脑卒中性别差异的比较分析

发布时间：2018-05-14 10:47

本文选题：脑卒中 + 性别差异　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：脑卒中是危害人类生命与健康的常见病之一，其发病率和患病率常年居高不下，且有不断上升的趋势，针对脑卒中的不同病因和危险因素，做好相应的预防和治疗显得尤为重要。随着对脑血管病研究的不断深入，不同性别的卒中患者在发病率、患病率、危险因素、卒中亚型、临床表现、治疗和预后等各方面均存在差异逐渐受到人们的重视。本研究旨在通过对1000余名急性脑卒中患者进行回顾性分析，来观察不同性别脑卒中患者发病年龄、常见危险因素、卒中类型、缺血性卒中病因分型、病情严重程度等方面的不同，另外本研究对缺血性脑卒中病因分型与不同危险因素的关系进行探讨，继而实现针对性的诊断、治疗及预防。方法：回顾性收集自2011年11月至2013年11月于吉林大学第一医院神经内科住院的出血性脑卒中患者202例和缺血性脑卒中患者1143例，记录其年龄和危险因素，并且对缺血性脑卒中患者的死亡率、是否应用溶栓治疗、出入院时NIHSS评分进行记录，分析其性别差异。另外参考急性卒中治疗低分子肝素试验（TOAST）分型方法将缺血性脑卒中患者分组，分析其性别差异及相关危险因素对其发病风险的影响。结果：在脑卒中患者中，女性平均年龄大于男性，另外女性发病高峰年龄较男性大。在所有脑卒中患者中，缺血性脑血管病患者平均年龄大于出血性脑血管病，且差异有统计学意义。在常见的危险因素中，高血压和糖尿病的女性患者中所占比例高于男性，而吸烟史、饮酒史、高同型半胱氨酸、高尿酸病史在男性中所占比例则明显高于女性。相对于脑出血，与脑梗死显著相关的危险因素依次为高同型半胱氨酸血症、房颤、糖尿病、吸烟史、高脂血症，而相对于脑梗死，高血压和年龄对脑出血的影响更大。在出血性脑血管病患者中，平均发病年龄、高峰年龄、死亡率不存在性别差异。在常见危险因素中，吸烟史和饮酒史在男性中所占比例明显高于女性，其他危险因素对出血性脑血管病的影响不存在性别差异。在缺血性脑血管患者中，女性平均发病年龄及高峰年龄大于男性。在常见危险因素中，高血压和糖尿病病史在女性中所占比例高于男性，而吸烟史、饮酒史、高同型半胱氨酸、高尿酸血症在男性重的比例高于女性。在严重程度、病死率、和溶栓治疗方面不存在性别差异。对缺血性脑卒中进行TOAST分型后，LAA（大动脉粥样硬化卒中）组中男性比例高于女性，CE（心源性栓塞）和SAO（小动脉粥样硬化卒中）卒中，，女性比例高于男性，差异有统计学意义。而在SOE（其他原因所致卒中）和SUE（不明原因所致卒中）组中，男女比例无差异。房颤对CE的发生有显著作用，吸烟史对LAA的发生作用显著。结论：（1）脑卒中在危险因素和平均发病年龄方面存在性别差异。（2）无论缺血性脑卒中还是出血性脑卒中，不同危险因素对其发生所起的作用存在差异。（3）不同缺血性脑卒中亚型的发生与不同危险因素之间的相关性存在差异。因此，在脑卒中的危险因素研究和防治工作中，应该考虑不同性别患者的危险因素的不同以及不同危险因素对卒中亚型的影响，做到有的放矢，这样对于降低脑卒中的发病率、病死率和致残率才具有重要的参考价值和指导意义。
[Abstract]:Objective: stroke is one of the common diseases which are harmful to human life and health. The incidence and incidence of stroke are constantly high, and there is a rising trend. It is particularly important to prevent and treat the different causes and risk factors of stroke. The incidence, prevalence, risk factors, risk factors, Central Asian type, clinical manifestation, treatment and prognosis are gradually paid attention to. The purpose of this study is to observe the age, common risk factors, type of stroke, and the deficiency of more than 1000 acute stroke patients. The etiology of hemorrhagic stroke is different, and the severity of the disease is different. In addition, the relationship between the etiological classification of ischemic stroke and the different risk factors is discussed in this study, and then the targeted diagnosis, treatment and prevention are achieved.
Methods: 202 patients with hemorrhagic stroke and 1143 patients with ischemic stroke were collected from November 2011 to November 2013 in the Department of Neurology of No.1 Hospital of Jilin University. The age and risk factors were recorded, and the mortality of ischemic stroke patients was treated with thrombolytic therapy, and the NIHSS score was carried out at the time of admission. The gender differences were recorded. In addition, the effects of gender differences and related risk factors on the risk of ischemic stroke were analyzed with the acute stroke treatment of low molecular weight heparin test (TOAST).
Results: in stroke patients, the average age of women is greater than that of men, and the peak age of women is larger than that of men. In all stroke patients, the average age of ischemic cerebrovascular disease is greater than hemorrhagic cerebrovascular disease, and the difference is statistically significant. Among the common risk factors, women with hypertension and diabetes are among the common risk factors. The proportion of smoking history, drinking history, high homocysteine, high uric acid history was significantly higher in men than in women. Compared with cerebral hemorrhage, the risk factors associated with cerebral infarction were hyperhomocysteinemia, atrial fibrillation, diabetes, smoking history, hyperlipidemia, and relative to cerebral infarction, hypertension, and high blood pressure. Age has a greater impact on cerebral hemorrhage.
Among the patients with hemorrhagic cerebrovascular disease, the average age of onset, the peak age and the death rate did not exist in gender differences. Among the common risk factors, the history of smoking and the history of alcohol consumption were significantly higher in men than in women, and the influence of other risk factors on hemorrhagic cerebrovascular disease did not exist in gender differences.
Among the patients with ischemic cerebrovascular disease, the average age and peak age of women were greater than men. Among the common risk factors, the history of hypertension and diabetes was higher in women than in men, while smoking history, drinking history, high homocysteine, hyperuricemia were higher in males than in women. There was no gender difference in the treatment of thrombus. After the TOAST typing of ischemic stroke, the male proportion in the LAA (large atherosclerotic stroke) group was higher than that of the female, CE (cardiogenic embolism) and SAO (small atherosclerotic stroke) stroke, the female ratio was higher than that of the male, and the difference was statistically significant. In SOE (other causes of stroke) and SUE (no) There was no difference in the ratio of male to female in the stroke group. There was a significant effect of atrial fibrillation on the occurrence of CE. Smoking history had a significant effect on the occurrence of LAA.
Conclusions: (1) there is a gender difference between the risk factors and the average age of onset of cerebral apoplexy. (2) there are differences in the role of different risk factors in both ischemic stroke and hemorrhagic stroke. (3) there is a difference in the correlation between the occurrence of different ischemic stroke subtypes and the different risk factors. Therefore, in the brain In the study and prevention of the risk factors of stroke, we should consider the different risk factors of the different sex patients and the influence of different risk factors on the stroke Central Asian type, so as to make a definite target in order to reduce the incidence of stroke, the mortality rate and the rate of disability.

【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】：R743.3

【参考文献】