急性穿支动脉脑梗死合并脑微出血患病率、危险因素及临床变化分析

发布时间：2018-06-10 20:27

  本文选题：脑梗死 + 穿支动脉　； 参考：《河北北方学院》2017年硕士论文

【摘要】：本研究主要探索不同部位急性穿支动脉脑梗死合并脑微出血患病率,危险因素及临床变化。本研究通过收集邯郸市中心医院急性穿支动脉脑梗死住院患者,结合头颅核磁弥散加权成像(Diffusion Weighted Imaging,DWI)和磁敏感加权成像(Susceptibility Weighted Imaging,SWI)序列检查结果,筛选出基底节-丘脑和脑干急性穿支动脉脑梗死合并脑微出血(Cerebral Microbleeds,CMBs)患者作为研究对象,记录研究对象临床基本信息、相关危险因素及神经功能评分(National Institutes of Health Stroke Scale,NIHSS)。将研究对象按新发梗死位置分为:基底节-丘脑梗死组和脑干梗死两组。依据MARS(Microbleed Anatomical Rating Scale,MARS)表格[1](见图1)分见别记录研究对象责任病灶相关部位CMBs数量:基底节-丘脑梗死患者记录病灶同侧大脑半球CMBs数量及脑干CMBs数量;脑干梗死患者记录脑干CMBs数量及双侧大脑半球CMBs数量。统计分析不同部位急性穿支动脉脑梗死中脑微出血患病率,危险因素及NIHSS评分变化。本次研究连续纳入急性穿支动脉脑梗死患者214例,符合条件的急性穿支动脉脑梗死患者198例,其中6例资料不完善,10例为非基底节-丘脑、脑干急性穿支动脉脑梗死患者。最终共有198例急性穿支动脉脑梗死患者入组进入统计分析。198例基底节-丘脑或脑干急性穿支动脉脑梗死患者中伴有CMBs(阳性组)103例,不伴有CMBs(阴性组)95例,阳性组高血压发病率80.6%,显著高于阴性组63.2%(χ2=4.51,P=0.03),余相关危险因素无统计学差异。基底节-丘脑梗死患者合并有脑微出血67例,脑干梗死患者合并有脑微出血36例。基底节-丘脑梗死合并CMBs患者中高血压发病率为86.6%,高于脑干梗死合并CMBs患者中高血压发病率69.4%(χ2=4.39,P=0.04)。基底节-丘脑梗死组中梗死同侧大脑半球CMBs数量为280个(4.2±4.8),显著高于脑干梗死组双侧大脑半球CMBs数量23个(0.64±3.2)(t=5.18,P=0.00)。脑干梗死组脑干CMBs数量为174(4.8±3.2),高于基底节-丘脑梗死组脑干CMBs数量62(0.93±1.2),(t=8.8,P=0.00)。NIHSS评分与CMBs相关性分析显示:急性穿支动脉脑梗死合并CMBs患者入院时NIHSS评分与责任病灶伴随CMBs数量无明显相关性(r=0.091,P=0.363),3月后神经功能改善程度与责任病灶伴随CMBs数量呈负相关,相关系数(r=0.381,P=0.001)。急性穿支动脉脑梗死患者CMBs患病率较高,高血压对基底节-丘脑梗死伴CMBs生成有重要作用。入院时NIHSS评分与责任病灶区CMBs数量无关,但3月后神经功能改善程度与责任病灶梗死区CMBs数量有一定相关性,责任病灶伴随CMBs越多,神经功能恢复越差。及时行SWI扫描,对急性穿支动脉脑梗死合并CMBs患者预后评估及二级预防有重要临床意义。
[Abstract]:This study was to investigate the prevalence, risk factors and clinical changes of acute perforating artery cerebral infarction with cerebral microhemorrhage in different locations. In this study, we collected the results of brain diffusion weighted imaging (DWI) and magnetic sensitivity weighted imaging (WSI) sequences in patients with acute perforating artery cerebral infarction (ACI) in Handan Central Hospital. Patients with acute perforating artery infarction of basal ganglia thalamus and brain stem with cerebral microhemorrhage (Cerebral microbleeds) were selected as study subjects. The basic clinical information, related risk factors and neurological function scores were recorded. The subjects were divided into basal ganglia-thalamic infarction group and brainstem infarction group according to the location of new infarction. According to the MARSS-microbleed Anatomical scaling scale table [1] (see figure 1), the number of CMBs related to the responsible lesion was recorded: the number of ipsilateral cerebral hemispheres and the number of brainstem CMBs were recorded in patients with basal ganglia and thalamic infarction. The number of cerebral stem CMBs and the number of bilateral cerebral hemispheres were recorded in patients with brainstem infarction. The prevalence, risk factors and NIHSS score of cerebral microhemorrhage in acute perforating artery cerebral infarction were analyzed statistically. In this study, 214 patients with acute perforating artery cerebral infarction and 198 patients with acute perforating artery cerebral infarction were included in this study. Among them, 6 patients with incomplete data were non-basal ganglia thalamus and 10 patients with acute perforating artery cerebral infarction in the brainstem. A total of 198 patients with acute perforating artery cerebral infarction entered the group. 198 patients with acute perforating artery cerebral infarction in basal ganglia thalamus or brain stem were accompanied with CMBs103 cases in positive group and 95 cases in negative group. The incidence of hypertension in the positive group was 80.6, which was significantly higher than that in the negative group (蠂 2, 4.51, P 0.03). There was no significant difference in the remaining risk factors. There were 67 cases of cerebral microhemorrhage in patients with basal ganglia-thalamic infarction and 36 cases of cerebral microhemorrhage in patients with brainstem infarction. The incidence of hypertension in patients with basal ganglia thalamic infarction and CMBs was 86.6, which was higher than that in brainstem infarction patients with CMBs. The number of CMBs in the ipsilateral cerebral hemispheres in the basal ganglia thalamic infarction group was 280 卤4.2 卤4.8, which was significantly higher than that in the bilateral cerebral hemispheres in the brainstem infarction group. The number of CMBs in the ipsilateral cerebral hemispheres was 0.64 卤3.2. The number of brainstem CMBs in brainstem infarction group was 174V 4.8 卤3.2g, which was higher than that in basal ganglia thalamic infarction group (620.93 卤1.2). NIHSS score and CMBs correlation analysis showed that NIHSS score and responsible lesion were associated with CMBs at admission in patients with acute perforating artery cerebral infarction. There was no significant correlation between the amount of nerve function and the number of CMBs, but there was a negative correlation between the degree of improvement of nerve function and the number of CMBs associated with the responsible lesion after 3 months. The correlation coefficient is 0.381P0. 001g. The prevalence of CMBs in patients with acute perforating artery cerebral infarction is high. Hypertension plays an important role in the formation of CMBs in basal ganglia-thalamic infarction. The NIHSS score was not related to the number of CMBs in the responsible lesion area at admission, but there was a certain correlation between the degree of improvement of nerve function and the number of CMBs in the responsible infarct area after 3 months. The more the responsible lesion accompanied by CMBs, the worse the recovery of nerve function. SWI scan in time has important clinical significance for prognosis evaluation and secondary prevention in patients with acute perforating artery cerebral infarction complicated with CMBs.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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