吸烟指数与脑血管狭窄程度及部位相关性研究

发布时间：2019-07-05 05:21

【摘要】：背景缺血性脑血管病(Ischemic Cerebrovascular Disease,ICVD)有高发病率、高复发率、危害性大[1]等特点,是导致残疾的主要危险因素。近来吸烟与ICVD的关系越来越受到重视,虽然吸烟导致ICVD和动脉粥样硬化的确切机制尚不完全明了,但吸烟已被确认为脑梗死发病的独立危险因素之一。吸烟指数等于吸烟支数/天×吸烟年数,因此通过研究吸烟指数与ICVD脑血管狭窄程度及部位的关系,可量化吸烟与脑血管狭窄的关系,为更有效的防治ICVD提供理论基础。目的通过研究吸烟指数与ICVD脑血管狭窄程度及部位相关性,量化吸烟与脑血管狭窄的关系,为更有效的防治ICVD提供理论基础。方法选取2011年1月-2016年12月之间在大连市中心医院住院治疗的ICVD患者,收集样本(病例)相关资料,包括年龄、性别、每日吸烟支数、吸烟年数、高脂血症、高血压、糖尿病、高同型半胱氨酸血症(Hyperhomocysteinemia,Hcy)、饮酒、血管狭窄程度及部位等,最终纳入吸烟并发高血压高脂血症的男性患者207例,依据头颈部CTA报告分别记录每名患者血管狭窄程度及部位,分别比较分析各组不同血管狭窄程度之间在年龄、吸烟年数、每日吸烟支数、吸烟指数等因素上差异有无统计学意义,使用统计软件SPSS 21.0 for Windows作统计学处理,P0.05为差异有统计学意义,并用多元逐步线性回归进一步分析各因素与血管狭窄程度的相关性。结果1.脑血管狭窄组轻度狭窄组76例,中度狭窄组25例,重度狭窄组45例,闭塞组61例。各组之间在年龄、吸烟年数、吸烟支数、吸烟指数、饮酒、Hcy上差异无统计学意义。2.按脑血流动脉供应系统分为前循环组和后循环组(1)前循环血管狭窄组前循环无狭窄组7例,轻度狭窄组111例,中度狭窄组26例,重度狭窄组18例,闭塞组45例。各组之间在年龄、吸烟年数、吸烟支数、吸烟指数、饮酒、hcy上差异无统计学意义。(2)后循环血管狭窄组1)后循环无狭窄组61例,轻度狭窄组60例,中度狭窄组22例,重度狭窄组45例,闭塞组19例。各组之间在吸烟年数上差异有统计学意义。各组之间在年龄、吸烟支数、吸烟指数、饮酒、hcy上差异无统计学意义。2)多元逐步线性回归分析:以a=0.05水平为界,最后吸烟年数可进入回归模型,并且后循环血管狭窄程度与吸烟年数呈正相关关系(b=0.256)。3.按脑血管狭窄部位分为颅内组和颅外组(1)颅内血管狭窄组1)颅内无狭窄组17例,轻度狭窄组74例,中度狭窄组26例,重度狭窄组34例,闭塞组56例。各组之间在吸烟指数上差异有统计学意义,各组之间在年龄、吸烟年数、吸烟支数、饮酒、hcy上差异无统计学意义。2)多元逐步线性回归分析:将吸烟指数进行多元逐步线性回归分析,以a=0.05水平为界,最后吸烟指数不可进入回归模型,说明颅内血管狭窄程度与吸烟指数不呈线性相关关系。(2)颅外血管狭窄组1)颅外无狭窄组14例,轻度狭窄组121例,中度狭窄组20例,重度狭窄组26例,闭塞组26例。各组之间在吸烟年数、吸烟指数上差异有统计学意义。各组之间在年龄、吸烟支数、饮酒、hcy上差异无统计学意义。2)多元逐步线性回归分析:将上述2个因素进行多元逐步线性回归分析,以a=0.05水平为界,最后吸烟指数可进入回归模型,并且颅外血管狭窄程度与吸烟指数呈正相关关系(b=0.278)。结论1.脑血管狭窄程度与吸烟指数未见相关性。2.后循环血管狭窄程度与吸烟指数未见相关性;后循环血管狭窄程度与吸烟年数呈正相关关系,吸烟年数越长,后循环血管狭窄程度越重;前循环血管狭窄程度与吸烟指数未见相关性。3.颅外血管狭窄程度与吸烟指数呈正相关关系,吸烟指数越大,颅外血管狭窄程度越重;颅内血管狭窄程度与吸烟指数未见相关性。
[Abstract]:Background Ischemic Cerebrovascular Disease (ICVD) has the characteristics of high incidence, high recurrence rate, and great harm[1], which is the main risk factor leading to disability. Recently, the relationship between smoking and ICVD is becoming more and more important, although the exact mechanism of smoking leading to ICVD and atherosclerosis is not completely clear, smoking has been identified as one of the independent risk factors for the onset of cerebral infarction. The smoking index is equal to the number of smokers per day and the number of years of smoking. Therefore, by studying the relationship between the smoking index and the degree and location of the cerebrovascular stenosis of the ICVD, the relationship between smoking and cerebrovascular stenosis can be quantified, and the theoretical basis for more effective prevention and control of ICVD is provided. Objective To study the relationship between smoking index and the degree of cerebral stenosis of ICVD, to quantify the relationship between smoking and cerebrovascular stenosis, and to provide a theoretical basis for more effective prevention and treatment of ICVD. Methods The patients with ICVD in the Central Hospital of Dalian were selected from January 2011 to December 2016, and the relevant data of the samples (cases) were collected, including age, sex, daily smoking count, number of years of smoking, hyperlipidemia, hypertension, diabetes, hyperhomocysteinemia (Hyperhomocysteinmia, etc.). "Hcy), alcohol consumption, degree of blood vessel stenosis and location, etc., were included in 207 male patients with hypertension and hyperlipidemia, respectively, and the degree of blood vessel stenosis and the location of each patient were recorded according to the report of the head and neck CTA, respectively, and the age between the different degree of stenosis of each group was compared and analyzed, respectively. There was no significant difference in the number of years of smoking, the number of cigarette smoking, the smoking index and other factors. The statistical software was used for statistical treatment with SPSS 21.0 for Windows. The difference was statistically significant, and the correlation between the factors and the degree of stenosis was further analyzed by the stepwise linear regression. Results 1. There were 76 cases of mild stenosis group,25 cases of moderate stenosis group,45 cases of severe stenosis group and 61 cases of occlusion group. There was no significant difference in age, number of years of smoking, number of smoking, smoking index, alcohol consumption and Hcy. According to the cerebral blood flow artery supply system, there were 7 cases with no stenosis group,111 cases of mild stenosis group,26 cases of moderate stenosis group,18 cases of severe stenosis group and 45 cases of occlusion group. There was no significant difference in age, number of years of smoking, number of smoking, smoking index, alcohol consumption and hcy among the groups. (2) There were 61 cases of non-stenosis group,60 cases of mild stenosis group,22 cases of moderate stenosis group,45 cases of severe stenosis group and 19 cases of occlusion group. There was a significant difference in the number of years of smoking among the groups. There was no statistical significance between the groups in age, number of smoking, smoking index, alcohol consumption and hcy. (2) Multiple stepwise linear regression analysis: the last number of years of smoking can enter the regression model at a = 0.05 level, and the degree of the posterior circulation of the vessel is positively related to the number of years of smoking (b = 0.256). The cerebral vascular stenosis was divided into two groups: the intracranial group, the extracranial group (1), the intracranial vascular stenosis group (1), the intracranial no-stenosis group (17 cases), the mild stenosis group (74 cases), the moderate stenosis group (26 cases), the severe stenosis group (34 cases) and the occlusion group (56 cases). There was a significant difference in the smoking index among the groups, and there was no statistical significance between the groups in the age, the number of years of smoking, the number of cigarettes, the alcohol consumption and the hcy. The final smoking index could not enter the regression model, and the relationship between the degree of stenosis of the intracranial vessel and the smoking index was not shown. (2) There were 14 cases of extracranial stenosis group (1), the extracranial non-stenosis group (n = 14), the mild stenosis group (121 cases), the moderate stenosis group (20 cases), the severe stenosis group (26 cases) and the occlusion group (26 cases). There was a significant difference in the number of years of smoking and the smoking index among the groups. There was no statistical significance between the groups in age, number of smoking, alcohol consumption and hcy. (2) the multiple stepwise linear regression analysis: the above two factors were analyzed by stepwise linear regression, and the last smoking index could enter the regression model. And the degree of extracranial vascular stenosis was positively related to the smoking index (b = 0.278). Conclusion 1. There was no correlation between the degree of cerebrovascular stenosis and the smoking index. There was no correlation between the degree of the posterior circulation of the vessel and the smoking index; the degree of the posterior circulation of the vessel was positively related to the number of years of smoking, the longer the number of years of smoking, the more the degree of stenosis of the posterior circulation vessel was, and the degree of the anterior circulation of the vessel was not related to the smoking index. There was a positive correlation between the degree of extracranial vascular stenosis and the smoking index, the greater the smoking index, the higher the degree of extracranial vascular stenosis, and the no correlation between the degree of intracranial vessel stenosis and the smoking index.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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