分支动脉粥样硬化病CISS亚型临床差异性研究

发布时间：2018-05-05 19:15

本文选题：分支动脉粥样硬化病 + CISS分型　；参考：《武汉大学》2016年博士论文

【摘要】：目的：探讨在中国缺血性卒中分型(China Ischemic Stroke Subclassification, CISS)分型基础上分支动脉粥样硬化病(Branch Atheromatous Disease, BAD)和非BAD的之间、BAD各种亚型之间临床差异性。方法：回顾性收集2013年3月24日至2015年1月16日于武汉大学中南医院神经内科住院治疗并行颅内动脉高分辨核磁共振(high-resolution magnetic resonance imaging, HR-MRI)检查的脑缺血性卒中患者146例,经过筛选最终纳入80例,依据影像学表现诊断为BAD组45例,非BAD组35例。对这两组之间的临床特征及危险因素进行对比,并行逐步回归分析探讨危险因素与分组的相关性。参照CISS分型,结合高分辨核磁共振斑块成像将两组患者进一步分为大动脉粥样硬化型(Large artery atherosclerosis, LAA)、穿支动脉疾病型(Penetrating artery disease, PAD),共纳入BAD-LAA组32例、BAD-PAD组13例、非BAD-LAA组21例、非BAD-PAD组14例,对这四组之间的临床特征及危险因素进行对比,并行逐步回归分析探讨危险因素与分组的相关性。按照缺血病灶部位将BAD组进一步分为豆纹动脉(lenticulostriate artery, LSA)组和脑桥旁正中动脉(paramedian pontine artery, PPA)组,参照CISS分型,结合高分辨核磁共振斑块成像将全部患者分为BAD-LSA-LAA组16例、BAD-LSA-PAD组8例、BAD-PPA-LAA组16例. BAD-PPA-PAD组5例,对这四组之间的临床特征及危险因素进行对比。结果：在BAD组与非BAD组的对比中发现,两组患者在危险因素方面无明显差异性,在临床特征方面BAD组入院时NIHSS评分高于非BAD组(6.09±3.01 vs 4.31±3.68,P=0.002),逐步回归分析发现吸烟患者比不吸烟患者发生BAD的风险高4.928倍(P=0.021)。在BAD-LAA组、BAD-PAD组对比中发现,BAD-LAA占所有BAD类型的71.11%,在病因危险因素及临床特征方面两组患者具有高度的一致性,行逐步回归分析后发现BAD患者中吸烟患者比不吸烟患者更易发生LAA样改变,风险比为10.20倍(P=0.048),糖尿病患者比不合并糖尿病的患者发生PAD风险高16.41 1倍(P=0.014)。在BAD-LAA组、非BAD-LAA组对比中发现,危险因素方面BAD-LAA组糖尿痫患病率低于非BAD-LAA组(18.8% vs 47.6%,P=0.035),临床特征方面两组无明显差异,行逐步回归分析BAD患者中吸烟患者比不吸烟患者相对非BAD更易发生LAA样改变,风险比为15.97倍(P=0.014),糖尿病患者比不合并糖尿病的患者发生非BAD-LAA风险高7.042倍(P=0.039)。在BAD-PAD组、非BAD-PAD组对比中发现,危险因素方面非BAD-PAD组患者年龄高于BAD-PAD组(66.64±11.08vs 55.31±15.86,P=0.040),临床特征方面BAD-PAD组入院时NIHSS评分高于非BAD-PAD组(5.38±2.99 vs 2.14±1.70,P0.001)。在BAD-LSA-LAA组、BAD-LSA-PAD组、BAD-PPA-LAA组、BAD-PPA-PAD组两两对比中,各临床特征及危险因素表现出高度的一致性,仅BAD-LSA-PAD组低密度脂蛋白高于BAD-PPA-PAD组(3.79±0.77 vs 2.57±0.96,P=0.028)。结论：BAD是一种特殊类型的脑梗死,在CISS分型下其危险因素及临床特征与大动脉粥样硬化接近。穿支动脉原位动脉粥样硬化病变约占所有BAD的三分之一。BAD各亚组之间具有高度的同质性,相同部位、不同等级动脉上相似病理改变导致的BAD和相同等级动脉上相似病理改变、不同部位的BAD在临床症状和进展特征上具有高度的一致性。
[Abstract]:Objective: To explore the clinical differences between Branch Atheromatous Disease (Branch Atheromatous Disease, BAD) and non BAD on the basis of China Ischemic Stroke Subclassification (CISS) classification in China. Methods: retrospective collection from March 24, 2013 to January 16, 2015 at Wuhan University. 146 cases of cerebral ischemic stroke were hospitalized in the neurology department of central and South hospitals in parallel with high-resolution magnetic resonance imaging (HR-MRI). After screening, 80 cases were included, 45 cases in group BAD and 35 in non BAD group according to imaging findings. The clinical features and risk factors between these two groups were analyzed. Contrast, parallel stepwise regression analysis to explore the correlation between risk factors and groups. Referring to CISS typing and high resolution MRI imaging, two groups of patients were further divided into Large artery atherosclerosis (LAA), perforator artery disease type (Penetrating artery disease, PAD), and BAD-LAA were incorporated into BAD-LAA. Group 32, BAD-PAD group 13 cases, non BAD-LAA group 21 cases, non BAD-PAD group 14 cases, compare the clinical features and risk factors between these four groups, parallel stepwise regression analysis to explore the correlation between the risk factors and the group. According to the focal site of ischemia, the BAD group is further divided into the bean striate dynamic pulse (lenticulostriate artery, LSA) group and the parasponic median. Paramedian pontine artery (PPA) group, according to CISS typing, combined with high resolution MRI imaging, all the patients were divided into group BAD-LSA-LAA 16 cases, BAD-LSA-PAD Group 8 cases, BAD-PPA-LAA group 16 cases and BAD-PPA-PAD group 5 cases. The comparison between the four groups of clinical features and risk factors were compared. Results: the comparison between the BAD group and the non BAD group It was found that there was no significant difference in the risk factors between the two groups. The NIHSS score in the BAD group was higher than that in the non BAD group (6.09 + 3.01 vs 4.31 + 3.68, P=0.002), and the stepwise regression analysis found that the smoking patients were 4.928 times higher than the non smoking patients (P=0.021). In group BAD-LAA, the BAD-PAD group was found, BAD-LAA. In 71.11% of all BAD types, two groups of patients were highly consistent in the cause of risk factors and clinical features. Stepwise regression analysis found that smoking patients in BAD were more likely to have LAA like changes than non smokers. The risk ratio was 10.20 times (P=0.048), and the risk of PAD was 16 higher in diabetics than in non diabetic patients. .41 1 times (P=0.014). In group BAD-LAA and non BAD-LAA group, the risk factors of diabetic epilepsy in group BAD-LAA were lower than that of non BAD-LAA group (18.8% vs 47.6%, P=0.035), and there was no significant difference in clinical characteristics. The stepwise regression analysis showed that smoking patients in BAD patients were more likely to have LAA like changes than non smokers. The risk of non BAD-LAA in diabetic patients was 15.97 times higher than that of non diabetic patients (P=0.039). In group BAD-PAD, non BAD-PAD groups found that the risk factors of non BAD-PAD patients were higher than those in the BAD-PAD group (66.64 + 11.08vs 55.31 + 15.86, P=0.040). The clinical characteristics of the BAD-PAD group were NIHSS. The score was higher than that in the non BAD-PAD group (5.38 + 2.99 vs 2.14 + 1.70, P0.001). In group BAD-LSA-LAA, group BAD-LSA-PAD, BAD-PPA-LAA and BAD-PPA-PAD, each clinical feature and risk factor showed a high consistency. Only BAD-LSA-PAD group low density lipoprotein was higher than group BAD-PPA-PAD (3.79 + 0.77 vs 2.57 + 0.96, P=0.028). Conclusion: BAD is A special type of cerebral infarction, whose risk factors and clinical characteristics are close to the large atherosclerosis in the CISS classification. The in situ atherosclerotic lesion of the perforator artery accounts for a high degree of homogeneity between the 1/3.BAD subgroups of all BAD, the same site, and the same pathological changes in the arteries of different grades of BAD and the same Similar pathological changes in grade arteries showed that BAD in different parts had high consistency in clinical symptoms and progress characteristics.

【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R743

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