急性缺血性卒中患者脑微出血相关因素分析及与认知功能的临床研究

发布时间：2018-06-07 22:10

本文选题：脑微出血 + 急性缺血性卒中　；参考：《河北医科大学》2017年硕士论文

【摘要】：第一部分急性缺血性卒中患者脑微出血危险因素分析目的:探讨急性缺血性卒中(acute ischemic stroke,AIS)患者脑微出血(cerebral microbleeds,CMBs)的危险因素。方法:连续收集2014年1月至2015年12月在河北省人民医院神经内科住院的AIS患者226例,根据是否存在CMBs,分为CMBs组(111例)和无CMBs组(115例)。收集研究对象人口统计学资料和临床资料,通过头颅核磁共振成像(magnetic resonance imaging,MRI)不同序列分别对CMBs、脑白质病变(white matter lesions,WML)及陈旧腔隙性脑梗死(lacunar infarcts,LI)进行评价,并采用t检验、χ~2检验、Logistic回归等统计学方法分析AIS患者中发生CMBs的危险因素。结果:1本部分研究共入组患者226例,CMBs的总体发生率为49.1%(111/226),其中首次发生AIS的患者CMBs的发生率为44.0%(66/150),再发AIS的患者CMBs的发生率为59.2%(45/76);AIS患者CMBs出现部位的分布情况为:幕下39.6%(44/111),深部58.6%(65/111),脑叶64.9%(72/111);CMBs严重程度分布情况:0级:50.9%(115/226),1级:32.3%(73/226),2级:9.3%(21/226),3级:7.5%(17/226);2与无CMBs组比较,CMBs组患者年龄大,高血压病史、陈旧LI、既往脑卒中病史及口服抗血小板药物的构成比例高,高密度脂蛋白水平和WML评分高;而高脂血症构成比例、空腹血糖、总胆固醇、甘油三脂、极低密度脂蛋白水平均较低,具有统计学差异(P0.05);3多因素Logistic回归分析显示年龄(OR=1.063,95%CI:1.025~1.104,P0.01)、高血压病史(OR=3.488,95%CI:1.113~10.927,P0.05)、WML(OR=1.282,95%CI:1.155~1.423,P0.01)及陈旧LI(OR=5.815,95%CI;1.539~21.973,P0.01)是AIS合并CMBs的独立危险因素;4spearman’s等级相关分析显示,cmbs的分级和wml的分级(γs=0.354,p0.01)、陈旧li的分级(γs=0.394,p0.01)均呈正相关;线性趋势检验分析显示,cmbs的分级和wml的分级(χ~2_(线性)=35.07,p0.01;χ~2_(偏离线性)=14.07,p0.05)、陈旧li的分级(χ~2_(线性)=37.88,p0.01;χ~2_(偏离线性)=6.01,p0.05)均存在线性变化趋势。第二部分脑微出血与急性缺血性卒中病因及病灶部位的相关性研究目的:探讨cmbs与ais的病因及卒中病灶部位的相关性。方法:结合toast病因分型对第一部分中ais患者的病因进行分类评估;结合患者症状及体征,利用mri不同序列对第一部分ais患者责任病灶的部位进行评估。采用χ~2检验、kruskal-wallish检验等统计学方法评估cmbs与ais病因及卒中病灶部位的相关性。结果:1幕下、深部、脑叶及多部位卒中病灶组cmbs检出率分别为51.1%(24/47)、45.1%(23/51)、49.2%(30/61)和50.7%(34/67),各组cmbs检出率间比较,差异无统计学意义(χ~2=0.472,p=0.925)。cmbs部位分布及卒中病灶部位分布在统计学上无关联性(χ~2=8.514,p=0.519);2小动脉闭塞型、大动脉粥样硬化型及其它类型ais中cmbs检出率分别为59.3%(54/91)、40.0%(32/80)和45.5%(25/55),各组cmbs检出率间比较,差异有统计学意义(χ~2=6.762,p0.05),两两比较显示,小动脉闭塞型与大动脉粥样硬化型cmbs检出率比较差异有统计学意义(χ~2=6.370,p=0.0120.017),而小动脉闭塞型、大动脉粥样硬化型分别与其它类型相比cmbs检出率均无明显统计学差异(χ~2=2.662,p=0.1030.017;χ~2=0.397,p=0.5280.017);3kruskal-wallish检验发现,小动脉闭塞型、大动脉粥样硬化型和其它类型cmbs严重程度水平有统计学差异(χ~2=10.134,p=0.006),两两比较显示,小动脉闭塞型与大动脉粥样硬化型cmbs严重程度有统计学差异(χ~2=9.143,p=0.0020.017),而小动脉闭塞型、大动脉粥样硬化型与其它类型相比cmbs严重程度水平无统计学差异(χ~2=4.318,p=0.0380.017;χ~2=0.405,p=0.5250.017)。第三部分脑微出血对急性缺血性卒中后认知功能的影响目的:研究cmbs及其动态变化和卒中后认知障碍各认知域损害的关系。方法:从第一部分cmbs组中随机选取20例研究对象为实验组,第一部分无cmbs组中选取尽量多的研究对象为对照组(与实验组在年龄的分布、性别、教育年限、wml及陈旧li、新发卒中病灶的位置、ais的病因分型及既往重要病史方面匹配)。随访1年,使用规范的神经心理学评估量表评估ais患者1年后不同认知域的情况;复查磁敏感加权成像(susceptibilityweightedimaging,swi),评估cmbs变化的情况。并采用相应的统计学方法研究cmbs及其动态变化和卒中后认知障碍的关系。结果:1对照组与实验组在年龄的分布、性别、教育年限、wml评分、陈旧li数目、高血压病史、糖尿病病史、既往脑卒中病史、新发卒中病灶的位置及ais的病因分型方面相匹配(以上因素p0.5);2与对照组比较,1年后cmbs组tmtb用时延长,差异有统计学意义(p0.05);其余神经心理学评估,包括mmse总分、moca总分、tmta耗时、scwta耗时、scwtb耗时、scwtc耗时、dsmt评分、dst评分、bd评分、vft评分,两组比较均无明显统计学意义(p0.05);3随访1年后,psci总体发生率为64%(32/50),不同认知域的评估中,以执行功能损害最为常见,为52%(26/50),其他认知域也均有不同程度损害。与对照组比较,cmbs组执行功能损害发生率高,差异有统计学意义(p0.05);其它认知域的损害,包括总体认知功能、注意力及信息处理速度、视空间能力、语言能力、记忆力,两组比较均无明显统计学意义(p0.05);4随访1年后执行功能障碍的二元回归分析结果显示,年龄(or=1.11,95%ci:1.01~1.23)、基线期cmbs(or=3.5,95%ci:1.05~11.7)、及cmbs的动态变化(or=3.8,95%ci:1.09~13.3)是卒中1年后执行功能障碍发生的危险因素(p0.05)。其它因素如教育程度、高血压、whl及陈旧li与执行功能障碍发生无明显统计学意义(p0.05)。结论:1年龄、高血压病史、wml及陈旧li是ais合并cmbs的独立危险因素。2 CMBs严重程度随WML、陈旧LI的严重程度增加而增高。3 AIS患者CMBs检出率与不同AIS病因有关,在小动脉闭塞型导致的AIS中更易被发现。4 CMBs严重程度与AIS病因有关,在小动脉闭塞型导致的AIS中CMBs的严重程度较高。5 PSCI发病率高,可伴有多个不同认知域损害,其中以执行功能损害最常见。6基线CMBs与AIS患者1年后执行功能障碍的发生有关。7年龄、基线CMBs及CMBs的动态变化可能是AIS后执行功能障碍发生的危险因素。
[Abstract]:Part 1 Analysis of risk factors for cerebral microhemorrhage in patients with acute ischemic stroke Objective: To explore the risk factors for cerebral microhemorrhage (cerebral microbleeds, CMBs) in patients with acute ischemic stroke (AIS). Methods: 226 consecutive AIS patients hospitalized in Hebei People's Hospital from January 2014 to December 2015 were collected. According to the presence of CMBs, it was divided into group CMBs (111 cases) and no CMBs group (115 cases). The demographic data and clinical data of the subjects were collected, and CMBs, white matter lesions (white matter lesions, WML) and old lacunar cerebral infarction were respectively carried out by different sequences of magnetic resonance imaging (MRI). T test, t test, chi square ~2 test, Logistic regression and other statistical methods were used to analyze the risk factors of CMBs in AIS patients. Results: 1 the total of 226 patients were enrolled in this study, and the overall incidence of CMBs was 49.1% (111/226), and the incidence of CMBs in the first AIS patients was 44% (66/150), and the incidence of CMBs was again in the AIS patient. To 59.2% (45/76), the distribution of CMBs in patients with AIS was: sub episodes 39.6% (44/111), deep 58.6% (65/111), 64.9% (72/111); CMBs severity distribution: 0 level: 50.9% (115/226), 1: 32.3% (73/226), 9.3% (21/226), 3 grade: 7.5% (17/226); 2 and CMBs group, age, hypertension, obsolete, past, past, past, past, past, past, past, past, past, past, past, past, past, past, past, past, and past The history of stroke and the proportion of oral antiplatelet drugs were high, high density lipoprotein level and WML score, and the proportion of hyperlipidemia, fasting blood glucose, total cholesterol, glycerin three fat, extremely low density lipoprotein level were lower, with statistical difference (P0.05); more than 3 factor Logistic regression analysis showed age (OR=1.063,95%CI:1.025~1 .104, P0.01), the history of hypertension (OR=3.488,95%CI:1.113~10.927, P0.05), WML (OR=1.282,95%CI:1.155~1.423, P0.01) and old LI (OR=5.815,95%CI; 1.539~21.973, P0.01) are independent risk factors for AIS together. 01) positive correlation; linear trend test analysis showed that CMBS classification and WML classification (x ~2_ (linear) =35.07, P0.01; X ~2_ (deviating linear) =14.07, P0.05), the classification of old Li (x ~2_ (linear) =37.88, P0.01; chi square (deviation linear), there are linear trends. The second part of cerebral microhemorrhage and acute ischemic stroke cause and cause Objective: To investigate the correlation between the causes of CMBS and AIS and the correlation between the location of the focus of the stroke. Methods: the cause of the AIS patients in the first part of the first part was classified and evaluated according to the toast etiological classification. Combined with the symptoms and signs of the patients, the location of the responsible focus of the first part of the patients with AIS was evaluated with the different sequence of MRI. The X ~2 was used. Test, kruskal-wallish test and other statistical methods to evaluate the correlation between the CMBS and the cause of AIS and the location of the stroke. Results: the detection rates of CMBS in the 1 episodes, the deep, lobar and multi site stroke group were 51.1% (24/47), 45.1% (23/51), 49.2% (30/61) and 50.7% (34/ 67), and the difference was not statistically significant (x ~2=0.472, P). =0.925) the distribution of.Cmbs and the location of the focus of the stroke were not statistically correlated (x ~2=8.514, p=0.519), and the detection rates of CMBS in 2 arterioles occlusion, large atherosclerotic and other types of AIS were 59.3% (54/91), 40% (32/80) and 45.5% (25/55), and the difference was statistically significant (chi ~2=6.762, P0.05), 22 comparison showed that there was significant difference in the detection rates of arteriosclerosis obliterans and large atherosclerotic CMBS (x ~2=6.370, p=0.0120.017), but there was no significant difference in CMBS detection rates of arteriosclerosis obliterans and large atherosclerotic types, respectively (x ~2=2.662, p=0.1030.017; Chi ~2=0.397, p=0.5280.017); 3kr Uskal-wallish test found that the severity of arterioles occlusion, large atherosclerotic and other types of CMBS were statistically different (x ~2=10.134, p=0.006). 22 compared with the severity of large atherosclerotic CMBS, there was a statistically difference (x ~2=9.143, p=0.0020.017), while the arterioles were obliterans and large movements. There is no significant difference in the level of CMBS severity compared with other types of atherosclerosis (x ~2=4.318, p=0.0380.017; Chi ~2=0.405, p=0.5250.017). The effect of third partial cerebral microhemorrhage on cognitive function after acute ischemic stroke: To study the relationship between CMBS and its dynamic changes and cognitive impairment of poststroke cognitive impairment. The first part of the CMBS group randomly selected 20 subjects as the experimental group. The first part of the group no CMBS group selected as many subjects as the control group (the distribution of age, sex, education years, WML and old Li, the location of the new stroke focus, the AIS etiological classification and the previous important history of medical history). A model of neuropsychological assessment was used to assess the situation in different cognitive domains of AIS patients after 1 years; to review the susceptibilityweightedimaging (SWI) and evaluate the changes in CMBS. The relationship between the dynamic changes of CMBS and the disturbance of recognition after stroke was studied by the corresponding statistical methods. Results: the 1 control group and the experimental group were in the year of the year. The distribution of age, sex, years of education, WML score, the number of old Li, the history of hypertension, the history of diabetes, the history of the brain stroke, the position of the new stroke and the etiology of AIS (above factors p0.5); 2 compared with the control group, the difference was statistically significant (P0.05) in the CMBS group after 1 years (P0.05); the rest of the neuropsychology was not statistically significant. Evaluation, including MMSE total score, MOCA total score, tmta time consumption, scwta time-consuming, scwtb time-consuming, scwtc time-consuming, DSmT score, DST score, BD score, VFT score, two groups were no significant statistical significance (P0.05); 3 after 1 years of follow-up, the overall incidence of PSCI was 64% (52%), the most common, 52% The cognitive domain also had different degrees of damage. Compared with the control group, the CMBS group performed a high incidence of functional impairment (P0.05), and the other cognitive impairment, including the overall cognitive function, attention and information processing speed, visual spatial ability, language ability and memory, had no significant statistical significance (P0.05), and 4 (P0.05). The two yuan regression analysis of executive dysfunction after 1 years showed that age (or=1.11,95%ci:1.01~1.23), baseline CMBS (or=3.5,95%ci:1.05~11.7), and CMBS dynamic changes (or=3.8,95%ci:1.09~13.3) were risk factors for executive dysfunction after 1 years of stroke (P0.05). Other factors such as education, hypertension, WHL, and obsolete Li and obsession There was no significant statistical significance (P0.05). Conclusion: 1 age, history of hypertension, WML and old Li are independent risk factors of AIS combined with CMBS, the severity of.2 CMBs is associated with WML, the increase in the severity of old LI and the increase in.3 AIS is associated with the different etiology, and is more likely to be found in the arteriolo occlusive type. The severity of.4 CMBs is associated with the cause of AIS. The severity of CMBs in AIS caused by arteriolo occlusive type is higher than that of.5 PSCI, which can be accompanied by multiple cognitive impairment. The most common.6 baseline, which is the most common.6 baseline for performing functional impairment, is related to the.7 age, baseline CMBs, and the dynamic change of AIS after 1 years. Chemotherapy may be a risk factor for the occurrence of executive dysfunction after AIS.
【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】：R743.3

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