症状性颅内动脉重度狭窄或闭塞患者侧支循环影响因素及其对临床预后的影响

发布时间：2019-01-11 07:38

【摘要】：目的:探讨颅内动脉重度狭窄或闭塞患者侧支循环灌注的影响因素和对脑梗死体积以及临床症状的影响,为该类型病变患者临床预后及治疗提供依据。方法:分析我院2014年12月至2017年3月在广西壮族自治区人民医院住院的症状性颅内动脉重度狭窄或闭塞患者142例,所有入组患者均登记年龄、性别、血压、糖尿病、同型半胱氨酸、总胆固醇、低密度脂蛋白、高密度脂蛋白、吸烟饮酒史;记录入院时的NIHSS评分、ADL评分;所有患者均行磁共振平扫(MRI)+弥散功能成像检查(DWI),并计算脑梗死体积大小;所有患者行全脑血管造影检查(DSA),评估侧支循环血流灌注情况、明确狭窄部位和计算血管狭窄程度。参照美国放射介入学会(ASITN/SIR)的侧支循环评估系将入组患者分为侧支循环灌注良好组(3-4级)以及侧支循环灌注不良组(0-2级)。利用t检验、卡方检验以及logistics回归分析两组患者数据差异。结果:入组的142例患者当中,侧支循环灌注良好组68例,侧支循环灌注不良组74例;侧支循环灌注良好组与侧支循环灌注不良组比较,两组患者年龄、性别、糖尿病、同型半胱氨酸、总胆固醇、低密度脂蛋白、吸烟饮酒史差异无统计学意义(P0.05);高血压、高密度脂蛋白差异有统计学意义(P0.05);侧支循环灌注良好组脑梗死体积明显减小(P0.05);侧支循环灌注良好组入院时NIHSS评分较小、ADL评分较高(P0.05)。结论:1.高密度脂蛋白增高和轻度高血压与侧支循环血流灌注良好相关;2.良好的侧支循环血流灌注是急性脑缺血的保护性因素,可减小脑梗死的体积,减轻患者脑缺血的临床症状,改善患者的日常生活能力。
[Abstract]:Objective: to investigate the influencing factors of collateral circulation perfusion in patients with severe stenosis or occlusion of intracranial artery, and to provide evidence for clinical prognosis and treatment of patients with severe intracranial artery stenosis and occlusion. Methods: from December 2014 to March 2017, 142 patients with severe intracranial artery stenosis or occlusion in Guangxi Zhuang Autonomous region people's Hospital were analyzed. All the patients were enrolled in the study, including age, sex, blood pressure, diabetes mellitus. Homocysteine, total cholesterol, low density lipoprotein, high density lipoprotein, smoking and drinking history; The NIHSS and ADL scores were recorded on admission, and all patients were examined by plain Mr (MRI) diffusion function imaging (DWI),) and the size of cerebral infarction was calculated. All patients underwent (DSA), to evaluate the collateral circulation perfusion, to determine the stenosis location and to calculate the degree of stenosis. According to the evaluation of collateral circulation of the American Society of Radiological intervention (ASITN/SIR), the patients were divided into three groups: good collateral circulation perfusion group (grade 3-4) and bad collateral circulation perfusion group (grade 0-2). T test, chi-square test and logistics regression analysis were used. Results: among 142 patients, 68 cases were good collateral circulation perfusion group and 74 cases were bad collateral circulation perfusion group. There was no significant difference in age, sex, diabetes, homocysteine, total cholesterol, low density lipoprotein (LDL) and smoking and drinking history between the good collateral circulation perfusion group and the bad collateral circulation group (P0.05). Hypertension, high-density lipoprotein difference was statistically significant (P0.05); collateral circulation perfusion group cerebral infarction volume significantly decreased (P0.05); collateral circulation perfusion good group NIHSS score was smaller, ADL score was higher (P0.05). Conclusion: 1. High density lipoprotein and mild hypertension were associated with good collateral circulation perfusion. 2. Good collateral circulation perfusion is the protective factor of acute cerebral ischemia, which can reduce the volume of cerebral infarction, alleviate the clinical symptoms of cerebral ischemia, and improve the daily living ability of the patients.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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