24小时动态脉压与症状性颅内动脉狭窄的相关性研究

发布时间：2018-06-02 07:48

本文选题：缺血性脑卒中 + 动态脉压　；参考：《山东大学》2016年硕士论文

【摘要】：目的：本课题以患有症状性颅内动脉狭窄的人群为主要研究对象,旨在探讨症状性颅内动脉狭窄及狭窄的严重程度与24小时动态脉压之间的相关性,明确24小时动态脉压是影响症状性颅内动脉狭窄发生发展的重要因素,以指导临床预防工作。方法：收集157名罹患缺血性脑卒中,且具有明显颅内动脉狭窄病变的患者作为症状性颅内动脉狭窄组(狭窄组)的研究对象,148名无颅内动脉狭窄病变的患者作为对照组研究对象。采用无创性携带式动态血压监测仪对所有被测人员进行观察,监测参数包括24小时平均收缩压、24小时平均舒张压,并计算获得受试者的24小时动态脉压值(Ambulatory Pulse Pressure,APP)以及动态脉压指数(Pulse Pressure Index, PPI)O应用统计软件探讨24小时APP与症状性颅内动脉狭窄及严重程度的相关性,明确影响症状性颅内动脉狭窄病变发生发展的重要因素。结果：1.24小时APP与症状性颅内动脉狭窄之间的相关性(1)狭窄组与无颅内动脉狭窄的对照组24小时APP结果对比狭窄组24小时APP值为(70.25±11.95) mmHg,对照组24小时APP值为(60.10±12.03) mmHg,二者相比较,狭窄组24小时APP显著高于对照组的24小时APP值(P0.01)。(2)狭窄组与对照组动态PPI结果对比狭窄组动态PPI结果为(0.49±0.03),对照组动态PPI结果为(0.44±0.06),两组相比较,狭窄组动态PPI高于对照组(P0.05)。(3)狭窄组与对照组24小时APP分行构成的结果对比将24小时APP按照数值划分区间,统计狭窄组与对照组24小时APP的分布构成,结果显示,两组的24小时APP的分布构成具有显著差异,当24小时APP超过60 mmHg时,症状性颅内动脉狭窄出现的频率会明显增高,且24小时APP最大分布区域在71 mmHg.(4)狭窄组与对照组动态PP1分布构成的结果对比将动态PPI按照数值划分区间,比较狭窄组和对照组动态PPI的分布构成,结果显示,两组的动态脉压指数的分布构成具有显著差异(P0.05),当动态脉压指数超过0.4时,发生症状性颅内动脉狭窄频率会明显增高,且动态PPI的最大分布区域位于0.41-0.50之间。2.24小时APP与症状性颅内动脉狭窄的严重程度之间的相关性将所有狭窄组的患者进一步划分中度(50%-69%)狭窄组以及重度(70%-99%或完全闭塞)狭窄组。结果显示,中度狭窄组24小时APP值(66.73±8.01) mmHg显著高于无颅内动脉狭窄组(60.10±12.03) mmHg (P0.05)；重度狭窄组24小时APP值(74.82±7.80) mmHg显著高于中度狭窄组(66.73±8.01) mmHg (P0.05)。3.症状性颅内动脉狭窄发生的危险因素以症状性颅内动脉狭窄为因变量,分别以24小时APP和动态PPI为自变量,进行Logistic回归分析。结果显示,24小时APP和动态PPI均与症状性颅内动脉狭窄的发生独立相关,二者的OR值分别为1.091(95%CI为1.042-1.145)和1.045(95%CI为1.021-1.069)。结论：1.24小时APP和动态PPI均与症状性颅内动脉狭窄显著相关,随着24小时APP和动态PPI的增大,症状性颅内动脉狭窄的出现也随之增加。2.24小时APP和症状性颅内动脉狭窄的严重程度呈正相关,随着颅内动脉狭窄病变程度的加重,24小时APP值亦随之增高。3.24小时APP和动态PPI与症状性颅内动脉狭窄的发生关系密切,24小时APP和动态PPI均是症状性颅内动脉狭窄发生的危险因素。
[Abstract]:Objective: To explore the correlation between the severity of symptomatic intracranial artery stenosis and stenosis and the 24 hour dynamic pulse pressure, and to clarify that the 24 hour dynamic pulse pressure is an important factor affecting the development of symptomatic intracranial artery narrowing. Methods: 157 patients with ischemic stroke were collected as the subjects of symptomatic intracranial stenosis group (stenosis group), and 148 patients with no intracranial artery stenosis were studied as the control group. All the patients were measured by noninvasive portable ambulatory blood pressure monitor. The monitoring parameters included the 24 hour mean systolic pressure, 24 hour mean diastolic pressure, and the 24 hour dynamic pulse pressure (Ambulatory Pulse Pressure, APP) and the dynamic pulse pressure index (Pulse Pressure Index, PPI) O applied statistics software to explore the 24 hour APP and symptomatic intracranial artery stenosis and severity. Correlation, an important factor affecting the development of symptomatic intracranial stenosis. Results: the correlation between 1.24 hours APP and symptomatic intracranial artery stenosis (1) the 24 hour APP results in the stenosis group and the control group without intracranial artery stenosis were (70.25 + 11.95) mmHg (70.25 + 11.95) in the stenosis group, and 24 hours APP in the control group. (60.10 + 12.03) mmHg, compared with the two, the 24 hour APP in the stenosis group was significantly higher than the 24 hour APP value of the control group (P0.01). (2) the dynamic PPI results in the stenosis group and the control group were (0.49 + 0.03), and the dynamic PPI results in the control group were (0.44 + 0.06), and the dynamic PPI in the stenosis group was higher than the control group (P0.05). (3) stenosis group and the control group (3). The results of the 24 hours APP branch of the control group compared the 24 hours APP according to the numerical division interval, and the distribution of the 24 hours APP in the narrow group and the control group was statistically analyzed. The results showed that the distribution of the 24 hours APP in the two groups was significantly different. When the 24 hours APP exceeded 60 mmHg, the frequency of symptomatic intracranial artery stenosis increased significantly. The maximum distribution of 24 hours APP in the 71 mmHg. (4) stenosis group and the control group dynamic PP1 distribution results compared the dynamic PPI according to the numerical division interval, comparing the distribution of the dynamic PPI in the narrow group and the control group. The results showed that the distribution of the dynamic pulse pressure index of the two groups was significantly different (P0.05), when the dynamic pulse pressure index exceeded 0.. At 4, the frequency of symptomatic intracranial artery stenosis increased significantly, and the correlation between the maximum distribution of dynamic PPI and the severity of.2.24 hours APP between 0.41-0.50 and symptomatic intracranial artery stenosis further divided the patients in the stenosis group into the moderate (50%-69%) stenosis group and the severe (70%-99% or complete occlusion) stenosis. The results showed that the 24 hours APP value (66.73 + 8.01) mmHg of the moderate stenosis group was significantly higher than that of the non intracranial stenosis group (60.10 + 12.03) mmHg (P0.05), and the 24 hour APP value (74.82 + 7.80) mmHg in the severe stenosis group was significantly higher than that of the moderate stenosis group (66.73 + 8.01) mmHg (P0.05).3. symptomatic intracranial artery stenosis. Logistic regression analysis was performed with 24 hours APP and dynamic PPI as independent variables. The results showed that 24 hours APP and dynamic PPI were independent of symptomatic intracranial artery stenosis, and the OR values of two were 1.091 (95%CI 1.042-1.145) and 1.045 (95%CI 1.021-1.069) respectively. Conclusion: 1.24 hour APP and dynamic P. PI was significantly associated with symptomatic intracranial artery stenosis. With the increase of 24 hours APP and dynamic PPI, the occurrence of symptomatic intracranial stenosis was also increased by.2.24 hours APP and the severity of symptomatic intracranial artery stenosis. With the severity of intracranial stenosis, the 24 hour APP value also increased with.3.24 hour APP. Dynamic PPI is closely related to the occurrence of symptomatic intracranial arterial stenosis. 24 hour APP and dynamic PPI are all risk factors for symptomatic intracranial artery stenosis.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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