颅内动脉狭窄与内皮功能、亲环素A关系研究及三七通舒胶囊对高危缺血性脑卒中二级预防的疗效观察

发布时间：2018-06-18 19:32

  本文选题：颅内动脉狭窄 + 血管内皮功能　； 参考：《湖北中医药大学》2014年硕士论文

【摘要】：目的： 探讨缺血性脑卒中病患者血管内皮功能与颅内动脉狭窄的相关性；研究颅内颅内动脉狭窄程度与亲环素A和网膜素的关系，探讨颅内动脉狭窄的危险因素和亲环素A、网膜素与颅内动脉狭窄程度的关系；研究中药制剂三七通舒胶囊对缺血性脑卒中复发高危人群预后的影响及在缺血性脑卒中二级预防中的疗效。 方法： 1、将67例缺血性脑卒中患者根据有无颅内血管狭窄分为两组，颅内血管狭窄组和对照组。对两组患者一般资料及肱动脉血流介导的血管扩张功能、非内皮依赖性血管舒张功能进行对比分析，并进一步分析肱动脉血流介导的血管扩张功能、非内皮依赖性血管舒张功能与颅内血管狭窄数量的相关性； 2、将89例缺血性脑卒中患者分为颅内动脉多发狭窄组（n=29）、颅内动脉单发狭窄组（n=24）和对照组（n=36），应用ELISA方法测定血清亲环素A和网膜素浓度。比较三组间既往史、血清亲环素A和网膜素水平的差异； 3、按照纳入标准筛选出202例缺血性脑卒中患者。按出院后服用的药物分为两组，拜阿司匹林合并三七通舒胶囊的患者设为中西结合治疗组，共81例；拜阿司匹林的患者设为对照治疗组，共121例。对所有患者进行随访，随访内容包括有无复发卒中症状，服用药物情况等，并将疗效结果分为复发、未复发两种，并对两组的疗效结果进行统计。 结果： 1、颅内动脉狭窄组有50例，对照组有17例，年龄、肱动脉血流介导的血管扩张功能、非内皮依赖性血管舒张功能、高血压病、糖尿病、既往卒中或短暂性脑缺血发作史与颅内动脉狭窄相关，且肱动脉血流介导的血管扩张功能(rs=-0.869,p=0.000＜0.05)与非内皮依赖性血管舒张功能(rs=-0.490,p=0.000＜0.05)分别与颅内动脉狭窄的数量存在负相关关系。非条件Logistic回归分析得出肱动脉血流介导的血管扩张可作为评估颅内动脉狭窄的独立因素，以肱动脉血流介导的血管扩张功能值为2.95%时诊断颅内动脉狭窄的可能性最大； 2、在颅内动脉多发狭窄组、颅内动脉单发狭窄组、对照组既往史的比较中，糖尿病史和既往卒中史具有显著差异性（P0.017），颅内动脉多发狭窄组的患者合并糖尿病史、既往卒中史的概率比另两组的概率显著增高；三组中血清亲环素A浓度有显著差异性（P0.05），颅内动脉多发狭窄组较颅内动脉单发狭窄组患者的血清亲环素A浓度升高，且二者与对照组比较均有升高；与对照组相比，颅内动脉多发狭窄组和颅内动脉单发狭窄组血清网膜素-1浓度均有降低（P0.05），但二者之间血清网膜素浓度无显著差异性； 3、拜阿司匹林合并三七通舒胶囊治疗组和拜阿司匹林治疗组比较年龄、性别、高血压、糖尿病、冠心病、吸烟史、既往卒中史、ESRS评分平均总分均无显著差异(P＞0.05)；拜阿司匹林合并三七通舒胶囊治疗组中患者脑卒中复发率明显低于对照组，，且比较具有统计学意义（P＜0.05）。 结论: 1、颅内动脉狭窄患者存在肱动脉血流介导的血管扩张功能的降低，且肱动脉血流介导的血管扩张功能可能对颅内动脉狭窄有一定的预测价值； 2、有糖尿病史或既往卒中史的患者更容易合并颅内动脉狭窄，糖尿病、既往卒中史可能是颅内动脉狭窄的危险因素；颅内动脉多发狭窄组血清亲环素A水平明显升高、网膜素水平明显降低，提示亲环素A可能参与颅内动脉狭窄的形成发展；血清网膜素与颅内动脉狭窄相关，但与颅内动脉狭窄数量无关，提示颅内动脉狭窄患者可能存在内皮功能的受损； 3、在ESRS评分≥3分的缺血性脑卒中高危复发患者中，三七通舒胶囊联合拜阿司匹林预防脑卒中的再发比单用拜阿司匹林治疗效果更好，故在脑卒中复发高危人群患者的二级预防中，三七通舒胶囊与拜阿司匹林联合用药的治疗方案可能较单用拜阿司匹林其效果更佳。
[Abstract]:Purpose :

To investigate the correlation between vascular endothelial function and intracranial arterial stenosis in patients with ischemic stroke .
To study the relationship between the degree of intracranial arterial stenosis and the relationship between cyclophilin A and omental , and to explore the risk factors of intracranial arterial stenosis and the relationship between cyclophilin A and the degree of intracranial arterial stenosis .
To study the effect of Sanqi Tongshu capsule on the prognosis of patients with high risk of ischemic stroke recurrence and its curative effect in secondary prevention of ischemic stroke .

Method :

1 . Sixty - seven patients with ischemic stroke were divided into two groups , intracranial vessel stenosis group and control group according to the presence or absence of intracranial vascular stenosis .


2 . 89 patients with ischemic stroke were divided into multiple intracranial arterial stenosis group ( n = 29 ) , intracranial arterial stenosis group ( n = 24 ) and control group ( n = 36 ) .


3 . 202 patients with ischemic stroke were screened according to the inclusion criteria . The drug taken after discharge was divided into two groups .
All patients were followed up . The follow - up included the presence or absence of recurrent stroke symptoms , drug administration , etc . The results were divided into two groups : recurrence , no recurrence , and statistical analysis of the results of the two groups .

Results :

1 . There were 50 cases of intracranial arterial stenosis , 17 cases in the control group , age , brachial artery blood flow - mediated dilatation function , non - endothelium - dependent vasodilatation function , hypertension , diabetes mellitus , previous stroke or transient ischemic attack history had negative correlation with the number of intracranial arterial stenosis .


2 . There was a significant difference between the history of diabetes mellitus ( P < 0.01 ) and the history of previous stroke ( P 0 . 017 ) .
There was a significant difference in the serum levels of cyclophilin A in three groups ( P0.05 ) . Compared with the control group , the serum levels of cyclophilin A in the patients with intracranial arterial stenosis group were higher than those in control group .
Compared with the control group , there was a decrease in the serum levels of the serum levels in the patients with intracranial arterial stenosis group and intracranial arterial stenosis group ( P0.05 ) , but there was no significant difference between the serum levels of serum and the serum .


3 . There was no significant difference in the mean total score between the treatment group and the aspirin - treated group ( P > 0.05 ) .
Compared with the control group , the recurrence rate of stroke in the treatment group was significantly lower than that of the control group ( P < 0.05 ) .

Conclusion :

1 . The vascular dilatation function mediated by brachial artery flow is decreased in patients with intracranial arterial stenosis , and the function of brachial artery blood flow - mediated dilatation may have some predictive value for intracranial arterial stenosis ;


2 . Patients with history of diabetes or previous stroke are more likely to combine intracranial arterial stenosis , diabetes , and the history of previous stroke may be a risk factor for intracranial arterial stenosis ;
The levels of serum pro - cytolysin A in the patients with intracranial arterial stenosis were significantly increased , and the level of serum levels decreased significantly , suggesting that cyclophilin A might be involved in the development of intracranial arterial stenosis .
The results showed that the patients with intracranial arterial stenosis might be damaged by endothelial function .


3 . In the patients with high risk of ischemic stroke with the ESRS score 鈮

本文编号：2036624