腔隙性脑梗死患者颅内动脉狭窄与脑白质病变发生的关系
发布时间：2018-07-22 10:31
【摘要】：研究背景:脑白质病变(white matter lesions,WML)是指脑室周围及半卵圆中心区脑白质的帽状或斑片状对称性病变。WML在老年人群中有较高的发生率,严重的WML则会导致认知功能下降、行走不稳、吞咽困难等临床表现,严重影响老年人健康。WML由于病因和发病机制不清楚,治疗困难,所以是临床防治的难题。一些研究认为WML主要是由小血管病引起,与高血压、糖尿病、血脂异常以及吸烟、饮酒等血管危险因素关系密切。腔隙性脑梗死与WML同为脑小血管病,在临床中发现许多腔隙性脑梗死患者同时伴有WML,腔隙性脑梗死伴WML会加重WML的临床症状和体征。50岁以上的中老年人群中颅内动脉狭窄主要是由动脉粥样硬化导致的,颅内动脉狭窄不仅是急性脑梗死发生的重要原因,而且还与WML的发生密切相关。但是,很少有文献报道在腔隙性脑梗死患者中颅内动脉狭窄对WML发生、发展的影响。所以,我们将深入开展在腔隙性脑梗死患者中颅内动脉狭窄与WML发生关系的临床研究,希望能对WML的防治起到重要作用。目的:探讨腔隙性脑梗死患者颅内动脉狭窄与脑白质病变(WML)发生之间的关系。方法:2015年1月-2016年10月连续收集在第三军医大学大坪医院神经内科住院50岁以上529例腔隙性脑梗死患者的临床资料。通过头颅MRI评估是否存在WML,并根据Fazekas视觉评分法评估其严重程度。应用64排螺旋CT进行颅内血管检查,并参照症状性颅内动脉疾病华法林—阿司匹林研究方法评估颅内动脉狭窄率(管径狭窄率≥50%诊断成立)。使用多因素logistic回归模型分析颅内动脉狭窄与WML之间的关系。结果:1.共入组529例腔隙性脑梗死患者,平均年龄为65.8±7.9岁,273例(51.6%)为女性。WML有295例(55.7%),其中50-59岁,WML发生率是27.8%;60-69岁,WML发生率是56.0%;70-79岁,WML发生率是75.3%;80岁以上,WML发生率是88.7%。2.与无WML组比较,WML组年龄更大,高血压、糖尿病、冠心病和颅内动脉狭窄的患病率更高(P0.05),收缩压更高(P0.01),血浆TC浓度水平(P0.05)更高。WML组大脑中动脉狭窄、大脑前动脉狭窄和大脑后动脉狭窄的发生率较无WML显著增高(P0.05)。3.不同程度颅内动脉狭窄的WML评分有显著的差异(P0.01)。与颅内动脉狭窄50%组相比,颅内动脉狭窄70-90%和90%组的WML评分更高(P0.01)。不同数目颅内动脉狭窄的WML评分有显著的差异(P0.01)。与无颅内动脉狭窄组相比,颅内动脉狭窄2处和≥3处组的WML评分更高(P0.05;P0.01)。大脑中动脉狭窄、大脑前动脉狭窄和大脑后动脉狭窄的程度与WML严重程度呈正相关关系(P0.01;P0.05;P0.05)。4.在调整了年龄、性别、高血压、糖尿病、冠心病和总胆固醇这些危险因素的影响后,logistic回归分析显示年龄(OR=1.42,95%CI=1.15-1.79,P0.01)、高血压(OR=2.29,95%CI=1.54-3.02,P0.01)、糖尿病(OR=1.29,95%CI=1.19-1.45,P0.01)和颅内动脉狭窄(OR=1.94,95%CI=1.35-2.54,P0.01)与WML的发生风险有关。5.在调整了相关混杂因素后,大脑中动脉狭窄(OR=2.91,95%CI=1.54-4.02,P0.01)与WML之间存在显著的相关性。与颅内动脉狭窄50%组比,颅内动脉狭窄70-90%组(OR=1.74,95%CI=1.26-2.05,P0.01)和90%组(OR=2.38,95%CI=1.48-3.17,P0.01)与WML之间也存在显著的相关性。此外,与无颅内动脉狭窄相比,颅内动脉狭窄2处(OR=1.34,95%CI=1.14-1.65,P0.05)和颅内动脉狭窄≥3处(OR=3.49,95%CI=1.78-4.77,P0.01)与WML之间同样存在显著的相关性。结论:1.在腔隙性脑梗死中,发现颅内动脉狭窄与WML的发生显著相关。此外,年龄、高血压、糖尿病也与WML的发生显著相关。2.在腔隙性脑梗死中,发现大脑中动脉狭窄、大脑前动脉狭窄和大脑后动脉狭窄程度与WML的严重程度呈正相关。3.在腔隙性脑梗死不同部位的颅内动脉狭窄中,大脑中动脉狭窄增加2.9倍WML发生的风险。不同程度的颅内动脉狭窄中,发现颅内动脉狭窄70-90%和90%与WML发生有显著的相关性,使WML的发生风险分别增加1.7和2.4倍。不同数目的颅内动脉狭窄中,发现颅内动脉狭窄2处和≥3处与WML的发生显著相关,使WML的发生风险分别增加1.3倍和3.5倍。
[Abstract]:Background: white matter lesions (WML) refers to the cap like or flaky symmetrical lesion of the white matter around the ventricle and the center of the oval circle..WML has a higher incidence in the elderly. Severe WML will lead to cognitive decline, unstable walking, dysphagia and other clinical manifestations, which seriously affect the healthy.WML in the elderly. Some studies suggest that WML is mainly caused by small vascular disease, which is closely related to hypertension, diabetes, dyslipidemia, and smoking, drinking and other vascular risk factors. Lacunar cerebral infarction and WML are small cerebrovascular diseases, and many lacunae are found in the clinic. The patients with cerebral infarction are accompanied with WML, lacunar cerebral infarction with WML will aggravate the clinical symptoms and signs of WML, and the intracranial artery stenosis is mainly caused by atherosclerosis in the middle aged and elderly people over.50 years old. The intracranial artery stenosis is not only an important cause of acute cerebral infarction, but also closely related to the occurrence of WML. However, few of them are related to the occurrence of WML. There are reports on the effects of intracranial artery stenosis on the occurrence and development of WML in patients with lacunar cerebral infarction. Therefore, we will carry out a clinical study on the relationship between intracranial artery stenosis and WML in patients with lacunar cerebral infarction and hope to play an important role in the prevention and control of WML. The relationship between narrow and white matter lesions (WML). Methods: the clinical data of 529 patients with lacunar infarction over 50 years of age in the neurology department of Daping Hospital of Third Military Medical University in October January 2015 were collected. WML was assessed by MRI in the head, and the severity of the patients was evaluated according to the Fazekas visual score. 64 The intracranial vascular examination was performed with a spiral CT, and the intracranial artery stenosis rate (the stenosis rate was more than 50%) was evaluated according to the warfarin aspirin study of symptomatic intracranial artery disease. Multiple factor Logistic regression model was used to analyze the relationship between intracranial artery stenosis and WML. Results: 529 cases of lacunar cerebral infarction in the 1. co group. The average age was 65.8 + 7.9 years, 273 (51.6%) women.WML had 295 (55.7%), of which 50-59 years, the incidence of WML was 27.8%; 60-69 years old, the incidence of WML was 56%; 70-79 years of age, the incidence of WML was 75.3%; the incidence of WML was 88.7%.2. and no WML group, the WML group was older, hypertension, diabetes, CHD, and intracranial artery stenosis. The prevalence rate is higher (P0.05), the systolic pressure is higher (P0.01), the plasma TC concentration (P0.05) is higher in the.WML group, the incidence of the stenosis of the anterior cerebral artery and the posterior cerebral artery is higher than that without WML (P0.05), the WML score of the intracranial artery stenosis in different degrees is significantly different (P0.01). Compared with the 50% groups of intracranial artery stenosis, The WML score of 70-90% and 90% groups was higher (P0.01). The WML score of different number of intracranial artery stenosis was significantly different (P0.01). Compared with the group without intracranial artery stenosis, the WML score of the intracranial artery stenosis group was higher (P0.05; P0.01). The middle cerebral artery stenosis, the anterior cerebral artery stenosis and the posterior cerebral artery stenosis were higher than those in the group without intracranial artery stenosis. Degree has a positive correlation with WML severity (P0.01; P0.05; P0.05).4. after adjusting the risk factors of age, sex, hypertension, diabetes, coronary heart disease and total cholesterol, logistic regression analysis showed age (OR=1.42,95%CI=1.15-1.79, P0.01), hypertension (OR=2.29,95%CI=1.54-3.02, P0.01), and diabetes (OR=1.29,95%CI=1.19-) 1.45, P0.01) and intracranial artery stenosis (OR=1.94,95%CI=1.35-2.54, P0.01) were associated with the risk of WML..5. had a significant correlation with WML (OR=2.91,95%CI=1.54-4.02, P0.01) after adjusting the related confounding factors. The 50% groups of intracranial stenosis were compared with the intracranial artery stenosis group 70-90% (OR=1.74,95%CI=1.26-2.05, There was a significant correlation between P0.01 and 90% groups (OR=2.38,95%CI=1.48-3.17, P0.01) and WML. In addition, there was a significant correlation between 2 intracranial artery stenosis (OR=1.34,95%CI=1.14-1.65, P0.05) and intracranial stenosis more than 3 (OR=3.49,95%CI=1.78-4.77, P0.01) and WML compared with no intracranial artery stenosis. Conclusion: 1. in the lacunar space. There is a significant correlation between intracranial artery stenosis and the occurrence of WML in cerebral infarction. In addition, age, hypertension, and diabetes are also associated with the occurrence of WML,.2. in lacunar cerebral infarction, the stenosis of middle cerebral artery, the degree of anterior cerebral artery stenosis and the degree of posterior cerebral artery stenosis are positively related to the severity of WML,.3. is not in lacunar infarction. In the same part of the intracranial artery stenosis, middle cerebral artery stenosis increased by 2.9 times the risk of WML. In different degrees of intracranial artery stenosis, there was a significant correlation between the occurrence of intracranial artery stenosis 70-90% and 90% and WML, which increased the risk of WML by 1.7 and 2.4 times respectively. A narrow 2 and more than 3 locations were significantly associated with the occurrence of WML, which increased the risk of WML by 1.3 times and 3.5 times respectively.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
本文编号：2137142
[Abstract]:Background: white matter lesions (WML) refers to the cap like or flaky symmetrical lesion of the white matter around the ventricle and the center of the oval circle..WML has a higher incidence in the elderly. Severe WML will lead to cognitive decline, unstable walking, dysphagia and other clinical manifestations, which seriously affect the healthy.WML in the elderly. Some studies suggest that WML is mainly caused by small vascular disease, which is closely related to hypertension, diabetes, dyslipidemia, and smoking, drinking and other vascular risk factors. Lacunar cerebral infarction and WML are small cerebrovascular diseases, and many lacunae are found in the clinic. The patients with cerebral infarction are accompanied with WML, lacunar cerebral infarction with WML will aggravate the clinical symptoms and signs of WML, and the intracranial artery stenosis is mainly caused by atherosclerosis in the middle aged and elderly people over.50 years old. The intracranial artery stenosis is not only an important cause of acute cerebral infarction, but also closely related to the occurrence of WML. However, few of them are related to the occurrence of WML. There are reports on the effects of intracranial artery stenosis on the occurrence and development of WML in patients with lacunar cerebral infarction. Therefore, we will carry out a clinical study on the relationship between intracranial artery stenosis and WML in patients with lacunar cerebral infarction and hope to play an important role in the prevention and control of WML. The relationship between narrow and white matter lesions (WML). Methods: the clinical data of 529 patients with lacunar infarction over 50 years of age in the neurology department of Daping Hospital of Third Military Medical University in October January 2015 were collected. WML was assessed by MRI in the head, and the severity of the patients was evaluated according to the Fazekas visual score. 64 The intracranial vascular examination was performed with a spiral CT, and the intracranial artery stenosis rate (the stenosis rate was more than 50%) was evaluated according to the warfarin aspirin study of symptomatic intracranial artery disease. Multiple factor Logistic regression model was used to analyze the relationship between intracranial artery stenosis and WML. Results: 529 cases of lacunar cerebral infarction in the 1. co group. The average age was 65.8 + 7.9 years, 273 (51.6%) women.WML had 295 (55.7%), of which 50-59 years, the incidence of WML was 27.8%; 60-69 years old, the incidence of WML was 56%; 70-79 years of age, the incidence of WML was 75.3%; the incidence of WML was 88.7%.2. and no WML group, the WML group was older, hypertension, diabetes, CHD, and intracranial artery stenosis. The prevalence rate is higher (P0.05), the systolic pressure is higher (P0.01), the plasma TC concentration (P0.05) is higher in the.WML group, the incidence of the stenosis of the anterior cerebral artery and the posterior cerebral artery is higher than that without WML (P0.05), the WML score of the intracranial artery stenosis in different degrees is significantly different (P0.01). Compared with the 50% groups of intracranial artery stenosis, The WML score of 70-90% and 90% groups was higher (P0.01). The WML score of different number of intracranial artery stenosis was significantly different (P0.01). Compared with the group without intracranial artery stenosis, the WML score of the intracranial artery stenosis group was higher (P0.05; P0.01). The middle cerebral artery stenosis, the anterior cerebral artery stenosis and the posterior cerebral artery stenosis were higher than those in the group without intracranial artery stenosis. Degree has a positive correlation with WML severity (P0.01; P0.05; P0.05).4. after adjusting the risk factors of age, sex, hypertension, diabetes, coronary heart disease and total cholesterol, logistic regression analysis showed age (OR=1.42,95%CI=1.15-1.79, P0.01), hypertension (OR=2.29,95%CI=1.54-3.02, P0.01), and diabetes (OR=1.29,95%CI=1.19-) 1.45, P0.01) and intracranial artery stenosis (OR=1.94,95%CI=1.35-2.54, P0.01) were associated with the risk of WML..5. had a significant correlation with WML (OR=2.91,95%CI=1.54-4.02, P0.01) after adjusting the related confounding factors. The 50% groups of intracranial stenosis were compared with the intracranial artery stenosis group 70-90% (OR=1.74,95%CI=1.26-2.05, There was a significant correlation between P0.01 and 90% groups (OR=2.38,95%CI=1.48-3.17, P0.01) and WML. In addition, there was a significant correlation between 2 intracranial artery stenosis (OR=1.34,95%CI=1.14-1.65, P0.05) and intracranial stenosis more than 3 (OR=3.49,95%CI=1.78-4.77, P0.01) and WML compared with no intracranial artery stenosis. Conclusion: 1. in the lacunar space. There is a significant correlation between intracranial artery stenosis and the occurrence of WML in cerebral infarction. In addition, age, hypertension, and diabetes are also associated with the occurrence of WML,.2. in lacunar cerebral infarction, the stenosis of middle cerebral artery, the degree of anterior cerebral artery stenosis and the degree of posterior cerebral artery stenosis are positively related to the severity of WML,.3. is not in lacunar infarction. In the same part of the intracranial artery stenosis, middle cerebral artery stenosis increased by 2.9 times the risk of WML. In different degrees of intracranial artery stenosis, there was a significant correlation between the occurrence of intracranial artery stenosis 70-90% and 90% and WML, which increased the risk of WML by 1.7 and 2.4 times respectively. A narrow 2 and more than 3 locations were significantly associated with the occurrence of WML, which increased the risk of WML by 1.3 times and 3.5 times respectively.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
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