动脉粥样硬化性血栓性脑梗死患者脑微出血的危险因素分析

发布时间：2018-05-31 02:26

本文选题：脑微出血 + 动脉粥样硬化性血栓性脑梗死　；参考：《吉林大学》2017年硕士论文

【摘要】：研究目的:通过研究分析动脉粥样硬化性血栓性脑梗死患者脑微出血的临床与影像学资料,找到此类型脑梗死患者脑微出血的危险因素、影像学分布特征的临床特点,为脑微出血对动脉粥样硬化性血栓性脑梗死患者的治疗影响进一步研究奠定基础。研究方法:收集2014年9月至2016年12月在吉林大学中日联谊医院神经内科住院的已行SWI检查的住院患者,从中随机选择符合动脉粥样硬化性血栓性脑梗死类型、无严重内科疾病患者,排除其他原因引起的脑梗死类型,排除脑出血、颅内占位等患者。共收集到有完善的CT、MRI、SWI序列影像学资料及其他相关的临床资料的研究对象60例。将60例符合入选标准的研究对象分为两个组,其中合并CMBs的患者35例,非CMBs(对照组)患者共25例。采用EXCEL及SPSS统计入选患者基本信息(人口学特征等)、既往史、个人史、实验室检查结果、影像学检查结果。对两组资料进行统计学分析,符合正态分布的计量资料采用独立样本t检验,多组资料采用方差分析,非正态分布的计量资料采用Wilcoxon秩和检验;计数资料各组间比较采用X~2检验、率的优势比比较;相关分析采用Logistic回归分析,对独立危险因素进行Spearman相关分析。P0.05视为两组差别具有统计学意义。研究结果:1、将符合纳入标准的动脉粥样硬化性血栓性脑梗死患者分为合并CMBs及未合并CMBs两组,对两组研究对象的临床特征进行比较:合并CMBs组的甘油三酯平均值、低密度脂蛋白胆固醇平均值、高血压患病率高于未合并CMBs组,两组资料比较差异具有统计学意义(P分别为0.0010.05,0.001,0.010.05)。CMBs组腔隙性脑梗死计数、脑白质疏松程度评分均比非CMBs组腔隙性脑梗死多(P=0.0040.05),比较差异具有统计学意义。对两组临床资料具有统计学意义的项目进行Logistic多因素回归分析发现:LDL、脑白质疏松程度、腔隙性梗死数有明显相关性(P分别为0.006、0.5、0.001,均0.05),为动脉粥样硬化性血栓性脑梗死合并CMBs的独立危险因素。对上述自变量进行Spearman相关分析,发现低密度脂蛋白胆固醇、腔隙性脑梗死数量、脑白质病变严重程度评分与CMBs的严重程度呈显著正相关(r分别为0.451,0.061,0.309,P0.05)。2、对合并CMBs的动脉粥样硬化性血栓性脑梗死研究对象的CMBs影像学分布特点研究。动脉粥样硬化性血栓性脑梗死CMBs分布于皮层的CMBs受年龄的影响,年龄越大,皮层CMBs患病率越高(P=0.0430.05)。同型半胱氨酸、脑白质严重程度、腔隙性脑梗死计数是丘脑部位的CMBs的独立危险因素(P分别为0.019、0.041、0.042,均小于0.05),同型半胱氨酸越高,脑白质病变越严重,腔隙性脑梗死计数越多,丘脑部位的CMBs的患病率越高。脑干CMBs的分布与腔隙性脑梗死计数有关(P=0.0240.05)。高血压病史是基底节区CMBs的危险因素(P=0.0360.05)。小脑CMBs受腔隙性脑梗死计数的影响(P=0.0150.05)。研究结论:当脑梗死患者同时具有低密度脂蛋白胆固醇升高、脑白质病变程度严重、腔隙性脑梗死数目较多中一种或多项高危因素时,应高度警惕同时存在CMBs,及时进行SWI序列扫描确诊,以利于指导溶栓、抗栓等治疗方案的制定,积极控制危险因素。动脉粥样硬化性血栓性脑梗死合并的不同分布部位的的CMBs影响因素具有差异性。
[Abstract]:Objective: to find out the clinical and imaging data of cerebral microhemorrhage in patients with atherosclerotic thrombotic cerebral infarction and to find out the risk factors of cerebral microhemorrhage in this type of cerebral infarction and the clinical characteristics of the characteristics of imaging distribution, so as to further the effect of cerebral microhemorrhage on the treatment of atherosclerotic thrombotic cerebral infarction. The study method: to collect the hospitalized patients who were hospitalized in the neurology department of the Sino Japanese Friendship Hospital of Jilin University from September 2014 to December 2016, and randomly select the type of atherosclerotic thrombotic cerebral infarction, the patients without serious internal medical diseases, the type of cerebral infarction caused by other causes, and the elimination of the brain. A total of 60 patients with complete CT, MRI, SWI sequence imaging data and other related clinical data were collected. 60 cases were divided into two groups, including 35 patients with CMBs and 25 non CMBs (control group) patients. The patients were selected by EXCEL and SPSS. Information (demographic characteristics, etc.), previous history, personal history, laboratory examination results, and imaging findings. Statistical analysis of two groups of data was carried out. The measurement data conforming to normal distribution were tested by independent sample t test, multiple data were analyzed by variance analysis, and Wilcoxon rank sum test was used for non normal distribution data. Comparative advantage compared with X~2 test; correlation analysis using Logistic regression analysis and Spearman correlation analysis for independent risk factors as two groups of differences were statistically significant. Results: 1, patients with atherosclerotic thrombotic cerebral infarction were divided into groups of CMBs and unincorporated CMBs two, which were in accordance with the inclusion criteria, The clinical characteristics of the two groups were compared: the average value of triglyceride in the combined CMBs group, the average of low density lipoprotein cholesterol, the prevalence of hypertension was higher than that in the non CMBs group. The difference of the data was statistically significant (P 0.0010.05,0.001,0.010.05) in the.CMBs group, the lacunar cerebral infarction count and the degree of leukoaraiosis in the group of.CMBs. The scores were more than those of non CMBs lacunar infarction (P=0.0040.05), and the difference was statistically significant. The Logistic multiple regression analysis of two groups of clinical data showed that LDL, the degree of leukoaraiosis and the number of lacunar infarcts were significantly correlated (P was 0.006,0.5,0.001, all 0.05), which were arterial atherosclerosis. The independent risk factors for sclerosing thrombotic cerebral infarction combined with CMBs. Spearman correlation analysis of the above independent variables showed that low density lipoprotein cholesterol, the number of lacunar infarction, the severity score of brain white matter lesions were positively correlated with the severity of CMBs (R.2, respectively, 0.451,0.061,0.309, P0.05), for the congee of CMBs. Study on the distribution characteristics of CMBs imaging in the subjects of thrombotic cerebral infarction. The CMBs distribution of atherosclerotic thrombotic cerebral infarction is influenced by the age of CMBs in the cortex, the older the age is, the higher the age of the cortical CMBs (P=0.0430.05). The degree of homocysteine, the severity of white matter in the brain, and the count of lacunar cerebral infarction is the CMB of the thalamus. The independent risk factors of S (P are 0.019,0.041,0.042, respectively less than 0.05), the higher the homocysteine, the more serious the white matter, the more the lacunar cerebral infarction count, the higher the incidence of CMBs in the thalamus. The distribution of CMBs in the brain stem is related to the count of lacunar cerebral infarction (P =0.0240.05). The history of hypertension is a dangerous cause of CMBs in the basal ganglia region. P=0.0360.05. Cerebellar CMBs is affected by lacunar cerebral infarction (P=0.0150.05). Conclusion: when patients with cerebral infarction have high level of low density lipoprotein cholesterol, serious cerebral white matter, one or more high risk factors of lacunar cerebral infarction, CMBs should be present at the same time, and SWI sequence is carried out in time. The scan was confirmed to guide the formulation of thrombolytic and anti thrombolytic therapy and actively control the risk factors. The factors of CMBs affecting the different distribution parts of atherosclerotic thrombotic cerebral infarction were different.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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