后循环梗死与基底动脉弯曲的相关性分析
发布时间：2018-11-25 11:20
【摘要】：目的:后循环梗死(posterior circulation infarction,PCI)的发病机制主要为动脉粥样硬化、穿支小动脉的病变以及栓塞,随着核磁共振技术的广泛应用,后循环血管出现了多种转变,不仅仅是单纯血管危险因素机制下促使后循环梗死的发生。在不同群体的核磁共振成像中均能发现后循环血管的变异,而基底动脉弯曲是最常见的血管形态改变。本文主要研究后循环梗死与基底动脉(basilar artery,BA)弯曲两者之间的相关性,探讨基底动脉弯曲导致后循环梗死的发生机制,同时分析影响后循环梗死的相关危险因素,以及基底动脉弯曲与椎动脉优势(vertebral artery dominance,VAD)之间的关系,这不仅对后循环梗死危险因素的再认识有重要意义,而且也为脑血管病的预防与治疗开辟新的路径。方法:回顾性收集314例在河北省保定市第一医院神经内科住院治疗的资料完整的急性脑梗死患者(2015年1月-2016年12月),所有患者均完成头颅MRI(magnetic resonance imaging)+MRA(magnetic resonance angiography)检查,详尽记录每例患者的病史及体征,如病人的性别、年龄及常见脑血管疾病危险因素,包括高血压、糖尿病、冠心病、既往短暂性脑缺血发作史(transient ischemic attack,TIA)、高脂血症、高同型半胱氨酸血症(hyperhomocysteinemia,HCY)、吸烟史、饮酒史等,并通过血液化验、心电图等检查来评估危险因素。根据头颅核磁的弥散加权成像(diffusion weighted imaging,DWI)的表现,将患者分为前循环梗死(anterior circulation nfarction,ACI)组和后循环梗死组,记录两组患者基底动脉弯曲的形态、方向,比较两组间脑血管病危险因素以及两组间基底动脉弯曲的比率,将单因素比较的阳性指标采用Logistic多因素回归方法统计,筛查后循环梗死的独立危险因素,同时探讨后循环梗死与基底动脉弯曲的关系;进一步将后循环梗死组患者按照基底动脉弯曲度标准分为基底动脉弯曲组及基底动脉无弯曲组,计算两组患者中存在椎动脉优势的比例,比较两组间vad的发生率,采用χ2检验分析ba弯曲的方向与椎动脉优势侧的关系。结果:1.314例脑梗死患者中,前循环梗死者212例(212/314,67.5%),男127例,女85例,平均年龄为60.34士11.27岁;后循环梗死者102例(102/314,32.5%),男67例,女35例,平均年龄为61.41士12.46岁,所有患者中存在64例基底动脉弯曲者(64/314,20.4%),基动脉弯曲患者在前循环梗死中34例(34/212,16.0%),后循环梗死中30例(30/102,29.4%),两者差异有统计学意义(p=0.006)。2.64例基底动脉弯曲者中c型弯曲者28例(28/64,43.8%)、反c型弯曲者16例(16/64,25.0%)、s型弯曲者11例(11/64,17.2%),因此基底动脉的弯曲形状以c型为主。3.对11个可能影响后循环梗死发病的危险因素进行两组间单因素分析,结果表明年龄、性别、吸烟、饮酒、高血压、糖尿病、冠心病、高脂血症在两组患者中的发生率没有统计学意义(p0.05)。而基底动脉弯曲、高同型半胱氨酸血症、既往tia两组比较,有显著统计学差异(p0.05)。4.采用多因素logistic回归方法分析基底动脉弯曲、高同型半胱氨酸血症、既往tia史与后循环梗死的相关性,结果表明,基底动脉弯曲(or2.74,95%ci1.477~5.112;p=0.001)、高同型半胱氨酸血症(or5.08,95%ci2.984~8.662;p0.001)、既往tia史(or2.96,95%ci1.499~5.861;p=0.002)是后循环梗死的独立危险因素。5.102例后循环梗死患者,基底动脉弯曲者30例(30/102,29.4%),伴椎动脉优势者为25例(25/30,83.3%),基底动脉无弯曲者72例(72/102,70.6%),伴椎动脉优势者12例(12/72,16.7%),两组比较差异具有统计学意义(p0.05)。30例基底动脉弯曲者中,左弯曲者11例,右弯曲者14例。在14例右侧弯曲者中,左侧椎动脉优势者12例,在11例左侧弯曲者中,右侧椎动脉优势者8例,两组比较差异有统计学意义(p=0.003)。结论:1.基底动脉弯曲与后循环梗死的发生密切相关,基底动脉弯曲是促使后循环梗死的一个独立危险因素。2.高同型半胱氨酸血症、既往卒中史是发生后循环梗死的独立危险因素,后循环梗死的发生机制可能与其有关。3.基底动脉弯曲者椎动脉优势发生率较高,且基底动脉弯曲的方向一般朝向椎动脉优势的对侧,且以C型弯曲为多见，椎动脉优势可能是后循环梗死患者发生基底动脉弯曲的危险因素。
[Abstract]:Objective: The pathogenesis of post-circulation infarction (PCI) is mainly the atherosclerosis, the pathological changes of the small arteries and the embolization. With the wide application of the nuclear magnetic resonance technique, the post-circulation blood vessel has many changes. It is not only the occurrence of post-circulation infarction under the mechanism of simple vascular risk factors. The change of the posterior circulating blood vessel can be found in the magnetic resonance imaging of different populations, and the bending of the basilar artery is the most common change of the vascular morphology. In this paper, the relationship between the posterior circulation infarction and the basilar artery (BA) was studied, and the mechanism of the post-circulatory infarction was discussed, and the related risk factors of the post-circulatory infarction were also analyzed. and the relationship between the bending of the basilar artery and the advantage of the vertebral artery (vad) is of great significance not only for the re-recognition of the risk factors of the post-circulation infarction, but also for the prevention and treatment of the cerebrovascular disease. Methods: The data of 314 patients with acute cerebral infarction (January-December, 2016) in the first hospital of Baoding City, Hebei Province were retrospectively collected. All patients were examined by magnetic resonance imaging (MRI) and MRA (magnetic resonance imaging), and the medical history and physical signs were recorded in detail. such as the patient's sex, age, and common cerebrovascular disease risk factors, including hypertension, diabetes, coronary heart disease, prior transient ischemic attack (tia), hyperlipidemia, hyperhomocysteinemia (HCY), smoking history, history of alcohol, etc., and the risk factors are assessed by examination of blood tests, electrocardiograms, and the like. according to the performance of the diffusion weighted imaging (DWI) of the head nuclear magnetic field, the patients were divided into the anterior circulation infarction (ACI) group and the post-circulation infarction group, and the patterns and the directions of the bending of the basilar artery of the two groups of patients were recorded, The risk factors of cerebrovascular disease and the ratio of the two groups of basal artery were compared, and the positive index of single factor was compared with logistic multiple factor regression method, and the independent risk factors of the post-screening cycle infarction were analyzed, and the relationship between the post-circulation infarction and the basilar artery was discussed. further, the patients of the post-circulating infarction group are divided into a base artery bending group and a base artery non-bending group according to the bending degree standard of the base artery, the proportion of the advantages of the vertebral artery in the two groups is calculated, the incidence rate of the two groups of vad is compared, The relationship between the direction of the ba-bending and the advantage side of the vertebral artery was analyzed by the method of the second test. Results: Of the 314 patients with cerebral infarction, 212 cases (212/ 314, 67.5%), 127 males and 85 females, the average age was 60. 34 + 11. 27 years old, 102 cases (102/ 314, 32.5%), 67 males and 35 females, the average age was 61.41 卤 12.46 years. 64 of all patients (64/ 314, 20. 4%), 34 (34/ 212, 16. 0%), 30 (30/ 102, 2.9. 4%) in the anterior circulation infarction, and 28 (28/ 64, 43.8%) of the c-type in the basal artery of 64 patients. In 16 cases (16/ 64, 25. 0%) and 11 (11/ 64, 17. 2%), the curved shape of the basilar artery was c-type. A single-factor analysis of 11 risk factors that could affect the incidence of post-circulatory infarction was carried out. The results showed that age, sex, smoking, alcohol consumption, hypertension, diabetes, coronary heart disease and hyperlipidemia were not statistically significant in the two groups (p0.05). However, there was a significant difference in basal artery bending, hyperhomocysteinemia and prior tia (p0.05). A multi-factor logistic regression was used to analyze the correlation of basal artery bending, hyperhomocysteinemia, and prior tia and post-cycle infarction. The results showed that the basal artery was curved (or2.74, 95% ci1. 477 ~ 5.112; p = 0.001), hyperhomocysteinemia (or5.08, 95% ci2. 984 ~ 8. 662; p0.001). The previous tia history (or2.96, 95% ci1. 499-5.861; p = 0. 002) was an independent risk factor for posterior circulation infarction. There was a significant difference between the two groups (p0.05). Of the 14 cases of right bending, there were 12 cases of the left vertebral artery in the left and 8 in the right vertebral artery in 11 cases of the left vertebral artery, and the difference between the two groups was statistically significant (p = 0.003). Conclusion: 1. The bending of the basilar artery is closely related to the occurrence of post-circulatory infarction, and the bending of the basilar artery is an independent risk factor for the post-circulatory infarction. Hyperhomocysteinemia, a previous history of stroke, is an independent risk factor for post-cycle infarction, and the mechanism of the post-circulatory infarction may be related to it. The incidence of the vertebral artery of the basilar artery is high, and the direction of the basilar artery is generally toward the opposite side of the advantage of the vertebral artery, and in the C-type, the advantage of the vertebral artery may be the risk factor of the basilar artery bending in the patients with post-circulatory infarction.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
本文编号：2355922
[Abstract]:Objective: The pathogenesis of post-circulation infarction (PCI) is mainly the atherosclerosis, the pathological changes of the small arteries and the embolization. With the wide application of the nuclear magnetic resonance technique, the post-circulation blood vessel has many changes. It is not only the occurrence of post-circulation infarction under the mechanism of simple vascular risk factors. The change of the posterior circulating blood vessel can be found in the magnetic resonance imaging of different populations, and the bending of the basilar artery is the most common change of the vascular morphology. In this paper, the relationship between the posterior circulation infarction and the basilar artery (BA) was studied, and the mechanism of the post-circulatory infarction was discussed, and the related risk factors of the post-circulatory infarction were also analyzed. and the relationship between the bending of the basilar artery and the advantage of the vertebral artery (vad) is of great significance not only for the re-recognition of the risk factors of the post-circulation infarction, but also for the prevention and treatment of the cerebrovascular disease. Methods: The data of 314 patients with acute cerebral infarction (January-December, 2016) in the first hospital of Baoding City, Hebei Province were retrospectively collected. All patients were examined by magnetic resonance imaging (MRI) and MRA (magnetic resonance imaging), and the medical history and physical signs were recorded in detail. such as the patient's sex, age, and common cerebrovascular disease risk factors, including hypertension, diabetes, coronary heart disease, prior transient ischemic attack (tia), hyperlipidemia, hyperhomocysteinemia (HCY), smoking history, history of alcohol, etc., and the risk factors are assessed by examination of blood tests, electrocardiograms, and the like. according to the performance of the diffusion weighted imaging (DWI) of the head nuclear magnetic field, the patients were divided into the anterior circulation infarction (ACI) group and the post-circulation infarction group, and the patterns and the directions of the bending of the basilar artery of the two groups of patients were recorded, The risk factors of cerebrovascular disease and the ratio of the two groups of basal artery were compared, and the positive index of single factor was compared with logistic multiple factor regression method, and the independent risk factors of the post-screening cycle infarction were analyzed, and the relationship between the post-circulation infarction and the basilar artery was discussed. further, the patients of the post-circulating infarction group are divided into a base artery bending group and a base artery non-bending group according to the bending degree standard of the base artery, the proportion of the advantages of the vertebral artery in the two groups is calculated, the incidence rate of the two groups of vad is compared, The relationship between the direction of the ba-bending and the advantage side of the vertebral artery was analyzed by the method of the second test. Results: Of the 314 patients with cerebral infarction, 212 cases (212/ 314, 67.5%), 127 males and 85 females, the average age was 60. 34 + 11. 27 years old, 102 cases (102/ 314, 32.5%), 67 males and 35 females, the average age was 61.41 卤 12.46 years. 64 of all patients (64/ 314, 20. 4%), 34 (34/ 212, 16. 0%), 30 (30/ 102, 2.9. 4%) in the anterior circulation infarction, and 28 (28/ 64, 43.8%) of the c-type in the basal artery of 64 patients. In 16 cases (16/ 64, 25. 0%) and 11 (11/ 64, 17. 2%), the curved shape of the basilar artery was c-type. A single-factor analysis of 11 risk factors that could affect the incidence of post-circulatory infarction was carried out. The results showed that age, sex, smoking, alcohol consumption, hypertension, diabetes, coronary heart disease and hyperlipidemia were not statistically significant in the two groups (p0.05). However, there was a significant difference in basal artery bending, hyperhomocysteinemia and prior tia (p0.05). A multi-factor logistic regression was used to analyze the correlation of basal artery bending, hyperhomocysteinemia, and prior tia and post-cycle infarction. The results showed that the basal artery was curved (or2.74, 95% ci1. 477 ~ 5.112; p = 0.001), hyperhomocysteinemia (or5.08, 95% ci2. 984 ~ 8. 662; p0.001). The previous tia history (or2.96, 95% ci1. 499-5.861; p = 0. 002) was an independent risk factor for posterior circulation infarction. There was a significant difference between the two groups (p0.05). Of the 14 cases of right bending, there were 12 cases of the left vertebral artery in the left and 8 in the right vertebral artery in 11 cases of the left vertebral artery, and the difference between the two groups was statistically significant (p = 0.003). Conclusion: 1. The bending of the basilar artery is closely related to the occurrence of post-circulatory infarction, and the bending of the basilar artery is an independent risk factor for the post-circulatory infarction. Hyperhomocysteinemia, a previous history of stroke, is an independent risk factor for post-cycle infarction, and the mechanism of the post-circulatory infarction may be related to it. The incidence of the vertebral artery of the basilar artery is high, and the direction of the basilar artery is generally toward the opposite side of the advantage of the vertebral artery, and in the C-type, the advantage of the vertebral artery may be the risk factor of the basilar artery bending in the patients with post-circulatory infarction.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
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