脑动脉粥样硬化型狭窄患者侧支循环开放的影响因素研究

发布时间：2018-06-04 03:37

本文选题：脑动脉粥样硬化型狭窄 + 侧支循环　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探讨脑动脉粥样硬化型狭窄(狭窄程度≥50%)患者脑血管病危险因素对侧支循环开放的影响。[方法]本课题选择2011年5月至2016年12月在昆明医科大第五附属医院神经内科经全脑血管造影检查并诊断为单支颅内动脉粥样硬化性狭窄(狭窄程度≥50%)的急性脑梗死患者104例作为研究对象。根据脑动脉狭窄程度分为中度狭窄、重度狭窄和闭塞,探讨脑动脉狭窄程度与侧支循环开放的相关性。采用ASITN/SIR血流分级系统将患者分为侧支循环开放不良组(血流0-2级)48例和侧支循环开放良好组(血流3-4级)56例,收集两组患者资料(年龄、性别、血管狭窄的程度、高血压、糖尿病、血脂异常、高同型半胱氨酸、吸烟史及饮酒史等资料),探讨脑血管病危险因素与侧支循环开放(侧支血流开放)的相关性。根据侧支循环开放的等级对入组患者进行分组,分为侧支循环未开放组17例,一级侧支循环开放组(一级组)38例,二级侧支循环开放组(二级组)38例和三级侧支循环开放组(三级组)11例,比较各组脑血管危险因素差异性,探讨脑血管病危险因素与不同等级侧支循环开放的相关性。[结果]1在不同狭窄程度分组中,侧支循环开放良好组总秩次较不良组高,经Spearman等级相关分析提示脑动脉粥样硬化型狭窄程度与侧支循环开放良好与否呈负相关,狭窄程度越重,侧支循环开放越好。2侧支循环开放良好组与侧支循环开放不良组比较,高血压、吸烟史在两组中存在差异,且差异具有统计学意义(P0.05)。年龄、性别、糖尿病、血脂异常、甘油三酯、高同型半胱氨酸血症、总胆固醇、饮酒史、低密度脂蛋白、高密度脂蛋白在两组中比较,差异无统计学意义(P0.05)。3以侧支循环开放良好与否为应变量,高血压、吸烟史为自变量,运用二分类Logistic回归分析,提示吸烟史不是侧支循环开放的影响因素,高血压为侧支循环开放的保护因素(OR值1),高血压有利于侧支循环开放。4脑动脉粥样硬化型狭窄程度与侧支循环开放的等级正相关,狭窄程度越重,侧支循环开放的等级越高。5比较侧支循环未开放组、一级组、二级组、三级组患者一般资料情况,其中年龄、性别、高血压、总胆固醇、饮酒史、甘油三酯、高同型半胱氨酸血症、低密度脂蛋白、糖尿病、吸烟史、高密度脂蛋白在上述4组中比较差异不具有统计学意义(P0.05)。血脂异常在上述4组中比较时差异具有统计学意义(P0.05),提示血脂异常在上述4组中分布不完全相同。6血脂异常在上述4组中两两比较,侧支循环开放一级组、二级组、三级组这3组间两两比较差异无统计学意义(P0.05),侧支循环未开放组与一级组比较,差异亦无统计学意义(P0.05)。血脂异常的秩均值在侧支循环未开放组高于二级组、未开放组高于三级组,差异有统计学意义(P0.05)。7血脂异常与二级侧支循环开放呈负相关,且具有统计学意义(P0.05),血脂异常不利于二级侧支循环开放。本研究尚未显示血脂异常对三级侧支循环开放的影响(P0.05)。8总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白这四种指标分别对不同等级侧支循环开放无明显影响(P0.05),而侧支循环开放受到血脂异常指标的影响。[结论]1本研究提示脑动脉粥样硬化型狭窄患者脑动脉狭窄程度越重,侧支循环开放可能越好,侧支循环开放的等级可能越高。2高血压可能有利于脑动脉粥样硬化型狭窄患者侧支循环开放。3高密度脂蛋白、低密度脂蛋白、总胆固醇、甘油三酯这四种指标发生异常,可能会协同加重血管损伤,不利于侧支循环开放。4本研究采用ASITN/SIR血流分级系统和三级侧支循环开放两种分级分组方法评估侧支循环,但各种脑血管病危险因素对侧支循环开放影响的结果不同。脑血管病危险因素对侧支循环开放影响的研究结果可能会受侧支循环开放不同分级分组方法的影响。5脑血管病危险因素对脑动脉粥样硬化型狭窄患者侧支循环的作用靶点可能不同。当以侧支循环开放的等级为分组对象时,血脂异常不利于二级侧支循环的开放,而本研究未显示血脂异常对侧支循环未开放组、一级及三级侧支循环开放的影响,可能是各级侧支循环开放的病理生理机制不同,导致脑血管病危险因素对不同等级侧支循环开放的影响存在差异。
[Abstract]:[Objective] to investigate the effect of cerebrovascular disease risk factors on collateral circulation opening in patients with cerebral atherosclerotic stenosis (or more than 50%). [Methods] the subjects were selected from May 2011 to December 2016 in the neurology department of the Fifth Affiliated Hospital of Kunming Medical University by whole brain angiography and diagnosis of single intracranial atherosclerotic narrowness. 104 cases of acute cerebral infarction with narrow (degree of stenosis or more than 50%) were divided into moderate stenosis, severe stenosis and occlusion, and the correlation between the degree of cerebral artery stenosis and collateral circulation opening was discussed. The patients were divided into 48 cases of collateral circulation and opening group (0-2 levels of blood flow) by ASITN/SIR flow classification system. 56 cases of collateral circulation (blood flow 3-4) were used to collect data of two groups of patients (age, sex, degree of vascular stenosis, hypertension, diabetes, dyslipidemia, high homocysteine, smoking history and drinking history), and the correlation between the risk factors of cerebrovascular disease and the opening of collateral circulation (the opening of collateral flow). The open class was divided into groups, divided into 17 cases of collateral circulation unopen group, 38 cases of first grade collateral circulation open group (first class group), 38 cases of grade two collateral circulation open group (two grade group) and 11 cases of grade three collateral circulation open group (three group), compared the difference of risk factors of cerebrovascular disease in each group, to explore the risk factors and different of cerebrovascular disease and so on. The correlation between the circulation and opening of the lateral branch of the lateral branch was higher than that in the group with different degree of stenosis. The total rank of the lateral branch and open good group was higher than that of the bad group. The degree of cerebral atherosclerotic stenosis was negatively correlated with the good or not of the collateral circulation. The greater the degree of stenosis was, the better the degree of stenosis was, the better the collateral circulation was open, the better the lateral branch circulation was better.2 collateral circulation]1. There was a significant difference in hypertension and smoking history between the two groups, and the difference was statistically significant (P0.05). Age, sex, diabetes, dyslipidemia, triglycerides, hyperhomocysteinemia, total cholesterol, drinking wine history, low density lipoprotein, and high-density lipoprotein were compared in the two groups. There was no statistical significance (P0.05).3 as a variable, hypertension and smoking history as the independent variable, hypertension and smoking history, using two classified Logistic regression analysis, suggesting that smoking history is not the influence factor of collateral circulation open, hypertension is the protective factor of collateral circulation open (OR value 1), hypertension is beneficial to the collateral circulation and open.4 brain movement The degree of arteriosclerosis stenosis was positively correlated with the level of collateral circulation opening, the more severe the degree of stenosis was, the higher the level of the collateral circulation was, the higher the level of collateral circulation was.5 compared with the unopen group of collateral circulation, the first class, the two class and the three group, of which age, sex, hypertension, total cholesterol, drinking history, triglycerides, high homocysteine blood Disease, low density lipoprotein, diabetes, smoking history, high density lipoprotein in the above 4 groups, the difference was not statistically significant (P0.05). The difference of dyslipidemia in the above 4 groups was statistically significant (P0.05), suggesting that the distribution of blood lipid abnormality in the above 4 groups was not exactly the same.6 dyslipidemia in the above 4 groups, and the lateral branch was 22. There was no statistical difference between the 3 groups of the 3 groups (P0.05). The difference was not statistically significant (P0.05). The rank mean of blood lipid abnormality was higher than the group two in the unopen group of collateral circulation, and the unopen group was higher than the three group, and the difference was statistically significant (P0.05). .7 dyslipidemia was negatively correlated with the opening of grade two collateral circulation, and had statistical significance (P0.05). Dyslipidemia was not conducive to the opening of the two level collateral circulation. The effect of dyslipidemia on the opening of grade three collateral circulation (P0.05).8 total cholesterol, triglycerides, low density lipoprotein and high-density lipoprotein, respectively There is no obvious effect on the opening of collateral circulation in different grades (P0.05), and the lateral circulation opening is influenced by abnormal blood lipid. [conclusion]1 this study suggests that the more severe cerebral artery stenosis in patients with cerebral atherosclerotic stenosis, the better the lateral circulation opening may be better, the higher the level of the collateral circulation may be, the higher the.2 hypertension may be beneficial to the brain movement. The four indexes of.3 high density lipoprotein, low density lipoprotein, total cholesterol and triglyceride are abnormal in the collateral circulation of patients with atherosclerotic stenosis, which may synergistically aggravate vascular injury and be not conducive to collateral circulation open.4 study by using the ASITN/SIR flow classification system and the three stage lateral branch circulation to open two classification grouping methods Evaluation of collateral circulation, but the impact of risk factors for cerebrovascular disease on collateral circulation is different. The results of risk factors for cerebrovascular disease may be affected by lateral branch circulation opening different classification grouping methods in.5 cerebrovascular disease risk factors on collateral circulation in patients with cerebral atherosclerotic stenosis The target of the ring may be different. When the level of the collateral circulation and opening is classified as the group object, the dyslipidemia is not conducive to the opening of the two level collateral circulation, but this study does not show that the effect of dyslipidemia on the lateral circulation unopened group and the opening of the first and three level collateral circulation may be the pathophysiological mechanism of the collateral circulation open at all levels. The risk factors of cerebrovascular disease have different effects on different levels of collateral circulation.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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