血清胆固醇水平对高血压性脑出血患者影响的临床研究

发布时间：2019-05-06 08:42

【摘要】：背景——由于中国人口老龄化,脑卒中发病率逐年增长,而脑梗死和脑出血占绝大部分。相对于脑梗死,脑出血发病急,病情重,病死率高。低密度脂蛋白胆固醇增高被认为是脑梗死的一项危险因素,临床上对于有脑梗死危险因素或脑梗死患者要求降低LDL-C,甚至很低。但有研究提出,LDL-C水平过低可增加脑出血的风险,尤其对于有高血压病史患者,因此LDL-C不应降的过低。但关于低水平的LDL-C是否可以增加脑出血风险仍有争论。方法——收集山东大学齐鲁医院2007-2016年满足18-80岁高血压患者以及只有高血压一项危险因素的脑梗死和脑出血患者,排除有吸烟、糖尿病、冠心病、血液病、房颤、甲亢、动静脉畸形及动脉瘤等与脑梗死或脑出血相关的危险因素或病因。对收集患者的性别、年龄、口服降压药情况以及脑梗死和脑出血患者的血清胆固醇的差异性进行统计学分析。结果——1261名患者中,高血压患者344名,平均年龄55.4岁(19.0-80.0岁);脑梗死患者538名,平均年龄59.4岁(26.0-80.0岁);脑出血379名,平均年龄54.2岁(28.0-80.0岁),占所有患者的30.1%。脑梗死和脑出血患者中未服用降压药或未规律服药的患者有395名(40%),规律服药的仅有282名(30.8%);而高血压患者中规律服用降压药的患者有223名(64.8%)。高血压性脑出血及脑梗死两组中患者的高血压病史时间和高血压分级与高血压组患者无统计学差异,但脑梗死组患者的年龄较脑出血组明显增高(P0.001),脑梗死和脑出血患者未规律服药和未服药患者较高血压患者明显增多。脑梗死组患者LDL-C(3.12mmol/L,P0.001)和脑出血组患者LDL-C(2.68mmol/L,P0.001)与高血压组患者LDL-C均有明显差异性,脑梗死组患者TC(P=0.026)和脑出血组患者TC(P0.001)与高血压组患者同样有显著差异性。在男性和女性患者中,脑出血组患者LDL-C和TC与高血压患者均有明显差异性。在脑出血患者组中,只有50-59岁和70-80岁年龄组中LDL-C与高血压患者LDL-C是有显著差异性,而TC是在50-59岁、60-69岁和70-80岁年龄组均有差异性。脑出血组患者LDL-C和TC在高血压病史5-10年和10-20年分组中较高血压组患者明显降低。在不同高血压分级组中,脑出血组患者与高血压组患者的胆固醇水平均无统计学差异。而在根据患者服用降压药情况的分组中,脑出血患者LDL-C(P=0.020)和TC(P=0.013)水平只有在规律服用降压药组与高血压患者有明显差异性。随着LDL-C值和TC值降低,脑出血患者比例明显增加,而脑梗死比例降低。在LDL-C2.59mmol/L不同分组和TC2.86mmol/L分组中均为脑出血患者所占比例较未分组患者中脑出血患者所占比例明显增高;而在LDL-C3.37mmol/L和TC5.98mmol/L患者中脑出血患者所占比例较未分组患者中脑出血患者所占比例明显降低。结论——LDL-C和TC对不同类型的脑卒中影响不同,高水平的LDL-C和TC增加脑梗死发生的风险,而低水平的LDL-C和TC是发生脑出血的危险因素。不管在男性还是女性患者中,尤其在老年患者、高血压病史20年以下以及规律服用降压药的患者中,低水平的LDL-C和TC增加脑出血风险。但对于高血压患者,仍需要进行积极的降压治疗。并且LDL-C水平越低发生脑出血的风险越大。
[Abstract]:Background _ The incidence of stroke is increasing year by year due to the aging of the Chinese population, and the cerebral infarction and the cerebral hemorrhage account for a large part. Compared with cerebral infarction, the incidence of cerebral hemorrhage is acute, the disease is heavy and the case fatality rate is high. The increase of low-density lipoprotein cholesterol is considered a risk factor for cerebral infarction, and is clinically relevant to the risk factors of cerebral infarction or the requirements of patients with cerebral infarction to lower the LDL-C and even lower. However, it is suggested that low levels of LDL-C may increase the risk of cerebral hemorrhage, especially for patients with a history of hypertension, so that the LDL-C refractory should not be reduced. But there is a debate about whether low levels of LDL-C can increase the risk of cerebral hemorrhage. Method _ Collect the patients with hypertension of 18 to 80 years of age in Qilu Hospital of Shandong University from 2007 to 2016, and the patients with cerebral infarction and cerebral hemorrhage with only one risk factor of hypertension, and exclude smoking, diabetes, coronary heart disease, hemopathy, atrial fibrillation, hyperthyroidism, The risk factors or causes associated with cerebral infarction or cerebral hemorrhage such as arteriovenous malformations and aneurysms. The difference of serum cholesterol in patients with cerebral infarction and cerebral hemorrhage was analyzed statistically. Results Among the 1261 patients,344 patients with hypertension, mean age of 55.4 years (19.0-80.0 years),538 patients with cerebral infarction, mean age of 59.4 years (26.0-80.0 years), and 379 patients with cerebral hemorrhage, the average age was 54.2 years (28.0-80.0 years), accounting for 30.1% of all patients. In the patients with cerebral infarction and cerebral hemorrhage, there were 395 (40%) of the patients who had not taken the drugs or the non-regular drugs, and only 282 (30.8%) of the regular drugs were taken; and 223 (64.8%) of the patients with the regular administration of the hypotensive drugs in the patients with hypertension. There was no statistical difference between the history of hypertension and the level of hypertension in the patients with hypertensive cerebral hemorrhage and cerebral infarction, but the age of the patients with cerebral infarction was significantly higher than that in the group with cerebral hemorrhage (P 0.001). In the patients with cerebral infarction and cerebral hemorrhage, the patients with non-regular administration and non-drug administration were significantly higher than those in the patients with high blood pressure. LDL-C (3.12 mmol/ L, P0.001) in patients with cerebral infarction and LDL-C (2.68 mmol/ L, P0.001) in patients with cerebral hemorrhage were significantly different from those in patients with hypertension. In both male and female patients, there was a significant difference between the levels of LDL-C and TC in patients with cerebral hemorrhage. In the group of patients with cerebral hemorrhage, LDL-C in the 50-59 and 70-80-year-old age group was significantly different, and the TC was in the age group of 50-59,60-69, and 70-80 years. The levels of LDL-C and TC in the patients with cerebral hemorrhage were significantly lower in the hypertension group than in the 5-10 and 10-20 years of hypertension. There was no statistical difference between the levels of cholesterol in the patients with the ICH group and the hypertension group in the different hypertension grade group. In the patients with cerebral hemorrhage, the levels of LDL-C (P = 0.020) and TC (P = 0.013) in patients with cerebral hemorrhage were significantly different from those of patients with hypertension. With the decrease of LDL-C and TC, the proportion of patients with cerebral hemorrhage increased significantly, and the proportion of cerebral infarction decreased. In that LDL-C2.59 mmol/ L and TC2.86 mmol/ L, the proportion of patients with cerebral hemorrhage in the patients with cerebral hemorrhage was significantly increased, while the proportion of patients with cerebral hemorrhage in the patients with cerebral hemorrhage was significantly lower in the patients with cerebral hemorrhage in the patients with cerebral hemorrhage in the patients with low density of LDL-3.37 mmol/ L and TC5.98 mmol/ L. Conclusion _ LDL-C and TC have different effects on different types of stroke, and high levels of LDL-C and TC increase the risk of cerebral infarction, while low levels of LDL-C and TC are the risk factors for cerebral hemorrhage. Low levels of LDL-C and TC increase the risk of cerebral hemorrhage, whether in male or female patients, especially in the elderly, in patients with a history of hypertension of less than 20 years, and in patients with regular administration of the drug. However, a positive step-down treatment is still required for patients with high blood pressure. And the lower the ldl-c level, the greater the risk of cerebral hemorrhage.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.34

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