迁徙相关脑梗死危险因素和机理研究

发布时间：2018-04-11 06:31

  本文选题：不同气候带迁徙 + 脑梗死　； 参考：《中国人民解放军医学院》2014年硕士论文

【摘要】：目的： 1.通过流行病学调查，初步分析中老年秋冬季不同气候带迁徙后脑梗死的发生与气候带迁徙的相关性。 2.对中老年秋冬季不同气候带迁徙相关脑梗死的危险因素和发病机理进行研究，，以利于采取有效的预防及治疗措施。 方法: 1.（1）在三亚东北、华北、西北地区（“三北”地区）人群居住集中的小区进行随机抽样调查，根据比例计算每月由“三北”地区迁徙至三亚的中老年人数，以及非迁徙组、非秋冬季迁徙组及秋冬季迁徙组中老年人数；（2）在三亚市各大医院收集来自“三北”地区中老年脑梗死患者；（3）计算以上各组中老年脑梗死发病率，以及秋冬季迁徙组和非秋冬季迁徙组中老年迁徙后3周内脑梗死发病率。（4）应用卡方检验计算脑梗死发病率差异。 2.收集秋冬季由“三北”地区迁徙至三亚3周内发生脑梗死的中老年患者144例作为病例组，收集同期由“三北”地区至三亚但3周内未发生脑梗死的中老年147例作为对照组。登记两组中老年的一般资料、脑血管病危险因素、迁徙相关因素及临床特点。根据患者临床及影像学结果分析病例组患者脑梗死类型。应用单因素分析及多因素分析分析中老年冬季不同气候带迁徙相关脑梗死的危险因素。 结果: 1.（1）非迁徙组、非秋冬季迁徙组及秋冬季迁徙组中老年在秋冬季脑梗死发病率分别为17.18/万、29.85/万和39.97/万，各组间存在统计学差异，秋冬季迁徙组秋冬季脑梗死发病率高于非秋冬季迁徙组及非迁徙组。（2）中老年在秋冬季迁徙及非秋冬季迁徙后3周内脑梗死的发病率分别为20.86/万和3.85/万，存在统计学差异。 2.中老年秋冬季不同气候带迁徙相关脑梗死独立危险因素包括男性、脑血管病史、糖代谢异常、脑动脉狭窄、高同型半胱氨酸血症、迁徙前后温差≥30℃、迁徙后平均动脉压低。糖代谢异常、脑动脉狭窄、迁徙前后温差≥30℃分别使该类脑梗死发病率提高10.938、14.966和2.51倍。高血压不是该类脑梗死的独立危险因素。分水岭型脑梗死占该类脑梗死的78.47%（113/144）。 结论： 1.中老年秋冬季不同气候带迁徙后发生的脑梗死为一特殊类型的脑梗死，其发生可能与气候带迁徙因素以及个人因素有关。 2.秋冬季由寒带边缘、寒温带跨越温带、亚热带到达热带的中老年迁徙后脑梗死的发生与不同气候带迁徙和个体因素相关。分水岭型脑梗死为此类脑梗死的主要类型。考虑血流动力学障碍引起的脑灌注不足为该类脑梗死的主要原因，可针对以上危险因素及病因进行预防及治疗。
[Abstract]:Objective:1.Through epidemiological investigation, the correlation between cerebral infarction and climatic zone migration in autumn and winter was preliminarily analyzed.2.The risk factors and pathogenesis of cerebral infarction associated with migration in different climatic zones in autumn and winter were studied in order to take effective preventive and therapeutic measures.Methods:(1) A random sampling survey was conducted in the residential areas of the northeast, north and northwest of Sanya ("three northern" areas), and the number of middle-aged and old people migrating to Sanya from the "three north" areas per month, as well as the non-migration groups, were calculated according to the proportions.In the non-autumn and winter migration group and the autumn and winter migration group, the number of middle-aged and elderly people were collected from various hospitals in Sanya City. The incidence of middle and old age cerebral infarction was calculated in the above groups, which were collected from the middle and old aged cerebral infarction patients in the "three north" areas.And the incidence of cerebral infarction within 3 weeks after migration in autumn and winter migration group and non-autumn winter migration group.) chi-square test was used to calculate the incidence of cerebral infarction.2.144 middle-aged and elderly patients with cerebral infarction in three weeks from "three north" areas to Sanya in autumn and winter were collected as case group, and 147 middle-aged and elderly patients from "three north" area to Sanya in the same period were collected as control group.General data, cerebrovascular risk factors, migration related factors and clinical features of the two groups were registered.The type of cerebral infarction was analyzed according to the clinical and imaging results.Univariate analysis and multivariate analysis were used to analyze the risk factors of cerebral infarction associated with migration in different climatic zones in winter.Results:1.The incidence of cerebral infarction in the middle and old aged in the non-migration group, non-autumn winter migration group and autumn winter migration group were 171.8 / 10 5 / 10 5 and 39 97 / 10 5 respectively in autumn and winter, and there were statistical differences among the three groups.The incidence of cerebral infarction in autumn and winter migration group was higher than that in non autumn winter migration group and non migration group.2.The independent risk factors of cerebral infarction associated with migration in different climatic zones in autumn and winter included male, history of cerebrovascular disease, abnormal glucose metabolism, cerebral artery stenosis, hyperhomocysteinemia, temperature difference of 鈮

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