒中患者为研究对象，根据ABI评价结果，将观察对象分为ABI正常组和ABI减低组用颈动脉椎及锁骨下动脉彩超心脏彩色多普勒超声及心电图或动态心电图血清胱抑素（Cys）测定，并结合既往病史评价两组患者动脉粥样硬化多血管床损害情况结果：共纳入非心源性缺血性脑卒中患者122例，其中ABI正常者89（72.95%）例，ABI减低者33（27.05%）例，其中仅有8例（24.24%）患者有间歇性跛行症状 ABI减低组的ABI值低于正常组(0.740.15vs1.100.58，P0.01)两组患者性别吸烟饮酒比例比较，差异无统计学意义（P0.05）；但ABI减低组中高血压（78.79%vs51.69%）糖尿病（45.45%vs21.34%）血脂异常（75.75%vs60.67%）的患病率均比正常组高（P0.05）两组患者冠心病（48.48%vs26.69%）肾功能异常（75.76%vs48.31%）的比率相比较， AB I减低组均高于正常组（P0.05）且CysC的中位数ABI减低组高于正常组（1.46vs1.12，P0.01）将两组患者的ABI值与CysC进行线性相关分析显示，结果显示两者之间无线性相关关系（P0.05）两组患者颈动脉椎动脉及锁骨下动脉粥样硬化的情况比较， ABI减低组的颈动脉粥样硬化比率（100%vs82.02%）及颈动脉合并椎动脉或锁骨下动脉粥样硬化的比率（66.67%vs41.57%）均高于正常组，且差异均有统计学意义（P0.05）两组患者颈动脉IMT增厚情况的比较，其中IMT一处增厚和两处增厚的比率无统计学意义（P0.05）；ABI减低组三处及以上增厚的比率明显高于ABI正常组（81.81%vs53.93%，P0.01）两组患者伴发冠心病肾功能异常颈或椎动脉及锁骨下动脉粥样硬化的情况比较，两组患者中伴发两种疾病的比率无明显差异；伴发三种疾病的比率高于ABI正常组（27.27%vs8.99%,P0.05）以ABI减低为因变量，将年龄高血压病糖尿病血脂异常冠心病肾功能异常颈动脉粥样硬化作为自变量，进行多因素Logistic回归分析，结果除高血压及颈动脉硬化外，，年龄（OR=0.923，95%的CI：0.857～0.994；P0.05）糖尿病（0R=0.183,95%的CI：0.055～0.606；P0.01）血脂异常（OR=0.243,95%的CI：0.067～0.882； P0.05）冠心病（OR=0.327,95%的CI：0.134～0.795；P0.05）及肾功能异常(OR=0.264，95%的CI=0.101～0.685， P0.01)均为ABI减低的独立危险因素结论：非心源性缺血性脑卒中患者ABI异常的发生率较高27.05%，其中仅有24.24%左右患者有间歇性跛行症状年龄糖尿病血脂异常冠心病肾功能异常是ABI减低的独立危险因素ABI减低的患者合并冠心病及肾功能异常的比率较高，提示非心源性缺血性脑卒中患者可能存在着动脉粥样硬化多血管床的损害测量ABI是评价动脉粥样硬化多血管床损害的一种简便无创的筛查方法
[Abstract]:Objective: to investigate the relationship between ankle-brachial index ABI (ankle brachial index) and atherosclerotic multivascular bed damage and its risk factors in patients with non-cardiogenic ischemic stroke. Methods: Non-cardiogenic ischemic stroke patients who were evaluated by ABI were selected as the study subjects. According to the results of ABI evaluation, The subjects were divided into two groups: normal ABI group and low ABI group. The subjects were measured by color Doppler echocardiography and electrocardiogram (ECG) or dynamic electrocardiogram (DECG) in carotid vertebrae and subclavian artery. Multivessel bed damage of atherosclerosis in both groups was evaluated in combination with previous medical history. Results: a total of 122 patients with non-cardiogenic ischemic stroke were included, of whom 8972.95 had normal ABI and 332.05 had decreased ABI, only 8 of them had intermittent claudication symptoms. The ABI value in the ABI reduction group was lower than that in the normal group (0.740.15 vs 1.100.58 / P0.01). There was no significant difference in smoking and drinking ratio between the two groups, but the prevalence rate of 78.79 vs 51.69 in the ABI reduction group was higher than that in the normal group (75.75 vs 60.67). The ratio of abnormal renal function (75.76 vs 48.31) in the two groups was higher than that in the normal group (P 0.05), and the median ABI of the CysC decreased group was higher than that of the normal group (1.46 vs 1.12 P 0.01). The linear correlation analysis showed that the ABI value of the two groups was correlated with CysC. The results show that there is a wireless correlation between them (P0.05). Comparison of carotid vertebral artery and subclavian artery atherosclerosis in two groups, the ratio of carotid artery atherosclerosis and carotid artery combined with vertebral artery or subclavian artery atherosclerosis in ABI reduction group was 100 vs 82.022.02) and the ratio of carotid artery with vertebral artery or subclavian artery atherosclerosis was 66.67 vs 41.57). The difference was statistically significant (P0.05). Comparison of carotid IMT thickening between the two groups, there was no significant difference in the ratio of IMT thickening in one place and two thickening. The ratio of thickening in three or more places in the IMT group was significantly higher than that in the normal ABI group (81.81 vs 53.93). There was no significant difference between the two groups in the incidence of coronary heart disease associated with abnormal renal function, cervical or vertebral artery and subclavian artery atherosclerosis, and the ratio of the three diseases was higher than that in the normal ABI group (27.27vs8.99g, P 0.05). With the decrease of ABI as dependent variable, coronary artery disease with abnormal renal function and carotid atherosclerosis were used as independent variables in patients with age hypertension, diabetes mellitus, dyslipidemia, coronary artery disease, and carotid atherosclerosis. The results were obtained by multivariate Logistic regression analysis, except hypertension and carotid atherosclerosis. Age: 0.8570.994P0.05) Diabetes mellitus 0.18395% CI: 0.055 0.606P0.01) dyslipidemia 0.24395% CI: 0.0670.882; P0.05) Coronary heart disease OR0.32795% CI0.1340.795P0.05) and abnormal renal function OR0.26495% CI 0.1010.685, P0.01) are independent risk factors for decreasing ABI. Conclusion: the incidence of abnormal ABI in patients with non-cardiogenic ischemic stroke is 27.05. Only 24.24% of the patients with intermittent claudication symptoms, age diabetes, dyslipidemia, coronary heart disease, abnormal renal function are independent risk factors of ABI reduction. The incidence of coronary heart disease and abnormal renal function was higher in patients with reduced ABI. The results suggest that ABI is a simple and noninvasive screening method for evaluating the multivascular bed damage of atherosclerosis in patients with non-cardiogenic ischemic stroke.
【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;R543.5

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