绝经后女性脑梗死雌激素和动脉粥样硬化的关系

发布时间：2018-06-03 17:12

本文选题：绝经后女性 + 雌二醇　；参考：《安徽医科大学》2014年硕士论文

【摘要】：目的：检测脑绝经后女性脑梗死患者血浆雌二醇（E2）水平，探讨其与脑梗死及颈动脉粥样硬化的关系，分析E2与相关代谢指标及炎性指标、颈动脉内膜厚度的相关性，为探讨绝经后女性E2对脑梗死和颈动脉粥样硬化的影响提供依据。方法：收集我院神经内科住院的90例绝经后女性脑梗死急性期患者（脑梗死组）和40例同期绝经后女性健康体检者（对照组），检测血浆E2水平，分析与脑梗死的关系，通过相关性分析，研究E2与代谢和炎性指标的关系。采用多普勒超声检测颈动脉，，计算双侧颈总动脉平均内-中膜厚度（IMT)并依据颈动脉是否存在斑块及其性质分亚组（无斑块组，稳定斑块组和不稳定斑块组），通过Logistic回归分析E2水平与脑梗死及斑块性质之间的关系。结果：（1）绝经后女性急性脑梗死组与正常对照组相比，E2水平明显降低,有显著性差异（P0.01）。 Logistic回归分析显示在考虑了脑梗死其他的独立危险因素后，雌激素水平降低并不能使脑梗的发病风险增加（OR:1.173;95%CI:0.743-1.875:;P=0.479）。（2）相关分析发现，脑梗死组患者中E2水平与高密度脂蛋白胆固醇胆固醇（HDL-C）、ISI呈正相关。与低密度脂蛋白胆固醇胆固醇（LDL-C）、hs-CRP、FINS水平呈负相关。均有统计学意义（P0.01）。与空腹血糖、BMI、血压无相关。（3）绝经后女性脑梗死组颈动脉IMT1.32±0.27mm，对照组颈动脉内膜厚度IMT（1.0±0.32）mm，两组间差异具有统计学意义（P0.05）。脑梗死患者中的血浆E2水平与颈动脉平均IMT呈负相关(r=-0.163; P=0.035)； (4)绝经后女性脑梗死患者中颈动脉粥样硬化发生率为87.7%，与对照组动脉粥样硬化发生率42.5%相比，差异具有显著性（P0.01）；绝经后女性脑梗死患者不稳定斑块检出率53.3%,显著高于对照组的15%，差异具有显著性（P0.01）；绝经后女性脑梗死组患者稳定斑块检出率较对照组差异无统计学意义(P0.05)。（5）脑梗死患者中非不稳定斑块患者E2水平高于不稳定斑块组，Logistic回归分析在考虑了hs-CRP、低密度脂蛋白胆固醇胆固醇水平后，E2水平下降并不能使不稳定斑块的风险增加（OR:1.035;95%CI:0.826-1.054；P=0.612)。结论：（1）绝经后女性脑梗死患者E2水平较对照组E2水平明显下降。绝经后女性E2水平的下降不是脑梗死发病的独立危险因素。（2）绝经后女性脑梗死患者E2水平与代谢及炎性指标相关，血浆E2水平与HDL-C、ISI水平呈正相关，与FINS、LDL-C、hs-CRP水平呈负相关。E2可能通过影响血糖、血脂及炎症因子的水平增加脑梗死的发生。（3）绝经后女性脑梗死患者血浆E2水平与颈动脉平均IMT呈负相关，颈动脉具有不稳定斑块的脑梗死患者较颈动脉具有稳定斑块的脑梗死患者E2水平明显下降，绝经后女性脑梗死患者E2水平可以预测动脉粥样硬化的严重程度。
[Abstract]:Objective: The plasma estradiol E _ 2 (E _ 2) levels in postmenopausal female patients with cerebral infarction were determined to explore the relationship between E _ 2 and cerebral infarction and carotid atherosclerosis, and to analyze the correlation between E _ 2 and related metabolic and inflammatory indexes, carotid intima thickness. To study the effect of E _ 2 on cerebral infarction and carotid atherosclerosis in postmenopausal women. Methods: A total of 90 postmenopausal female patients with acute cerebral infarction (cerebral infarction group) and 40 postmenopausal women healthy persons (control group) were collected from neurology department of our hospital. The plasma E 2 level was measured and the relationship between E 2 levels and cerebral infarction was analyzed. The relationship between E2 and metabolic and inflammatory indexes was studied by correlation analysis. Carotid artery was detected by Doppler ultrasound, the mean IMT of bilateral common carotid artery was calculated, and the carotid artery was divided into subgroup (no plaque group) according to whether there were plaques in the carotid artery or not. The relationship between E _ 2 level and cerebral infarction and plaque character was analyzed by Logistic regression analysis in stable plaque group and unstable plaque group. Results: The level of E 2 in postmenopausal women with acute cerebral infarction was significantly lower than that in normal controls (P 0.01). Logistic regression analysis showed that after taking into account other independent risk factors of cerebral infarction, the decrease of estrogen level did not increase the risk of cerebral infarction. Correlation analysis showed that there was a positive correlation between E _ 2 level and HDL-CU ISI in patients with cerebral infarction. There was a negative correlation between low density lipoprotein cholesterol and low density lipoprotein cholesterol hs-CRPN fins. All of them had statistical significance (P 0.01). There was no correlation with fasting blood glucose BMIand blood pressure. 3) the carotid IMT1.32 卤0.27 mm in postmenopausal female cerebral infarction group and IMT(1.0 卤0.32 mm in control group. The difference between the two groups was statistically significant (P 0.05). There was a negative correlation between plasma E2 level and carotid mean IMT in patients with cerebral infarction. The incidence of carotid atherosclerosis in postmenopausal women with cerebral infarction was 87.7%, compared with 42.5% in the control group. The detection rate of unstable plaques in postmenopausal women with cerebral infarction was 53.3%, which was significantly higher than that in the control group (15%), and the difference was significant (P 0.01). There was no significant difference in the detection rate of stable plaque in postmenopausal women with cerebral infarction compared with the control group (P 0.05). 5) the level of E _ 2 in non-unstable plaque patients with cerebral infarction was higher than that in the unstable plaque group. After considering hs-CRP, the decrease of E _ 2 level after low density lipoprotein cholesterol level did not increase the risk of unstable plaque. Conclusion: The level of E 2 in postmenopausal women with cerebral infarction was significantly lower than that in control group. The decrease of E 2 level in postmenopausal women is not an independent risk factor for cerebral infarction. 2) in postmenopausal women with cerebral infarction, the level of E2 was correlated with metabolic and inflammatory indexes, the level of plasma E2 was positively correlated with the level of HDL-CISI, and negatively correlated with the level of LDL-Chs-CRP. E2 may increase the occurrence of cerebral infarction by affecting the levels of blood glucose, blood lipids and inflammatory factors. 3) the plasma E2 level in postmenopausal female patients with cerebral infarction was negatively correlated with the average IMT of carotid artery, and the level of E2 in patients with unstable carotid plaques was significantly lower than that in patients with stable plaques of carotid artery. E 2 levels in postmenopausal women with cerebral infarction can predict the severity of atherosclerosis.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R543.5;R743.33

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