复发性脑梗死的临床和影像学分析

发布时间：2018-06-24 06:47

本文选题：脑梗死 + 复发　；参考：《山东大学》2017年硕士论文

【摘要】：背景与目的:脑梗死是严重危害人类健康的疾病之一,具有高致残率、高死亡率和高复发率的特点,复发后的死亡率、致残率均高于初发,给社会和许多家庭造成了沉重的负担。关于脑梗死复发的研究仍是医学界的热点,但是对导致复发的危险因素的确定、预测复发的多种量表的效度、药物及颅内外支架的预防效果等都存在一定争议。本研究的目的就是分析住院治疗的复发性脑梗死患者与未复发患者的临床和影像学有何差异,寻找导致脑梗死复发的主要危险因素及预测指标,以便筛选出具有复发倾向的对象,以加强对他们的健康宣教及针对性治疗,达到降低脑梗死复发的目标。方法:本研究收集自2014年12月至2015年12月在我院神经内科住院治疗的初次发病的急性脑梗死患者,初次筛选后按照流程进行相应的检查及治疗,出院后进行常规二级预防治疗,经电话随访或门诊复诊1年,最后筛选出226名患者进行研究分析。根据患者是否复发分为复发组21例及非复发组205例,使用SPSS 18.0统计软件对两组患者的临床和影像进行分析。结果:(1)1年内226名患者有21例复发,复发率为9.29%。(2)高血压病、糖尿病在复发组的比率明显高于非复发组,且差异有统计学意义(p0.05);两组性别、年龄、吸烟史、体重指数、高脂血症及心脏病等方面无统计学差异(P0.05)。(3)对两组M-TOAST分型分别进行总体和各亚型之间对比发现,动脉粥样硬化血栓形成(AT型)在复发组所占比率(66.67%)明显高于非复发组(43.41%),差异有统计学意义(P0.05)。(4)对两组ESSEN评分进行对比,复发组中ESSEN评分高危及以上患者比率(71.43%)明显高于非复发组(34.63%),且差异有统计学意义(p0.05)。(5)两组影像学资料对比:不稳定斑块在复发组所占比率(71.43%)明显高于非复发组(34.15%),颅内或颅外血管狭窄在复发组所占比率明显高于非复发组,且差异有统计学意义(P0.05)。结论:(1)本研究中初发脑梗死1年内的复发率为9.29%。(2)高血压病、糖尿病是脑梗死复发的主要危险因素。(3)有颈部不稳定斑块或颅内外血管狭窄患者的复发率明显增高。(4)M-T0AST分型中AT型患者复发率高,与本研究中存在颈部不稳定斑块或颅内外血管狭窄患者的复发率明显增高一致。(5)ESSEN评分能预测脑梗死复发的风险,但ESSEN评分未包含不稳定斑块及颅内外血管狭窄等影像学特征,可能会影响其预测的效度。
[Abstract]:Background & objective: cerebral infarction is one of the most serious diseases that endanger human health. It has the characteristics of high disability rate, high mortality rate and high recurrence rate. It places a heavy burden on society and many families. The research on the recurrence of cerebral infarction is still a hot topic in the medical field. However, the determination of the risk factors leading to recurrence, the validity of multiple scales for predicting recurrence, and the preventive effects of drugs and extracranial stents are still controversial. The purpose of this study was to analyze the clinical and imaging differences between patients with recurrent cerebral infarction and those without recurrence, and to find out the main risk factors and predictors of recurrent cerebral infarction. In order to select the target with recurrence tendency, to strengthen their health education and targeted treatment, to achieve the goal of reducing the recurrence of cerebral infarction. Methods: from December 2014 to December 2015, patients with primary acute cerebral infarction who were hospitalized in Department of Neurology in our hospital were examined and treated according to the procedure of primary screening, and the patients were treated with routine secondary preventive therapy after discharge. 226 patients were selected and analyzed by telephone follow-up or outpatient follow-up for 1 year. The patients were divided into recurrent group (21 cases) and non-recurrent group (205 cases) according to whether they recurred or not. The clinical and imaging data of the two groups were analyzed by SPSS 18.0 software. Results: (1) there were 21 cases of recurrence in 226 patients within one year, the recurrence rate was 9.29. (2) the rate of hypertension and diabetes mellitus in recurrent group was significantly higher than that in non-recurrence group (p0.05), the sex, age, smoking history, body mass index of the two groups were significantly higher than those of non-recurrence group (p0.05). There was no statistical difference in hyperlipidemia and heart disease (P0.05). (3). The percentage of atherosclerotic thrombosis (AT type) in recurrent group (66.67%) was significantly higher than that in non-recurrent group (43.41%). The difference was statistically significant (P0.05). (4). The ratio of high risk and above Essen score in recurrent group (71.43%) was significantly higher than that in non-recurrent group (34.63%), and the difference was statistically significant (p0.05). (5). The ratio of unstable plaque in recurrent group (71.43%) was significantly higher than that in non-recurrent group (34.15%). The proportion of internal or extracranial vascular stenosis in recurrent group was significantly higher than that in non-recurrent group. The difference was statistically significant (P0.05). Conclusion: (1) the recurrence rate of primary cerebral infarction in this study is 9.290.The second is hypertension. Diabetes mellitus was the main risk factor for recurrence of cerebral infarction. (3) the recurrence rate of patients with unstable plaque of neck or intracranial and external vascular stenosis was significantly higher. (4) the recurrence rate of AT type patients in M-T0AST classification was high. In this study, the recurrence rate of patients with cervical unstable plaque or intracranial and extracranial vascular stenosis was significantly higher. (5) ESSEN score could predict the risk of cerebral infarction recurrence, but ESSEN score did not contain the imaging features of unstable plaque and intracranial and extracranial vascular stenosis. It may affect the validity of its prediction.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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