青年脑梗死的头颈CTA特点及危险因素分析

发布时间：2018-05-13 20:45

本文选题：青年 + 脑梗死　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的探讨青年脑梗死的头颈CTA特点及血管情况、CISS分型及可能的危险因素,对青年脑梗死高风险人群提供一级和二级预防依据。方法病例选自2013年1月1日至2017年1月1日就诊于大连市中心医院神经内科的青年脑梗死患者,共278例,对照组选自同期住院的老年脑梗死患者(年龄均≥60岁)。符合2010年中国中华医学会所制定的急性缺血性脑卒中诊治指南标准。均经头颅DWI检查证实为脑梗死,且临床症状与影像学显示病灶相符合。对所有病例进行一般资料(包括性别、年龄、TIA或卒中史、高血压史、糖尿病史、冠心病史、心脑血管病家族史、高血压家族史、糖尿病家族史、吸烟及饮酒史)、实验室检查(包括血常规、凝血功能、血糖、血脂、同型半胱氨酸、尿酸等,部分患者行C反应蛋白及抗磷脂抗体检测)和头颈部CTA检查,并进行CISS分型。回顾性收集上述相关数据,探讨青年脑梗死的头颈CTA特点及危险因素分布。结果1.青年脑梗死占全部脑卒中的5.54%(278/5018),其中男性占87.41%,女性占15.82%,男女比例为5.52:1,发病年龄为18-45岁,平均38.27±5.36岁。2.青年组颅内动脉狭窄有108例(40.45%),颅外动脉狭窄67例(25.09%),颅内外血管同时受累44例(16.48%);老年组颅内动脉狭窄有90例(30.00%),颅外动脉狭窄106例(35.33%),颅内外血管同时受累68例(22.67%);对比两组的血管狭窄分布,青年组以颅内段为主,差异存在统计学意义(χ2=6.79,0.01P0.05)。青年组显示颅内动脉硬化152例患者,大脑前动脉病变17处,大脑中动脉病变78处,大脑后动脉病变19处,椎-基底动脉病变40处,其中大脑前动脉合并大脑后动脉病变1例,大脑中动脉合并大脑后动脉病变1例;颈总动脉硬化84处,颈内动脉硬化23处。青年组共检出血管狭窄或闭塞376处,其中有186处重度狭窄或闭塞,59处中度狭窄,131处轻度狭窄,前3个好发部位依次是大脑中动脉、颈动脉起始段及椎动脉开口处。3.青年脑梗死的CISS分型结果:大动脉粥样硬化型有136例(48.92%),心源性卒中有43例(15.47%),穿支动脉型有54例(19.42%),其他病因有7例(2.52%),病因不明有38例(13.67%),以大动脉粥样硬化型比例最高。4.在青年脑梗死患者中,既往史中有高血压病史的患者147例(53.03%),有糖尿病病史的患者80例(28.79%),有TIA或脑卒中病史的患者42例(15.15%),有脑卒中家族史的患者78例(28.03%),有高血压家族史的患者61例(21.91%),有糖尿病家族史的患者44例(19.51%),有吸烟史的患者191例(68.94%),有饮酒史的患者107例(38.64%),妊娠2例,应用毒品者1例;入院后实验室检查结果提示脂代谢异常200例(71.21%),高胆固醇血症79例(28.42%),高甘油三酯血症97例(34.89%),高低密度脂蛋白血症137例(49.28%),高密度脂蛋白降低130例(46.76%),载脂蛋白A升高53例(19.06%),脂蛋白a升高36例(12.95%),高同型半胱氨酸血症111例(40.15%),高尿酸血症80例(28.79%)。结论1.青年脑梗死患者中男性患者所占比例明显高于女性患者。2.青年脑梗死的血管病变主要分布在颅内血管,大脑中动脉是最常见的部位。CISS分型中主要的病因分型是大动脉粥样硬化型(LAA)。
[Abstract]:Objective to explore the characteristics of head and neck CTA and blood vessel, CISS classification and possible risk factors in young patients with cerebral infarction, and to provide primary and two level prevention basis for young people with high risk of cerebral infarction. Methods cases were selected from January 1, 2013 to January 1, 2017 in the neurology department of Dalian Central Hospital, 278 cases of cerebral infarction were compared. The elderly patients with cerebral infarction (aged more than 60 years old) were selected from the same period. They were in accordance with the guidelines for the diagnosis and treatment of acute ischemic stroke in China's Chinese Medical Association of China in 2010. All of them were confirmed by the head DWI examination as cerebral infarction, and the clinical symptoms were consistent with the imaging findings. General data (including sex, age, TI) were carried out. A or stroke history, history of hypertension, diabetes, coronary heart disease, family history of cardiovascular and cerebrovascular diseases, family history of hypertension, family history of diabetes, smoking and drinking history, laboratory examination (including blood routine, coagulation function, blood sugar, blood lipid, homocysteine, uric acid, C reactive protein and antiphospholipid antibody test) and head and neck CTA examination, CISS classification. A retrospective collection of the above data was made to explore the CTA characteristics and risk factors of the head and neck of young cerebral infarction. Results 1. young cerebral infarction accounted for 5.54% (278/5018) of all cerebral apoplexy, among which men accounted for 87.41%, women accounted for 15.82%, male and female ratio was 5.52:1, age of onset was 18-45, and the average of.2. youth group was 38.27 + 5.36 years old. There were 108 cases (40.45%) of arterial stenosis, 67 cases (25.09%) of cranial artery stenosis and 44 cases (16.48%) of intracranial and external vessels, 90 cases of intracranial artery stenosis (30%), 106 cases of extracranial artery stenosis (35.33%) and 68 cases (22.67%) involved in intracranial and external artery stenosis. Compared to the stenosis distribution in the two group, the young group was mainly intracranial segment, and the difference existed system in the young group. Study significance (chi 2=6.79,0.01P0.05). The young group showed 152 cases of intracranial arteriosclerosis, 17 lesions of the anterior cerebral artery, 78 lesions of the middle cerebral artery, 19 of the posterior cerebral artery and 40 of the vertebral basilar artery, 1 cases of the anterior cerebral artery and the posterior cerebral artery, 1 cases of the middle cerebral artery with the posterior cerebral artery, and the neck movement. There were 84 arteriosclerosis and 23 arteriosclerosis of internal carotid artery in the young group. There were 376 stenosis or occlusion in the young group, including 186 severe stenosis or occlusion, 59 moderate stenosis and 131 mild stenosis. The first 3 sites were the middle cerebral artery, the initial segment of the carotid artery and the CISS of the.3. young cerebral infarction in the vertebral artery opening: the large artery atherosclerosis was hard. There were 136 cases (48.92%), 43 cases (15.47%) of cardiogenic stroke, 54 of perforator artery type (19.42%), 7 (2.52%) in other causes, 38 (13.67%) of unknown etiology, with the highest proportion of.4. in young patients with cerebral infarction, 147 (53.03%) patients with history of hypertension in history, and 80 patients with diabetes history. (28.79%) 42 cases (15.15%) with TIA or stroke history, 78 patients with family history of stroke (28.03%), 61 patients with family history of hypertension (21.91%), 44 patients with family history of diabetes (19.51%), 191 cases (68.94%) with history of smoking history, 107 cases (38.64%) with history of drinking history, pregnancy 2, and drug users; The results of post hospital laboratory examination revealed 200 cases of lipid metabolism (71.21%), hypercholesterolemia in 79 cases (28.42%), high triglyceride in 97 cases (34.89%), high and low density lipoproteinemia in 137 cases (49.28%), high density lipoprotein in 130 cases (46.76%), apolipoprotein A increased in 53 (19.06%), lipoprotein a increased in 36 cases (12.95%), high homocysteine blood There were 111 cases (40.15%) and 80 cases of hyperuricemia (28.79%). Conclusion the proportion of male patients in 1. young cerebral infarction patients was significantly higher than that of female patients with.2.. The vascular lesions of cerebral infarction were mainly distributed in the intracranial vessels. The middle cerebral artery was the most common.CISS typing of the main cause classification is the large atherosclerotic type (LAA).

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

【参考文献】