临床和影像学特征对后循环脑梗死血管病变的预测作用
发布时间：2018-08-11 19:53
【摘要】：缺血性卒中20%发生在后循环，前后循环梗死的发病原因及机制不尽相同，目前，有关血管病变在前循环梗死中的作用，已得到肯定的认可，而在后循环中的作用亦逐渐被认识，本研究首先确定血管病变在后循环梗死中的作用，继而探讨影像学及临床特征对于后循环相关血管病变的预测作用。 【目的】 1、探讨血管病变与后循环梗死间的相关性及其影响因素； 2、探讨后循环血管病变的相关危险因素； 3、探讨后循环梗死影像学部位在血管病变预测中的作用； 4、探讨后循环梗死临床特征（包括严重程度和临床表现）在血管病变预测中的作用； 【方法】 回顾分析2010年3月至2013年12月在南京大学医学院附属鼓楼医院、靖江市人民医院神经内科、神经外科住院治疗的172例后循环缺血患者，根据头颅磁共振结果分为有无新发梗死存在，梗死部位分为近段、中段和远段梗死，梗死严重程度采用美国国立卫生研究院卒中量表（NIHSS）评分。经数字减影血管造影（DSA）判定其血管病变情况，并记录其性别、年龄、生化指标及相关病史、临床表现等。（1）比较不同程度血管狭窄在有无脑梗死组间的分布差异，进一步分析血管重度狭窄-闭塞在脑梗死发病中的作用及其相关危险因素；（2）分析后循环梗死病灶分布模式及与血管重度狭窄-闭塞间的相关性；（3）分析后循环梗死临床特征与血管重度狭窄-闭塞间的相关性。 【结果】 1、不同程度的血管狭窄在有无脑梗死组间存在显著的分布差异（Χ2=7.881，P=0.019），脑梗死组具有更高的重度狭窄-闭塞发生率（63%vs41%，P0.05）；回归分析显示，血管重度狭窄-闭塞为后循环梗死的重要危险因素（OR=2.293，，95%CI=1.180-4.455，P=0.014），以上数值虽然经过高密度脂蛋白、胆固醇、甘油三酯和纤维蛋白原等相关因素校正后，仍为其独立的危险因素（OR=2.947，95%CI=1.407-6.174，P=0.004）；对于重度血管狭窄-闭塞的发生，回归分析显示高血压和尿酸为其重要危险因素，OR（95%CI，P值）分别为3.574（1.774-7.204，0.000）和1.004（1.001-1.007，0.010）； 2、重度血管狭窄-闭塞在不同梗死部位的后循环梗死中发生率不同，近段组发生率显著升高（82%vs51%or59%，P=0.006or0.039），进一步的logistic回归分析显示，以中段组为参照，远段组和近段组OR（95%CI，P值）分别为1.357（0.592-3.110，0.470）和4.423（1.455-13.448，0.009）；由于重度血管狭窄-闭塞发生在椎动脉呈优势性选择，对于椎动脉重度狭窄-闭塞与近段梗死的相关性分析显示两者密切相关，其R和P值为0.343和0.000；对于后循环梗死是否发生在近段的回归分析显示，以椎动脉无重度狭窄-闭塞为参照，重度狭窄和闭塞组的OR（95%CI，P值）分别为3.167（1.023-9.802，0.046）和15.437（4.567-52.180，0.000）； 3、重度血管狭窄-闭塞在不同严重程度的后循环梗死中发生率不同，表现为轻症患者相对较低而重症患者较高，与NIHSS评分小于4分组相比，大于8分组显著升高（73%vs47%，P=0.023）；进一步的logistic回归分析显示，以小于4分组为参照，4到7分组和大于8分组OR（95%CI，P值）分别为2.228（0.952-5.215，0.065）和3.162（1.155-8.656，0.025）；对于重度血管狭窄-闭塞与具体临床症状间的回归分析显示，均未表现出明显的相关性。 【结论】 1、后循环梗死的发生与其相关血管重度狭窄-闭塞的存在密切相关； 2、近段梗死易于合并存在后循环的重度狭窄-闭塞，尤其是椎动脉； 3、临床症状较重的后循环梗死更易于合并存在重度血管狭窄-闭塞。
[Abstract]:20% of ischemic stroke occurs in the posterior circulation. The causes and mechanisms of anterior and posterior circulation infarction are different. At present, the role of vascular lesions in anterior circulation infarction has been recognized, and the role of vascular lesions in the posterior circulation has been gradually recognized. Prediction of posterior circulation related vascular diseases by imaging and clinical features.
[Objective]
1, to explore the correlation between vascular lesions and posterior circulation infarction and its influencing factors.
2, to explore the related risk factors of posterior circulation vascular disease.
3, to explore the role of posterior circulation infarct imaging site in prediction of vascular disease.
4. To explore the role of clinical features (including severity and clinical manifestations) of posterior circulation infarction in predicting vascular disease.
[method]
A retrospective analysis of 172 patients with posterior circulation ischemia admitted to the Department of Neurology and Neurosurgery of Jingjiang People's Hospital, Gulou Hospital Affiliated to Medical College of Nanjing University from March 2010 to December 2013 was carried out. According to the results of cranial magnetic resonance imaging, the patients were divided into new infarction or not. The infarction sites were divided into proximal, middle and distal infarctions. The National Institutes of Health Stroke Scale (NIHSS) score. The angiopathy was assessed by digital subtraction angiography (DSA), and its sex, age, biochemical parameters and related medical history, clinical manifestations were recorded. (1) To compare the distribution of different degrees of vascular stenosis between groups with and without cerebral infarction, and to further analyze the severity of vascular stenosis-occlusion in patients with or without cerebral infarction. The role of cerebral infarction in the pathogenesis and related risk factors; (2) To analyze the distribution pattern of posterior circulation infarction and its correlation with severe stenosis-occlusion; (3) To analyze the correlation between the clinical characteristics of posterior circulation infarction and severe stenosis-occlusion.
[results]
1. There was a significant difference in the distribution of vascular stenosis between groups with and without cerebral infarction (_2 = 7.881, P = 0.019), and the incidence of severe stenosis-occlusion was higher in cerebral infarction group (63% vs 41%, P 0.05); regression analysis showed that severe stenosis-occlusion was an important risk factor for posterior circulation infarction (OR = 2.293, 95% CI = 1.180-4.455, P = 0.014). Although adjusted for high-density lipoprotein, cholesterol, triglyceride and fibrinogen, the above values were independent risk factors (OR = 2.947, 95% CI = 1.407-6.174, P = 0.004); for the occurrence of severe vascular stenosis-occlusion, regression analysis showed that hypertension and uric acid were important risk factors, and OR (95% CI, P value) were respectively. 3.574 (1.774-7.204,0.000) and 1.004 (1.001-1.007,0.010);
2. The incidence of severe stenosis-occlusion in different infarction sites was different. The incidence of proximal infarction was significantly higher (82% vs 51% or 59%, P = 0.006 or 0.039). Further logistic regression analysis showed that the OR (95% CI, P value) of distal infarction and proximal infarction were 1.357 (0.592-3.110, 0.470) and 4.423 (1.455-13.448, 0.448, 0.470) respectively. Because severe stenosis-occlusion occurred in the vertebral artery was the dominant choice, the correlation analysis between severe stenosis-occlusion and proximal infarction showed that they were closely related, the R and P values were 0.343 and 0.000; Regression analysis of whether posterior circulation infarction occurred in the proximal segment showed that no severe stenosis-occlusion of the vertebral artery was the best choice. The OR (95% CI, P) values in severe stenosis and occlusion groups were 3.167 (1.023-9.802, 0.046) and 15.437 (4.567-52.180, 0.000), respectively.
3. The incidence of severe vessel stenosis-occlusion in different severity of posterior circulation infarction was different, manifested as mild patients were relatively low and severe patients were higher, compared with the NIHSS score less than 4 groups, greater than 8 groups significantly increased (73% vs 47%, P = 0.023); further logistic regression analysis showed that less than 4 groups as a reference, 4 to 7 groups and The OR (95% CI, P value) of more than 8 groups were 2.228 (0.952-5.215, 0.065) and 3.162 (1.155-8.656, 0.025), respectively. Regression analysis showed no significant correlation between severe stenosis-occlusion and specific clinical symptoms.
[Conclusion]
1, the occurrence of posterior circulation infarction is closely related to the existence of severe stenosis and occlusion.
2, proximal infarction is easy to merge with severe stenosis and occlusion after posterior circulation, especially vertebral artery.
3, severe posterior circulation infarction is more likely to be associated with severe vascular stenosis and occlusion.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3
本文编号：2178072
[Abstract]:20% of ischemic stroke occurs in the posterior circulation. The causes and mechanisms of anterior and posterior circulation infarction are different. At present, the role of vascular lesions in anterior circulation infarction has been recognized, and the role of vascular lesions in the posterior circulation has been gradually recognized. Prediction of posterior circulation related vascular diseases by imaging and clinical features.
[Objective]
1, to explore the correlation between vascular lesions and posterior circulation infarction and its influencing factors.
2, to explore the related risk factors of posterior circulation vascular disease.
3, to explore the role of posterior circulation infarct imaging site in prediction of vascular disease.
4. To explore the role of clinical features (including severity and clinical manifestations) of posterior circulation infarction in predicting vascular disease.
[method]
A retrospective analysis of 172 patients with posterior circulation ischemia admitted to the Department of Neurology and Neurosurgery of Jingjiang People's Hospital, Gulou Hospital Affiliated to Medical College of Nanjing University from March 2010 to December 2013 was carried out. According to the results of cranial magnetic resonance imaging, the patients were divided into new infarction or not. The infarction sites were divided into proximal, middle and distal infarctions. The National Institutes of Health Stroke Scale (NIHSS) score. The angiopathy was assessed by digital subtraction angiography (DSA), and its sex, age, biochemical parameters and related medical history, clinical manifestations were recorded. (1) To compare the distribution of different degrees of vascular stenosis between groups with and without cerebral infarction, and to further analyze the severity of vascular stenosis-occlusion in patients with or without cerebral infarction. The role of cerebral infarction in the pathogenesis and related risk factors; (2) To analyze the distribution pattern of posterior circulation infarction and its correlation with severe stenosis-occlusion; (3) To analyze the correlation between the clinical characteristics of posterior circulation infarction and severe stenosis-occlusion.
[results]
1. There was a significant difference in the distribution of vascular stenosis between groups with and without cerebral infarction (_2 = 7.881, P = 0.019), and the incidence of severe stenosis-occlusion was higher in cerebral infarction group (63% vs 41%, P 0.05); regression analysis showed that severe stenosis-occlusion was an important risk factor for posterior circulation infarction (OR = 2.293, 95% CI = 1.180-4.455, P = 0.014). Although adjusted for high-density lipoprotein, cholesterol, triglyceride and fibrinogen, the above values were independent risk factors (OR = 2.947, 95% CI = 1.407-6.174, P = 0.004); for the occurrence of severe vascular stenosis-occlusion, regression analysis showed that hypertension and uric acid were important risk factors, and OR (95% CI, P value) were respectively. 3.574 (1.774-7.204,0.000) and 1.004 (1.001-1.007,0.010);
2. The incidence of severe stenosis-occlusion in different infarction sites was different. The incidence of proximal infarction was significantly higher (82% vs 51% or 59%, P = 0.006 or 0.039). Further logistic regression analysis showed that the OR (95% CI, P value) of distal infarction and proximal infarction were 1.357 (0.592-3.110, 0.470) and 4.423 (1.455-13.448, 0.448, 0.470) respectively. Because severe stenosis-occlusion occurred in the vertebral artery was the dominant choice, the correlation analysis between severe stenosis-occlusion and proximal infarction showed that they were closely related, the R and P values were 0.343 and 0.000; Regression analysis of whether posterior circulation infarction occurred in the proximal segment showed that no severe stenosis-occlusion of the vertebral artery was the best choice. The OR (95% CI, P) values in severe stenosis and occlusion groups were 3.167 (1.023-9.802, 0.046) and 15.437 (4.567-52.180, 0.000), respectively.
3. The incidence of severe vessel stenosis-occlusion in different severity of posterior circulation infarction was different, manifested as mild patients were relatively low and severe patients were higher, compared with the NIHSS score less than 4 groups, greater than 8 groups significantly increased (73% vs 47%, P = 0.023); further logistic regression analysis showed that less than 4 groups as a reference, 4 to 7 groups and The OR (95% CI, P value) of more than 8 groups were 2.228 (0.952-5.215, 0.065) and 3.162 (1.155-8.656, 0.025), respectively. Regression analysis showed no significant correlation between severe stenosis-occlusion and specific clinical symptoms.
[Conclusion]
1, the occurrence of posterior circulation infarction is closely related to the existence of severe stenosis and occlusion.
2, proximal infarction is easy to merge with severe stenosis and occlusion after posterior circulation, especially vertebral artery.
3, severe posterior circulation infarction is more likely to be associated with severe vascular stenosis and occlusion.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3
【共引文献】
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2 杨红玲;郑健刚;;“病证结合”针刺治疗急性脑梗死后肝肾阴虚型睡眠障碍疗效观察[J];辽宁中医药大学学报;2015年04期
3 靳美;戴艳萍;宋培云;曹利;张春媛;;血管性认知障碍与甲状腺激素的相关性[J];中国现代药物应用;2015年08期
4 侯云丽;;探讨临床护理路径在脑出血伴精神障碍患者中的价值[J];中西医结合心血管病电子杂志;2014年14期
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1 翁贤君;解痉合剂联合盐酸替扎尼定片治疗中风后痉挛性偏瘫（阴虚风动型）的疗效评价[D];浙江中医药大学;2014年
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