侧支循环对中青年大脑中动脉慢性闭塞的影响
发布时间：2018-08-07 07:41
【摘要】：研究背景： 近年来，脑梗死发病年龄逐渐呈现出年轻化趋势，中青年脑梗死发病原因、其危险因素及发病的内在机制是近年来研究的焦点。在脑的供血动脉发生严重狭窄或闭塞时，脑的侧支循环建立可以通过增加脑血流量来防止脑缺血的发生，脑侧支循环网络的建立和发展对缺血性脑血管病的预防和治疗具有极其重要的作用。小血管梗死是一个非常复杂的现象，它的内在机制更是近年来研究的热点。目前大多数的研究主要探讨的是大血管的梗死的临床特点、影响因素和治疗方法，而对于一些不明原因的脑梗死，例如大脑中动脉慢性闭塞后发生的脑梗死的研究却比较少见，对中青年小血管梗死的研究则更少，这对于脑梗死机制的阐明和小血管梗死临床针对性治疗造成极大的限制。本研究的患者都是单侧大脑中动脉M1段慢性闭塞的患者，他们之中新发小血管梗死的患者的比例很高，由此可以对小血管梗死的特点进行研究。同时，这部分患者的侧支循环建立与其小血管梗死之间有怎样的关系？以往关于脑血管传统危险因素与侧支循环之间的关系的结论存在的不一致性，那么对于单侧大脑中动脉M1段慢性闭塞的患者其危险因素又和侧支循环的建立有怎样的关系？这是本研究要探索的问题。 研究目的： 探讨中青年单侧大脑中动脉起始段（M1段）慢性闭塞后新发脑梗死患者的侧支循环与脑梗死的关系，脑血管危险因素与脑梗死的关系，以及脑血管危险因素对中青年单侧大脑中动脉起始段（M1段）慢性闭塞患者侧支循环建立的影响。 研究方法: 分析2009年7月—2013年6月就诊于我院神经内科的90例单纯M1段慢性闭塞患者的临床资料，其中男48例，女42例，平均（44.6±9.7）岁，并将其分为新发脑梗死组和无脑梗死组两组，有新发梗死灶者50例，无脑梗死灶者40例。并对其脑梗死发病情况、脑血管危险因素情况、及其侧支循环建立的情况，以及它们之间的相互关系进行分析。 研究结果: 1.90例M1段慢性闭塞患者年龄分布趋势为50~59岁组最多，占37.8%，20~29岁组最少，占8.9%。有无脑梗死两组患者年龄分布差异无统计学意义，χ2=4.394，P0.05。 2.高血脂、糖尿病、吸烟、高血压、高同型半胱氨酸血症等危险因素与是否发生脑梗死无显著相关性。 3.大脑中动脉慢性闭塞患者侧支血流分级与其是否有脑梗死呈显著的负相关（r=-0.76，p0.01），新发脑梗死组侧支血流分级（采用ASITN/SIR的血流分级系统评估）1、2级占84%，而无脑梗死组1、2级只占10%，3、4级占90%，高于有脑梗死者，，侧支血流分级与脑梗死发生呈负相关，γs=-0.76，P0.01。 4.有无脑血管危险因素两组的侧支开放程度1级（前交通动脉和后交通动脉）、2级（眼动脉逆流和软脑膜侧支）和3级（新生血管）是否开放的差异均无统计学意义（P均＞0.05）。Spearman相关分析显示，侧支开放程度1级是否开放与年龄、发生高血压、高血脂、糖尿病、吸烟呈正相关，与高同型半胱氨酸血症呈负相关，但差异均无统计学意义（P均＞0.05）；侧支开放程度2级是否开放与年龄、发生高血压、吸烟、高同型半胱氨酸血症呈负相关，与高血脂、糖尿病呈正相关，但差异均无统计学意义（P均＞0.05）；侧支开放程度3级是否开放与高血压、高血脂、糖尿病、吸烟呈正相关，与年龄、同型半胱氨酸血症呈负相关，但差异均无统计学意义（P均＞0.05）。 5.侧支血流分级与高血压、同型半胱氨酸血症、吸烟之间的相关为负相关，而侧支血流分级与高血脂、糖尿病之间的相关为正相关，但差异均无统计学意义（P均＞0.05）。只有糖尿病与侧支血流之间的相关在统计学上显著。 结论: 1.本研究未显示脑血管病的传统危险因素与脑梗死发生，以及脑血管病的传统危险因素与侧支循环开放程度和侧支血流分级具有相关性。 2.MCA-M1段慢性闭塞使得侧支循环有充分时间建立，其侧支循环的血流分级起到重要作用，血流分级越高越不容易发生脑梗死。 3.本研究结果从侧面支持大脑中动脉慢性闭塞后，如果血管神经网络建立不充分，动脉的上游神经血管单元灌注阻力则会增加，从而会减少下游神经血管单元的灌注，使其供血不完全而导致梗死，可能是发生此类梗死重要的机制之一。 4.本研究结果显示，侧支血流分级是侧支循环评估指标中一个较为敏感和有效的指标，未来关于侧支循环的研究要充分考虑侧支随时间的动态变化的特点，且有必要将其纳入重要的研究指标，来探索侧支循环的形成、建立和发挥代偿作用的内在机理。 5.未来的在脑卒中研究中，要将那些动脉慢性闭塞且有充分时间建立侧支，但是其侧支代偿很差的患者重点纳入到研究当中。
[Abstract]:Research background:
In recent years, the age of cerebral infarction is becoming more and more young, the cause of cerebral infarction, the risk factors and the internal mechanism of the disease are the focus of research in recent years. In the case of severe stenosis or occlusion of the cerebral blood supply artery, the cerebral collateral circulation can be established through increasing the cerebral blood flow to prevent the occurrence of cerebral ischemia. The establishment and development of the collateral circulation network plays an extremely important role in the prevention and treatment of ischemic cerebrovascular disease. Small vascular infarction is a very complicated phenomenon. Its internal mechanism is a hot spot in recent years. Most of the research mainly focuses on the clinical characteristics, influencing factors and treatment of large vascular infarction. Methods, but for some unexplained cerebral infarction, such as the cerebral infarction that occurs after the chronic occlusion of the middle cerebral artery, the study of small and middle infarcts of small vessels is less, which makes a great limitation on the clarification of the mechanism of cerebral infarction and the clinical targeted treatment of small vascular infarction. In patients with chronic M1 segment of the middle cerebral artery, the proportion of the patients with new small vascular infarction is very high, which can be used to study the characteristics of small vascular infarction. At the same time, what is the relationship between the establishment of the collateral circulation and the small vascular infarction in this part of the patients? What is the relationship between the risk factors and the establishment of collateral circulation in patients with M1 segment chronic occlusion of the unilateral middle cerebral artery? This is a question to be explored in this study.
The purpose of the study is:
To investigate the relationship between collateral circulation and cerebral infarction, the relationship between cerebral vascular risk factors and cerebral infarction, and the effect of cerebrovascular risk factors on collateral circulation in patients with chronic occlusion of middle middle cerebral artery (M1 segment) of middle cerebral artery (M1 segment) after chronic occlusion of middle cerebral artery in young and middle-aged patients.
Research methods:
The clinical data of 90 patients with simple M1 segment chronic occlusion in the Department of Neurology from July 2009 to June 2013 were analyzed, including 48 males and 42 females, averaging (44.6 + 9.7) years old. They were divided into new onset cerebral infarction group and two group without cerebral infarction, 50 cases with new infarcts and 40 patients without cerebral infarction. The situation of vascular risk factors, the establishment of collateral circulation, and the relationship between them were analyzed.
The results of the study:
The age distribution trend of 1.90 patients with M1 segment chronic occlusion was the most in 50~59 years old group, accounting for 37.8%, and the least in 20~29 year old group. There was no statistical difference in age distribution between the two groups of 8.9%. patients with cerebral infarction, X 2=4.394, P0.05..
2. Hyperlipidemia, diabetes mellitus, smoking, hypertension, hyperhomocysteinemia and other risk factors have no significant correlation with the occurrence of cerebral infarction.
3. the lateral branch blood flow classification of the patients with chronic cerebral artery occlusion was significantly negatively correlated with cerebral infarction (r=-0.76, P0.01). The level of lateral branch blood flow in the new cerebral infarction group (using the ASITN/SIR blood flow classification system) was 84%, while the 1,2 level in the non cerebral infarction group was 10%, and the 3,4 level was 90%, which was higher than that of the cerebral infarction and the lateral branch blood flow classification. The incidence of cerebral infarction was negative correlation, gamma s=-0.76, P0.01.
4. there were 1 levels of lateral branch openness (anterior communicating artery and posterior communicating artery) in two groups without cerebral vascular risk factors, and there was no significant difference in the opening of level 2 (ocular artery countercurrent and lateral branch of MMA) and 3 (P > 0.05). Hyperlipidemia, diabetes and smoking were positively correlated with hyperhomocysteinemia, but the difference was not statistically significant (P > 0.05). The opening degree of lateral branch 2 was negatively correlated with high blood pressure, smoking and hyperhomocysteinemia, and was positively correlated with hyperlipidemia and diabetes, but the difference was not statistically significant. Meaning (P > 0.05); the opening degree of lateral branch 3 was positively correlated with hypertension, hyperlipidemia, diabetes and smoking, and was negatively correlated with age and homocysteine, but the difference was not statistically significant (P > 0.05).
5. lateral branch blood flow classification was negatively correlated with hypertension, homocysteine and smoking, but the correlation between collateral flow classification and hyperlipidemia and diabetes was positively correlated, but the difference was not statistically significant (P > 0.05). Only the correlation between diabetes and collateral flow was statistically significant.
Conclusion:
1. the traditional risk factors for cerebrovascular disease and cerebral infarction, as well as the traditional risk factors for cerebrovascular disease, are related to the degree of collateral circulation opening and the classification of collateral flow.
The chronic occlusion of the 2.MCA-M1 segment makes the collateral circulation fully established. The blood flow classification of the collateral circulation plays an important role. The higher the blood flow classification, the less prone to cerebral infarction.
3. the results of this study support the chronic occlusion of the middle cerebral artery. If the vascular neural network is not established sufficiently, the perfusion resistance of the upstream neurovascular unit will increase, which will reduce the perfusion of the downstream neurovascular units and make the blood supply incomplete and lead to infarction, which may be one of the important mechanisms of this kind of infarction.
4. the results of the study show that the lateral branch flow classification is a more sensitive and effective indicator of collateral circulation assessment. The future study of collateral circulation should take full account of the characteristics of the dynamic changes in the collateral circulation with time, and it is necessary to incorporate it into important research indicators to explore the formation of collateral circulation and to establish and play compensation for the collateral circulation. The internal mechanism of use.
5. in the future study of cerebral apoplexy, those arteries should be blocked by chronic occlusion and have sufficient time to establish collateral, but the patients with very poor collateral compensatory focus are included in the study.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3
本文编号：2169334
[Abstract]:Research background:
In recent years, the age of cerebral infarction is becoming more and more young, the cause of cerebral infarction, the risk factors and the internal mechanism of the disease are the focus of research in recent years. In the case of severe stenosis or occlusion of the cerebral blood supply artery, the cerebral collateral circulation can be established through increasing the cerebral blood flow to prevent the occurrence of cerebral ischemia. The establishment and development of the collateral circulation network plays an extremely important role in the prevention and treatment of ischemic cerebrovascular disease. Small vascular infarction is a very complicated phenomenon. Its internal mechanism is a hot spot in recent years. Most of the research mainly focuses on the clinical characteristics, influencing factors and treatment of large vascular infarction. Methods, but for some unexplained cerebral infarction, such as the cerebral infarction that occurs after the chronic occlusion of the middle cerebral artery, the study of small and middle infarcts of small vessels is less, which makes a great limitation on the clarification of the mechanism of cerebral infarction and the clinical targeted treatment of small vascular infarction. In patients with chronic M1 segment of the middle cerebral artery, the proportion of the patients with new small vascular infarction is very high, which can be used to study the characteristics of small vascular infarction. At the same time, what is the relationship between the establishment of the collateral circulation and the small vascular infarction in this part of the patients? What is the relationship between the risk factors and the establishment of collateral circulation in patients with M1 segment chronic occlusion of the unilateral middle cerebral artery? This is a question to be explored in this study.
The purpose of the study is:
To investigate the relationship between collateral circulation and cerebral infarction, the relationship between cerebral vascular risk factors and cerebral infarction, and the effect of cerebrovascular risk factors on collateral circulation in patients with chronic occlusion of middle middle cerebral artery (M1 segment) of middle cerebral artery (M1 segment) after chronic occlusion of middle cerebral artery in young and middle-aged patients.
Research methods:
The clinical data of 90 patients with simple M1 segment chronic occlusion in the Department of Neurology from July 2009 to June 2013 were analyzed, including 48 males and 42 females, averaging (44.6 + 9.7) years old. They were divided into new onset cerebral infarction group and two group without cerebral infarction, 50 cases with new infarcts and 40 patients without cerebral infarction. The situation of vascular risk factors, the establishment of collateral circulation, and the relationship between them were analyzed.
The results of the study:
The age distribution trend of 1.90 patients with M1 segment chronic occlusion was the most in 50~59 years old group, accounting for 37.8%, and the least in 20~29 year old group. There was no statistical difference in age distribution between the two groups of 8.9%. patients with cerebral infarction, X 2=4.394, P0.05..
2. Hyperlipidemia, diabetes mellitus, smoking, hypertension, hyperhomocysteinemia and other risk factors have no significant correlation with the occurrence of cerebral infarction.
3. the lateral branch blood flow classification of the patients with chronic cerebral artery occlusion was significantly negatively correlated with cerebral infarction (r=-0.76, P0.01). The level of lateral branch blood flow in the new cerebral infarction group (using the ASITN/SIR blood flow classification system) was 84%, while the 1,2 level in the non cerebral infarction group was 10%, and the 3,4 level was 90%, which was higher than that of the cerebral infarction and the lateral branch blood flow classification. The incidence of cerebral infarction was negative correlation, gamma s=-0.76, P0.01.
4. there were 1 levels of lateral branch openness (anterior communicating artery and posterior communicating artery) in two groups without cerebral vascular risk factors, and there was no significant difference in the opening of level 2 (ocular artery countercurrent and lateral branch of MMA) and 3 (P > 0.05). Hyperlipidemia, diabetes and smoking were positively correlated with hyperhomocysteinemia, but the difference was not statistically significant (P > 0.05). The opening degree of lateral branch 2 was negatively correlated with high blood pressure, smoking and hyperhomocysteinemia, and was positively correlated with hyperlipidemia and diabetes, but the difference was not statistically significant. Meaning (P > 0.05); the opening degree of lateral branch 3 was positively correlated with hypertension, hyperlipidemia, diabetes and smoking, and was negatively correlated with age and homocysteine, but the difference was not statistically significant (P > 0.05).
5. lateral branch blood flow classification was negatively correlated with hypertension, homocysteine and smoking, but the correlation between collateral flow classification and hyperlipidemia and diabetes was positively correlated, but the difference was not statistically significant (P > 0.05). Only the correlation between diabetes and collateral flow was statistically significant.
Conclusion:
1. the traditional risk factors for cerebrovascular disease and cerebral infarction, as well as the traditional risk factors for cerebrovascular disease, are related to the degree of collateral circulation opening and the classification of collateral flow.
The chronic occlusion of the 2.MCA-M1 segment makes the collateral circulation fully established. The blood flow classification of the collateral circulation plays an important role. The higher the blood flow classification, the less prone to cerebral infarction.
3. the results of this study support the chronic occlusion of the middle cerebral artery. If the vascular neural network is not established sufficiently, the perfusion resistance of the upstream neurovascular unit will increase, which will reduce the perfusion of the downstream neurovascular units and make the blood supply incomplete and lead to infarction, which may be one of the important mechanisms of this kind of infarction.
4. the results of the study show that the lateral branch flow classification is a more sensitive and effective indicator of collateral circulation assessment. The future study of collateral circulation should take full account of the characteristics of the dynamic changes in the collateral circulation with time, and it is necessary to incorporate it into important research indicators to explore the formation of collateral circulation and to establish and play compensation for the collateral circulation. The internal mechanism of use.
5. in the future study of cerebral apoplexy, those arteries should be blocked by chronic occlusion and have sufficient time to establish collateral, but the patients with very poor collateral compensatory focus are included in the study.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3
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