脑白质疏松的危险因素研究

发布时间：2018-05-14 01:04

本文选题：脑白质疏松 + 危险因素　；参考：《吉林大学》2014年硕士论文

【摘要】：脑白质疏松，是指经常在老年人头CT和MRI检查中出现的脑白质的异常信号改变，被广泛认为与高龄、高血压、糖尿病、腔隙性脑梗死及脑卒中史有关。近年来，由于CT和MRI等影像检查技术在脑血管疾病中的广泛应用，该病的检出率明显提高。尽管有多个研究表明了腔隙性脑梗死患者的脑白质疏松患病率显著提高，脑白质疏松患者的腔隙性脑梗死检出率也明显增加，且两者有多个共同的危险因素，进而认为两者同为脑的小血管疾病，但针对脑白质疏松的发病机制，国内外尚未得出一致的结论。本研究通过对脑白质疏松(LA)临床相关危险因素的研究，探讨动脉硬化与脑白质疏松发生的关系以及脑白质疏松可能的发病机制。本研究严格按照入选与排除标准，从2013年1月～2013年11月在吉林大学中日联谊医院神经内科住院的患者中，收集符合研究条件且经头MRI检查和依据Fazekas评分确诊为脑白质疏松的250例，作为病例组；确诊无脑白质疏松的221例，作为对照组。均完成颈部血管彩超、TCD和头颅MRI及MRA等检查。所有资料均采用SPSS2l．0软件进行储存和处理，使用卡方检验对计数资料如一般危险因素进行分析处理。再将有统计意义的危险因素作为自变量，应用二元Logistic回归分析脑白质疏松和危险因素的关系，采用逐步进入的方式，，p0．05为进入标准，p0．1为退出标准。计量资料如PI、VS的比较采用t检验，并以均数±标准差（x±s）表示，以P0．05认为差异有统计学意义。结果显示：（1）在单因素分析中，年龄、高血压、糖尿病、脑梗死病史、腔隙性脑梗死、颈内动脉狭窄及颈内动脉粥样硬化斑块均与脑白质疏松的发生有关（PO．05）。（2）在多因素Logistic回归分析中，年龄、腔隙性脑梗死及颈内动脉粥样硬化斑块均为脑白质疏松的主要危险因素(PO．05)。（3）在t检验中，LA组左侧MCA、ACA、PCA、VA及BA的脉动指数均较对照组高，而收缩期血流速度(VS)较对照组低，差异均有统计学意义(PO．05)。综上，得出如下结论：（1）年龄、腔隙性脑梗死及颈内动脉粥样硬化斑块均为脑白质疏松的主要危险因素。（2）脑血流动力学的变化与LA的发生相关。（3）推测供应脑的大血管的动脉硬化参与了LA的形成，慢性动脉硬化可能是LA的病理生理基础和过程。
[Abstract]:Leukoaraiosis refers to the abnormal signal changes of white matter which often appear in the head CT and MRI examination of the elderly. It is widely considered to be related to the history of old age hypertension diabetes lacunar infarction and cerebral apoplexy. In recent years, CT and MRI are widely used in cerebrovascular diseases. Although several studies have shown a significant increase in the prevalence of leukoaraiosis in patients with lacunar cerebral infarction, the detection rate of lacunar infarction in patients with leukoaraiosis has increased significantly, and both have multiple common risk factors. It is believed that both of them are small vascular diseases of the brain, but there is no consistent conclusion at home and abroad on the pathogenesis of leukoaraiosis. In this study, the relationship between arteriosclerosis and leukoaraiosis and the possible pathogenesis of leukoaraiosis were studied by studying the clinical risk factors of leukoaraiosis. From January 2013 to November 2013, patients hospitalized in the Department of Neurology, Sino-Japanese Friendship Hospital, Jilin University, were enrolled in the study according to the criteria of inclusion and exclusion. Two hundred and fifty cases of leukoaraiosis diagnosed by MRI examination and Fazekas score were collected as the case group and 221 cases as the control group. TCD, MRI and MRA were performed in all patients. All the data were stored and processed by SPSS2l.0 software, and the counting data such as general risk factors were analyzed and processed by chi-square test. Then the statistical risk factors were taken as independent variables, and the binary Logistic regression analysis was used to analyze the relationship between leukoaraiosis and risk factors. The measurement data such as PIV S were compared by t test, and expressed as mean 卤standard deviation (x 卤s), and the difference was statistically significant (P0.05). The results showed that in univariate analysis, age, hypertension, diabetes, history of cerebral infarction, lacunar infarction, Stenosis of internal carotid artery and atherosclerotic plaque of internal carotid artery were related to the occurrence of leukoaraiosis. Lacunar cerebral infarction and atherosclerotic plaque of internal carotid artery were the main risk factors of leukoaraiosis (P < 0. 05). The pulsation index of PCAVA and BA in left MCAA ACAA of LA group was higher than that in control group, while systolic blood flow velocity (VS) was lower than that in control group. The differences were statistically significant. In summary, the following conclusion is drawn: 1) Age, Lacunar infarction and atherosclerotic plaque of internal carotid artery were the main risk factors of leukoaraiosis. Chronic arteriosclerosis may be the pathophysiological basis and process of LA.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742

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