不稳定斑块的影像学特性和短暂性脑缺血发作临床特征的相关性研究

发布时间：2018-05-30 02:45

本文选题：短暂性脑缺血发作 + 高分辨磁共振　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:通过高分辨磁共振(High resolution magnetic resonance imaging HRMRI)检查分析颈动脉系统短暂性脑缺血发作(Transient ischemic attack TIA)患者的颈部血管不稳定斑块的特性,并研究这些斑块特性与颈动脉系统的TIA患者入院后短暂性神经功能缺失的发作次数、每次发作持续时间的相关性,对TIA患者临床治疗起指导作用。方法:1收集2015年1月份-2016年12月份,所有入住唐山工人医院神经内科并确诊为颈动脉系统的TIA患者,入院后常规对这些患者行头颈MRA,颈动脉超声,经颅多普勒超声(Transcranial doppler,TCD)等相关检查,同时收集患者的一般临床资料,筛选出有不稳定斑块或颈动脉狭窄的颈动脉系统的TIA患者,且TIA症状与颈动脉狭窄位置相关,然后对患者行HRMRI检查,并且筛选出因不稳定斑块引起的动脉狭窄患者,最终134例患者入组。2对入组患者均给予硫酸氢氯吡格雷片75mg口服1/早联合拜阿司匹林肠溶片100mg口服1/晚,阿托伐他汀钙片20mg口服1/晚等药物治疗。通过影像学结果研究不稳定斑块的特性-薄或破裂纤维冒(纤维冒厚度0.7mm)、大脂质核心(斑块体积的40%)、钙化、斑块内出血(intraplaque hemorrhage,IPH)等,同时分析斑块特性和颈动脉系统的TIA患者住院7天内的神经功能缺失的发作次数、每次发作持续时间的关系等的临床特征的相关性。3采用SPSS17.0统计软件进行临床实验数据的录入并进行统计学分析。根据TIA发作次数,每次发作的持续时间分组,不稳定斑块的每一特性分别在发作次数组内以及发作持续时间组内进行单因素分析的χ2检验,当P0.05时,有统计学意义,对有统计学意义的不稳定斑块的特性纳入有序Logistic回归方程,分析不稳定斑块的特征与颈动脉系统的TIA患者临床特征的相关性,进行统计学分析,当P0.05时说明有统计学意义,OR1时,说明是TIA患者神经功能缺失严重程度的保护因素,当OR1时,则是危险因素。结果:1研究期间对收集到符合条件的134例的颈动脉系统的TIA患者的资料进行统计分析。按照临床神经功能缺失次数,每次发作持续时间进行分组。研究期间临床神经功能缺失发作次数≤1次、2-3次、3次的病人数分别是55例、42例、37例,按照每次发作持续时间进行分组,依次是发作持续时间≤10min组、10-30min组、30min组,每组人数分别是45、52、37。2对患者的一般基线资料在每组间进行单因素分析的χ2检验,P值均大于0.05,无统计学意义,则患者的一般基线资料对TIA患者的神经功能发作次数以及每次发作的持续时间无影响。3记录住院7天内发作次数≤1次组中,薄或破裂纤维冒、大脂质核心、钙化、斑块内出血分别是10、13、30、9例,发作次数为2-3次组中分别有9、22、23、11例,发作次数3次组中有20、17、19、15例,以每次发作的持续时间进行分组,分别是发作持续时间≤10min组(45例),发作持续时间10-30min组(52例)以及有37例发作时间持续时长30min的患者为第三组。斑块在HRMRI检查结果显示有薄或破裂纤维冒、脂质核心、钙化、斑块内出血的患者中,每次发作症状持续时间≤10min有17、11、21、15例,发作症状持续时间10-30min组中,患者依次有20、24、27、10例,发作症状持续时间30min组中分别有23、27、20、17例。4分别对患者的计数及计量临床基线资料进行秩和检验或单因素的χ2检验,P值均大于0.05,无统计学意义,则患者的一般临床资料对TIA患者的神经功能发作次数以及每次发作的持续时间无影响。5 TIA患者临床特性影响因素分析:将单因素分析有意义的是否有薄或破裂纤维冒(无=0,有=1),是否有大脂质斑块(无=0,有=1),是否合并内出血(无=0,有=1)作为自变量,分别将发作的持续时间(≤10min=1,10-30min=2,30min=3)、发作次数(≤1次=1,2-3次=2,3次=3)为因变量进行有序Logistic回归分析。6结果患者的脂质核心、斑块内出血、薄或破裂纤维冒进入回归方程,说明不稳定斑块的这三个因素是影响TIA患者发作次数、每次发作的持续时间的因素,且OR1,说明脂质核心、斑块内出血、薄或破裂纤维冒是TIA患者临床特征的危险因素,使临床发作次数增加,每次发作的持续时间延长,斑块钙化对临床发作次数及每次发作的持续时间无明显相关性。结论:1通过HRMRI检查提示,不稳定斑块的薄或破裂纤维冒,大脂质核心,斑块内出血影响TIA患者的每次发作的持续时间长短及发作次数的多少,使患者每次发作的持续时间、发作次数比无相关因素的发作次数增多、每次发作的持续时间长。2斑块钙化对TIA患者的神经功能缺失发作的次数,每次发作的持续时间无明显相关性,没有使短暂性脑缺血发作患者每次发作的时间延长及次数增多。3斑块的不稳定性因素有很多,通过本次研究得出,并不是所有的不稳定因素与短暂性脑缺血发作临床特征有一定的相关性,所以在临床工作中通过了解斑块特性,并做出针对性治疗,对疾病的治疗及预防有着深远的意义。
[Abstract]:Objective: to examine the characteristics of cervical vascular instability in patients with transient ischemic attack (Transient ischemic attack TIA) of the carotid system (Transient ischemic attack TIA) by High resolution magnetic resonance imaging HRMRI and to study the characteristics of these plaque and the transient neurological deficit after admission to the carotid system. The frequency of loss of attack and the correlation of duration of each episode will guide the clinical treatment of TIA patients. Methods: 1 to collect all TIA patients who had been admitted to the Department of Neurology of Tangshan workers' hospital and diagnosed as carotid artery system in December January -2016 2015. After admission, the patients were routinely treated with the head neck MRA, carotid ultrasound, and transcranial Doppler. Transcranial Doppler (TCD) and other related examinations, and the general clinical data of the patients were collected, and TIA patients with unstable plaque or carotid artery stenosis were screened, and the TIA symptoms were associated with the position of carotid stenosis, then the patients were examined by HRMRI, and the patients with arterial stenosis caused by unstable plaques were screened. In the final 134 patients, 134 patients were treated with Clopidogrel Bisulfate Tablets 75mg oral 1/ early combined with Aspirin Enteric-coated Tablets 100mg oral 1/ evening, Atorvastatin Calcium Tablets 20mg oral 1/ late and other drugs. The characteristics of unstable plaques were studied by imaging results - thin or ruptured fiber (fiber riser thickness 0.7mm), large lipid core (40% of plaque volume), calcification, intraplaque hemorrhage (IPH) and so on. At the same time, the clinical characteristics of the clinical characteristics of the plaque characteristics and the clinical characteristics of TIA patients in the carotid system in the 7 days of hospitalization, the relationship of the duration of each seizure, and other clinical features, were performed by the SPSS17.0 statistical software for clinical data. According to the number of TIA episodes and the duration of the episodes, each characteristic of the unstable plaque was tested by the chi 2 test within the episodes and the duration of the attack, respectively. When P0.05, the statistical significance was statistically significant, and the characteristics of the statistically significant unstable plaques were brought into order. The Logistic regression equation analyzed the correlation between the characteristics of unstable plaques and the clinical features of TIA patients in the carotid artery system. Statistical analysis was made. When P0.05 was statistically significant, OR1 was a protective factor for the severity of neurological dysfunction in TIA patients. When OR1, it was a risk factor. Results: During the 1 study, the data were collected. The data of the TIA patients in the carotid artery system of the 134 cases were analyzed. The number of neurological deficits and duration of each episode were grouped. The number of clinical neural dysfunction episodes was less than 1 times, 2-3 times, and 3 times in 55 cases, 42 cases, 37 cases, respectively, according to the duration of each attack. The sequence was the duration of the onset duration less than 10min, group 10-30min, and group 30min. The number of people in each group was the chi 2 test of the general baseline data of the 45,52,37.2 for the patients in each group. The P values were all greater than 0.05, and there was no statistical significance. The general baseline data of the patients had the frequency of neural function seizures in the patients with TIA and the holding of each attack. In the 7 days of hospitalization, the duration of the.3 record was less than 1 times in the group, with thin or ruptured fibers, large lipid core, calcification, and hemorrhage in the plaque were 10,13,30,9 cases, and the number of episodes was 2-3 times in the group of 9,22,23,11, and the number of episodes in the 3 times group had 20,17,19,15 cases, which were divided into groups with each attack duration, respectively. Duration less than 10min (45 cases), paroxysmal duration 10-30min (52 cases) and 37 patients with long 30min duration in third. Plaque on HRMRI examination showed thin or ruptured fibrous, lipid core, calcification, and plaque bleeding in patients with each episode of symptomatic duration less than 10min there were 17,11,21,15 cases, paroxysmal symptoms In group 10-30min, there were 20,24,27,10 cases in sequence, and the duration of episodes of symptom duration in group 30min had 23,27,20,17 cases.4 respectively on the number of patients and the clinical baseline data of the patients and the single factor chi 2 test, the P values were all greater than 0.05, and the general clinical data of the patients were to the God of TIA patients. The frequency of functional seizures and duration of each attack did not affect the factors affecting the clinical characteristics of.5 TIA patients: whether a single factor analysis was meaningful for a thin or ruptured fiber (without =0, =1), whether there was a large lipid plaque (no =0, =1), or whether the internal bleeding (no =0, =1) was used as an independent variable, and the duration of the attack was respectively. Less than 10min=1,10-30min=2,30min=3), the number of episodes (less than 1 times =1,2-3 =2,3 =3) was the lipid core of the patients with.6 results based on the ordered Logistic regression analysis. The bleeding, thin or ruptured fibers entered the regression equation, indicating that the three factors of the unstable plaque were the duration of the attack of the TIA patients and the duration of each attack. The factors, and OR1, indicate that the lipid core, bleeding in the plaque, thin or ruptured fiber are risk factors for the clinical characteristics of TIA patients, which makes the number of clinical episodes increase, the duration of each episode prolonged, plaque calcification has no significant correlation to the frequency of clinical seizures and the duration of each attack. Conclusion: 1 by HRMRI examination, the instability is unstable. The thin or ruptured fibrous plaque of the plaque, the large lipid core, the bleeding in the plaque affects the duration of each episode of TIA and the number of episodes, which makes the duration of each attack, the number of episodes more than the number of episodes without related factors, and the nerve function of the TIA patients with.2 patch calcification at the duration of each seizure. There was no significant correlation between the number of missing attacks and the duration of each attack. There were many factors that did not prolong and increase the number of.3 plaques in patients with transient ischemic attacks. This study showed that not all the unstable factors have certain clinical features with transient ischemic attacks. Therefore, in clinical work, it is of great significance to understand the characteristics of plaques and make targeted treatment for the treatment and prevention of diseases.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.31

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