缺血性脑白质疏松病变部位及严重程度的相关因素分析

发布时间：2018-04-25 13:53

  本文选题：缺血性脑白质疏松 + 部位　； 参考：《大连医科大学》2014年硕士论文

【摘要】：目的：了解缺血性脑白质疏松（Ischemic leukoaraiosis,ILA）病变部位（脑室周围白质疏松（Periventricular lesions PVL）和皮质下白质疏松（Deep white matterlesions DWML））及严重程度的相关因素，探讨ILA可能的病理生理机制。 方法：选择健康体检者为对照组，ILA患者均符合纳入及排除标准。对照组(组1）60例，男性32例，女性28例，年龄27-77岁，平均(51.68±11.13)岁。ILA组又分为单纯侧脑室体旁白质疏松（Simple periventricular lesions SPVL）组（组2）和侧脑室体旁及皮质下白质共存组（periventricular lesions and deep white matterlesions PVLDWML）（组3）；组2患者78例，男性43例，女性35例，年龄40-82岁,平均(61.50±9.68)岁；组3患者49例，男性27例，女性22例，年龄46-88岁，平均(66.39±10.15)岁。记录研究对象的一般资料，测定空腹血糖（FastingBlood Glucose，FBG）、血清总胆固醇（Total cholesterol，TC）、甘油三酯（Triglyceride，TG）、高密度脂蛋白胆固醇（High density lipoprotein-cholesterol，HDL-ch）、低密度脂蛋白胆固醇（Low density lipoprotein-cholesterol，LDL-ch）、脂蛋白(a（)Lipoprotein(a)，LP(a)）、同型半胱氨酸（Homocysteine，Hcy）、尿素氮（Bloodurea nitrogen，BUN）、肌酐（Creatinine，Cre）、尿酸（Uric acid，UA）、胱抑素C(CystatinC，CysC)、C-反应蛋白(C-reactive protein，CRP)、血浆纤维蛋白原（Fibrinogen，Fib）、部分凝血活酶时间（Partial thromboplastin time，APTT）、凝血酶原时间（Prothrombin time，PT）、凝血酶时间（Thrombin time，TT）。行头颅MRI检查。应用Fazekas分级方法对ILA的严重程度进行评级。记录头颅MRI检查所示梗死灶的数量、部位及大小。所有数据使用SPSS20.0统计学软件进行分析。检验的显著性水准为双侧检验P＜0.05。 结果： 1.组2、组3的年龄明显高于组1(P＜0.01，P＜0.01)，组3的年龄明显高于组2(P＜0.05)；组3的高血压阳性例数明显高于组1及组2(P＜0.01，P＜0.05)；组3的血清Hcy水平明显高于组1(P＜0.05）；组3的血清CysC水平明显高于组1、组2(P＜0.05，P＜0.05)；组3的血浆Fib水平明显高于组1(P＜0.01）；组2的PT明显高于组1(P＜0.05)；组2的INR明显高于组1(P＜0.05)；组2、组3的PVL评级明显高于组1(P＜0.01，P＜0.01)，组3的PVL评级明显高于组2(P＜0.01)；组3的DWML评级明显高于组1、组2(P＜0.01，P＜0.01)。所有梗死灶直径＜1.5cm，组2、组3的基底节区梗死灶数量明显高于组1(P＜0.01，P＜0.01)，组3的基底节区梗死灶数量明显高于组2(P＜0.01)；组3的幕下梗死灶数量明显高于组1、组2(P＜0.01，P＜0.01)。三组的性别、高脂血症、糖尿病、冠心病例数、吸烟史及饮酒史构成比无显著差异，血清FBG、TC、TG、HDL-ch、LDL-ch、LP(a)、BUN、Cre、UA、CRP水平及血TT、APTT无显著差异。三组的皮质下梗死灶数量无显著差异。 2.组2病变部位危险因素分析，单因素Logistic回归分析：年龄(OR=1.103)、PT（OR=1.923）、INR（OR=566.985）3个指标进入回归方程，均有统计学意义(P＜0.01；P＜0.01；P＜0.05)。多因素Logistic回归分析：年龄（OR=1.103）有统计学意义(P＜0.05)。 3.组3病变部位危险因素分析，单因素Logistic回归分析：年龄(OR=1.157)、高血压(OR=0.176)、CysC (OR=105.793)、Hcy(OR=1.087)、Fib(OR=2.380)、PT（OR=1.727）6个指标进入回归方程，均有统计学意义(P＜0.01；P＜0.01；P＜0.01；P＜0.05；P＜0.01；P＜0.05)。多因素Logistic回归分析：年龄（OR=1.154）、高血压(OR=0.147)、PT(OR=2.418)有统计学意义(P＜0.01；P＜0.01；P＜0.05)。 4.总侧脑室旁白质疏松(Total periventricular lesions，TPVL）危险因素分析，单因素Logistic回归分析：年龄(OR=0.000)、高血压(OR=0.369)、CysC(OR=18.196)、Hcy(OR=1.059)、Fib(OR=1.908)、PT（OR=1.842）、INR（OR=331.257）7个指标进入回归方程，均有统计学意义(P＜0.01；P＜0.01；P＜0.05；P＜0.05；P＜0.05；P＜0.01；P＜0.05)。多因素Logistic回归分析：年龄（OR=1.118）有统计学意义(P＜0.01；P＜0.05)。 5.年龄与SPVL评级呈显著正相关（r=0.226，P＜0.05)。 6.CysC、Hcy、Fib水平与DWML评级无显著相关。 7.年龄与TPVL评级呈显著正相关（r=0.326，P＜0.01)。 8.年龄、CysC、Hcy水平与ILA总评级（F评级）呈显著的正相关(r=0.315，P＜0.01；r=0.249，P＜0.05；r=0.187，P＜0.05)。与F评级有关指标进行多元线性回归分析:F评级=-0.868+3.016CysC+0.764高血压。 结论： 1.年龄、PT、INR是SPVL的危险因素；其中年龄是SPVL的独立危险因素，且与SPVL评级呈正相关，，可以反映SPVL的严重程度。 2.高血压、血CysC、Hcy、Fib水平是DWML的危险因素；其中高血压是DWML的独立危险因素。上述指标不能反映DWML的严重程度。 3.年龄、高血压、血Hcy、CysC、Fib水平、PT、INR是TPVL的危险因素；其中年龄是TPVL的独立危险因素，且年龄与TPVL评级呈正相关，可以反映TPVL的严重程度。年龄、血清Hcy、CysC水平与ILA总评级呈正相关，可以反映ILA的总体严重程度。CysC、高血压对ILA形成的影响最大。
[Abstract]:Objective : To investigate the possible pathological and physiological mechanisms of acute ischemic leukoaraiosis ( ila ) at the lesion site ( Periventricular lesions PVL ) and deep white matterlesions DWML .

Methods : The healthy subjects were selected as the control group and the patients with ila were accorded with the inclusion and exclusion criteria . The control group ( group 1 ) 60 cases , the male 32 cases , the female 28 cases , the age 27 - 77 years , the average ( 51.68 卤 11.13 ) years old . The ila group was divided into simple periventricular lesions SPVL group ( group 2 ) and lateral ventricle and subcortical white matter coexistence group ( periventricular lesions and deep white matterlesions PVLDWML ) ( group 3 ) ;
There were 78 males , 43 females , 35 females , age 40 - 82 years , average ( 61.50 卤 9.68 ) years .
In group 3 , 49 cases , 27 male , 22 female , 46 - 88 years old , mean ( 66.39 卤 10.15 ) years old . General data of study subjects were recorded , fasting blood glucose ( FBG ) , total cholesterol ( TC ) , triglyceride ( TG ) , high density lipoprotein cholesterol ( HDL - ch ) , low density lipoprotein cholesterol ( LDL - ch ) , uric acid ( UA ) , cystatin C ( CysC ) , uric acid ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) TT). The severity of the infarction was graded using the Fazekas classification method . The number , location and size of the infarct focus indicated by the cranial MRI examination were recorded . All data were analyzed by SPSS 20.0 statistical software . The significance level of the test was 2 - sided test ( P & lt ; 0.05 ) .

Results :

1 . The age of group 2 and group 3 was significantly higher than that in group 1 ( P & lt ; 0.01 , P & lt ; 0.01 ) , and the age of group 3 was significantly higher than that of group 2 ( P & lt ; 0.05 ) ;
The positive number of hypertension in group 3 was significantly higher than that in group 1 and group 2 ( P < 0.01 , P < 0.05 ) .
The serum homocysteine level in group 3 was significantly higher than that in group 1 ( P < 0.05 ) .
The level of serum CysC in group 3 was significantly higher than that in group 1 and group 2 ( P < 0.05 , P < 0.05 ) .
The plasma Fib level in group 3 was significantly higher than that in group 1 ( P < 0.01 ) .
The PT of group 2 was significantly higher than that in group 1 ( P < 0.05 ) .
The INR of group 2 was significantly higher than that in group 1 ( P < 0.05 ) .
The scores of PVL in group 2 and group 3 were significantly higher than those in group 1 ( P < 0.01 , P < 0.01 ) , and the scores of PVL in group 3 were significantly higher than those in group 2 ( P < 0.01 ) .
The DWML rating of group 3 was significantly higher than that of group 1 and group 2 ( P & lt ; 0.01 , P & lt ; 0.01 ) . The number of infarction foci in basal ganglia of group 2 and group 3 was significantly higher than that in group 1 ( P & lt ; 0.01 , P & lt ; 0.01 ) , and the number of infarction foci in basal ganglia region of group 3 was significantly higher than that in group 2 ( P & lt ; 0.01 ) .
The number of infarction foci was significantly higher in group 3 than in group 1 and group 2 ( P < 0.01 , P < 0.01 ) . There was no significant difference in serum FBG , TC , TG , HDL - ch , LDL - ch , LP ( a ) , BUN , cre , UA , CRP level and blood TT and PT . There was no significant difference in the number of subcortical infarcts in three groups .

2 . Analysis of risk factors of 2 lesions in group 2 , single - factor logistic regression analysis : age ( OR = 1.103 ) , PT ( OR = 1.923 ) , INR ( OR = 565.985 ) , were statistically significant ( P < 0.01 ) .
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