颈动脉硬化和其他危险因素与老年脑梗死的相关性分析

发布时间：2018-07-04 16:38

本文选题：老年脑梗死 + 颈动脉硬化　；参考：《吉林大学》2017年硕士论文

【摘要】：研究背景:近年来,中国人口老龄化日益明显,人类疾病谱发生了很大变化,脑血管病的发病率逐年升高,在我国老年患者死亡原因中居首位。脑梗死因其高发病率、高复发率、高致残率及高致死率的特点,已经成为全球关注的公共健康问题。因此,早期筛查、干预和控制脑梗死的危险因素,是目前老年人卒中管理的重要举措。目的:探讨颈动脉硬化及其他危险因素与脑梗死发生及复发的相关性,比较两者对脑梗死的预测价值,为老年脑梗死的预防及改善预后提供临床指导。方法:在2015年1月至2016年12月吉大一院神经内科住院的患者中随机抽样选取年龄60岁及以上的脑梗死患者248例,按照发病情况分为初发脑梗死组(144例)及复发脑梗死组(104例),并在同期住院的患者中选取256例年龄60岁及以上的非脑梗死患者作为对照组。分别比较脑梗死组与对照组、初发脑梗死组与复发脑梗死组颈动脉硬化情况及相关因素的差异。对所有变量进行Logistic回归分析,分析脑梗死发生和复发的独立危险因素,P0.05认为有统计学意义。对危险因素数目(模式1)和颈动脉硬化情况(模式2)进行积分,并综合两者情况进行积分(模式3),评估三种积分对脑梗死的预测价值,并分别比较其敏感性和特异性。结果:(1)脑梗死组颈动脉狭窄程度及IMT积分均明显高于对照组,其差异具有统计学意义(P0.05)。(2)脑梗死组的年龄、FBG、高血压和糖尿病患病率、吸烟的比例均明显高于对照组,其差异具有统计学意义(P0.05),而两组数据中,性别、TC、TG、LDL的差异无统计学意义。(3)上述变量进行Logistic分析,可得出高血压史、糖尿病史、吸烟史、IMT积分是脑梗死的独立危险因素。(4)复发脑梗死组的内-中膜厚度(IMT)积分和颈动脉狭窄程度明显高于初发脑梗死组,具有统计学意义(P0.05),而斑块检出率差异无统计学意义(P0.05)。(5)复发脑梗死组患者的高血压、糖尿病患病率及吸烟比例明显高于初发脑梗死组患者,差异具有统计学意义(P0.05),而年龄、性别、胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL)及空腹血糖(FBG)差异没有统计学意义(P0.05)。(6)上述变量进行Logistic分析,可得出高血压史、糖尿病史、吸烟史、IMT积分是脑梗死复发的独立危险因素。(7)模式1及模式2两种积分与脑梗死均有相关性,行ROC曲线分析,三种积分曲线下面积均大于0.5,P值均小于0.05,将危险因素数目与颈动脉硬化情况结合的模式3积分的ROC面积远远大于模式1和模式2。结论:(1)综合考虑颈动脉硬化情况的IMT积分是脑梗死发生和复发的独立危险因素,因此,应加强颈动脉彩超的筛查,并及早干预,对预防脑梗死的发生有重要意义。(2)高血压、糖尿病、吸烟与脑梗死的发生及复发均有明显相关性,对合并上述危险因素的患者早期干预,是实施有效慢病管理的重要手段。(3)脑梗死的发生与年龄成正相关,对高龄患者早期干预不容忽视。(4)综合考虑危险因素及颈动脉硬化情况,可提高对脑梗死的预测价值。
[Abstract]:Background: in recent years, the population aging in China is becoming more and more obvious, the human disease spectrum has changed greatly, the incidence of cerebrovascular disease is increasing year by year, and the cause of death in the elderly is the first. The high incidence, high recurrence rate, high disability rate and high mortality rate have become a global public health question because of the death of cerebral infarction. Therefore, early screening, intervention and control of the risk factors of cerebral infarction are important measures for the management of stroke in the elderly. Objective: To explore the correlation between carotid atherosclerosis and other risk factors and the occurrence and recurrence of cerebral infarction, to compare the predictive value of the two to cerebral infarction, and to provide clinical guidance for the prevention and improvement of the prognosis of cerebral infarction. Methods: from January 2015 to December 2016, 248 patients with cerebral infarction aged 60 and above were randomly selected from the patients who were hospitalized in the neurology department of the University of JDA from January 2015 to December 2016. According to the incidence, the patients were divided into primary cerebral infarction group (144 cases) and recurrent cerebral infarction group (104 cases), and 256 cases of non cerebral infarction aged 60 years old and above were selected in the same period of hospitalization. The patients were compared with the control group, compared with the cerebral infarction group and the control group, the difference between the carotid atherosclerosis and the related factors in the primary cerebral infarction group and the recurrent cerebral infarction group. All the variables were analyzed by Logistic regression analysis to analyze the independent risk factors of the occurrence and recurrence of cerebral infarction. P0.05 thought that the number of risk factors was statistically significant (mode 1). The score of carotid arteriosclerosis (mode 2) was integrated and integrated (mode 3) to evaluate the predictive value of three kinds of integration on cerebral infarction, and their sensitivity and specificity were compared respectively. Results: (1) the degree of carotid stenosis and IMT score in cerebral infarction group were significantly higher than those in the control group (P0.05). (2) brain (2) The age, FBG, the prevalence of hypertension and diabetes and the proportion of smoking in the infarction group were significantly higher than those in the control group, and the difference was statistically significant (P0.05), but there was no significant difference in sex, TC, TG, LDL in the two groups. (3) the above variables were analyzed by Logistic, and the history of hypertension, diabetes, smoking, and IMT points were cerebral infarction. (4) the internal and middle membrane thickness (IMT) integral and the degree of carotid stenosis in the recurrent cerebral infarction group were significantly higher than those in the primary cerebral infarction group, with statistical significance (P0.05), but there was no significant difference in plaque detection rate (P0.05). (5) the incidence of hypertension, diabetes and smoking in the patients with recurrent cerebral infarction were significantly higher than that in the early onset of cerebral infarction. The differences in cerebral infarction group were statistically significant (P0.05), while age, sex, cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL) and fasting blood glucose (FBG) were not statistically significant (P0.05). (6) the above variables were analyzed by Logistic, and the history of hypertension, diabetes, smoking and IMT integral were the recurrence of cerebral infarction. Independent risk factors. (7) model 1 and mode 2, two kinds of integral and cerebral infarction have correlation, ROC curve analysis, three kinds of integral curve under 0.5, P value is less than 0.05, the number of risk factors and carotid artery sclerosis combined with the pattern 3 of the ROC area far greater than the pattern 1 and 2. conclusions: (1) comprehensive consideration of carotid artery The IMT integral of sclerotherapy is an independent risk factor for the occurrence and recurrence of cerebral infarction. Therefore, it is necessary to strengthen the screening of carotid color Doppler ultrasound and intervene early to prevent the occurrence of cerebral infarction. (2) hypertension, diabetes, smoking and cerebral infarction have a significant correlation with the occurrence and recurrence of cerebral infarction, and the patients with these risk factors are dry early. It is an important means to implement effective chronic disease management. (3) the occurrence of cerebral infarction is positively related to age, and early intervention for elderly patients can not be ignored. (4) comprehensive consideration of the risk factors and carotid atherosclerosis can improve the predictive value of cerebral infarction.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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