大脑中动脉病变及侧支循环与脑白质疏松的相关性研究

发布时间：2018-06-14 22:26

  本文选题：白质疏松 + 大脑中动脉病变　； 参考：《南京大学》2017年硕士论文

【摘要】：目的:基于脑血管造影检查探讨大脑中动脉病变及侧支循环与脑白质疏松(leukoaraiosis,LA)的相关性。方法:回顾性连续纳入2009年6月至2012年12月于南京军区总医院神经内科住院且经脑血管造影检查证实存在大脑中动脉M1段狭窄或闭塞患者299例,收集患者的相关临床资料。所有入选的研究对象入院后均行头颅MRI和全脑血管造影检查。采用Fazekas量表评分标准分别对双侧侧脑室旁白质和深部白质LA进行评分,大脑中动脉狭窄程度的判定采用的是北美症状性颈动脉内膜切除术试验组(NASCET)标准分级方法,侧支循环分级的评定采用的是美国介入治疗神经放射学学会/介入放射学学会侧支循环评估系统(ASTIN/SIR)标准分级方法。统计学方法:所有统计数据的处理采用SPSS statistics22.0统计软件包进行分析,计数资料采用卡方检验,非正态分布计量资料采用非参数检验,正态分布计量资料用t检验,采用Logistic回归分析大脑中动脉严重狭窄、侧支循环分级与LA的关系。P0.05表示有统计学意义。结果:本研究最终纳入299例患者,男性占68.6%,平均年龄(57 ±13)岁。侧脑室旁中重度LA组的年龄、高血压病、糖尿病、高脂血症、冠心病、卒中史均高于无或轻度LA组,两组比较其差异有统计学意义(均P0.05),而两组间在性别、吸烟史、TIA史上无显著统计学差异(均P0.05)。深部白质中重度LA组年龄、高血压病和冠心病患病率高于无或轻度LA组,而吸烟例数少于无或轻度LA组,差异有显著统计学意义(均P0.05),而性别、糖尿病、高脂血症、卒中史、TIA史与无或轻度LA组比较无统计学差异(均P0.05)。双侧侧脑室旁中重度LA组腔梗患病率及腔梗数目均高于无或轻度LA组(均P0.05);右侧深部白质中重度LA组腔梗患病率及腔梗数目高于无或轻度LA组(P0.05),而左侧深部白质两组间腔梗患病率及腔梗数目无统计学差异(P0.05)。大脑中动脉狭窄程度和侧支循环分级在双侧不同程度侧脑室旁白质以及深部白质LA中无统计学差异(均P0.05)。Spearman相关分析显示双侧半球侧脑室旁白质和深部白质LA程度与侧支循环分级和MCA狭窄程度均无相关性(均P0.05)。将单因素分析中P0.1的变量进行非条件多因素Logistic回归分析显示,调整相关混杂因素后,年龄(OR:1.107,95%CI:1.068～1.147,P0.01)、高血压病(OR:4.456,95%CI:1.612～12.318,P=0.004),卒中史(OR:2.278,95%CI:1.150～4.513,P=0.018)以及腔梗数目(OR:1.295,95%CI:1.005～1.668,P=0.046)与左侧侧脑室旁LA独立相关;年龄(OR:1.068,95%CI:1.032～1.105,P0.01)、高血压病(OR:4.481,95%CI:1.497～13.409,P=0.007)与左侧深部白质 LA独立相关;年龄(OR:1.097,95%CI:1.060～1.136,P0.01)、高血压病(OR:3.332,95%CI:1.301～8.529,P=0.012)以及腔梗数目(OR:1.265,95%CI:1.037～1.544,P=0.021)与右侧侧脑室旁LA独立相关;年龄(OR:1.085,95%CI:1.046～1.126,P0.01)、高血压病(OR:3.857,95%CI:1.275～11.670,P=0.017)、腔梗数目(OR:1.365,95%CI:1.107～1.682,P=0.004)与右侧深部白质 LA独立相关。结论:对于大脑中动脉病变患者,年龄、高血压病、腔梗数目是侧脑室旁LA的独立危险因素,年龄、高血压病是深部白质LA的独立危险因素,而MCA狭窄程度和侧支循环与两个部位的LA均无明显相关性,提示LA可能更倾向于是由小血管病变引起,但这一研究结果尚待进一步更大样本量的前瞻性研究加以证实。
[Abstract]:Objective: To investigate the correlation between the middle cerebral artery disease and the collateral circulation and leukoaraiosis (LA) based on cerebral angiography. Methods: retrospective and continuous admission from June 2009 to December 2012 in the General Hospital of Nanjing Military Region neurology department and the cerebral angiography confirmed the existence of M1 segment stenosis or occlusion of the middle cerebral artery. The clinical data of 299 patients were collected. All the selected subjects were performed head MRI and whole brain angiography after admission. The Fazekas scale score was used to score the bilateral lateral ventricle white matter and deep white matter LA. The degree of middle cerebral artery stenosis was determined by symptomatic carotid endarterosis in North America. In addition to the standard classification method of the operation test group (NASCET), the evaluation of collateral circulation classification is the standard classification method of the American Association of Interventional Neurology Association / Interventional Radiology Association (ASTIN/SIR). Statistical method: all statistical data are analyzed by SPSS statistics22.0 statistical package. The data were checked with chi square test, non normal distribution measurement data were tested by nonparametric test, normal distribution measurement data were tested with T, Logistic regression analysis was used to analyze the serious stenosis of middle cerebral artery, and the relationship between collateral circulation classification and LA was statistically significant. Results: 299 cases were included in this study, male accounted for 68.6%, average age (57). Age, hypertension, diabetes, hyperlipidemia, hyperlipidemia, coronary heart disease, and stroke history were higher than those in the non or mild LA group. The difference was statistically significant between the two groups (all P0.05), but there was no significant difference between the two groups in sex, smoking history, and TIA history (P0.05). The age of severe LA group in deep white matter, hypertension, and hypertension were all in the two groups. The incidence of coronary heart disease was higher than that in the non or mild LA group, but the number of smoking cases was less than that of the non or mild LA group. The difference was statistically significant (P0.05), while sex, diabetes, hyperlipidemia, stroke history, the history of TIA and the mild LA group had no statistical difference (P0.05). The incidence of infarction and the number of cavities in the moderate and severe LA group were higher in both sides of the lateral lateral ventricle. In the non or mild LA group (P0.05), the morbidity and the number of cavities in the moderate and severe group LA of the right deep white matter were higher than those in the non or mild LA group (P0.05), but there was no statistical difference between the two groups of the left deep white matter and the number of the cavities (P0.05). No statistical difference (P0.05).Spearman correlation analysis in deep white matter LA showed that there was no correlation between the degree of LA and the degree of collateral circulation and MCA stenosis in bilateral hemisphere lateral ventricle and deep white matter (P0.05). Unconditional multiple factor Logistic regression analysis of the variables of P0.1 in single factor analysis showed the adjustment of related confounding. After factors, age (OR:1.107,95%CI:1.068 to 1.147, P0.01), hypertension (OR:4.456,95%CI:1.612 to 12.318, P=0.004), stroke history (OR:2.278,95%CI:1.150 to 4.513, P=0.018) and the number of cavities (OR:1.295,95%CI:1.005 to 1.668, P=0.046) independent of the left lateral ventricle LA; age (OR:1.068,95%CI:1.032 to 1.105, P0.01), hypertension (OR:4.481,95%CI:1.497 ~ 13.409, P=0.007) was independent of the left deep white matter LA; age (OR:1.097,95%CI:1.060 ~ 1.136, P0.01), hypertension (OR:3.332,95%CI:1.301 ~ 8.529, P=0.012) and the number of cavities (OR:1.265,95%CI:1.037 to 1.544, P=0.021) were independent of the right lateral paraventricular LA; age (OR:1.085,95%CI:1.046 to 1.126, P0) .01), hypertension (OR:3.857,95%CI:1.275 ~ 11.670, P=0.017), the number of cavities (OR:1.365,95%CI:1.107 ~ 1.682, P=0.004) is independent of the right deep white matter LA. Conclusion: for patients with middle cerebral artery disease, age, hypertension, and the number of cavities are independent risk factors for LA near the lateral ventricle. Age, hypertension is the only one in deep white matter LA. There is no significant correlation between the risk factors and the degree of MCA stenosis and collateral circulation and the LA of two sites, suggesting that LA may be more likely to be caused by small vascular lesions, but the result of this study remains to be confirmed by further prospective studies of larger samples.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
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本文编号：2019175