缺血性脑卒中危险因素及火热证与血小板参数相关性的研究

发布时间：2018-08-05 10:21

【摘要】：目的1.通过对缺血性脑卒中组及对照组的资料进行二分类变量Logistic回归分析,探讨缺血性脑卒中患者的危险因素。2.通过总结缺血性脑卒中患者(包括急性期及恢复期)火热证组与非火热证组血小板参数水平变化的差异,探讨其与缺血性脑卒中火热证之间的相关性,以及将血小板参数作为判断缺血性脑卒中火热证的中医辨证依据的可能性,为今后缺血性脑卒中中医临床证型客观化及探索合适的中医药治疗方法提供参考。方法筛选于2015年01月01日-2015年12月31日就诊于北京中医药大学东直门医院住院的患者,根据相应纳入标准、排除标准和剔除标准收集缺血性脑卒中患者共计120例作为脑卒中组。其中急性期组(发病2周内)共计80例,经辨证分型后火热证组有45例,非火热证组有35例；恢复期组(发病2周至6个月内)共计40例,经辨证分型后火热证组有25例,非火热证组有15例。另收集同时期同一医院的非脑卒中患者(仅有高血压、血脂异常、糖尿病、冠心病、肥胖症基础病者)32例,其性别、年龄及年龄构成与脑卒中组无统计学差异,具有可比性。与患者签署知情同意书,填写病例调查表,内容包括纳入者病历号、姓名、性别、年龄、既往病史、个人史等相关资料。留取入组者静脉血,检测每位入组者的平均血小板体积、血小板计数、血小板压积水平。收集数据后,将各组数据用SPASS21.0软件包进行统计学分析。结果1.一般资料统计显示,脑卒中组120例与对照组32例在性别、年龄及年龄构成上无显著差异性(P0.01)。在吸烟饮酒上有显著差异(P0.01)。2.卡方检验或Mann-Whitney U检验显示,脑卒中组120例在吸烟、饮酒、高血压、肥胖症及MPV这些因素中较对照组32例所占比例大或水平高,差异有统计学意义(P0.01)。而在血脂异常、糖尿病、冠心病、PLT、PCT上无显著差异(P0.01)。3.二分类变量Logistic回归分析显示,脑卒中危险因素根据强度依次为吸烟、饮酒、高血压、MPV水平、肥胖症。其0R值及95%C1分别为14.000(95%CI：4.594-42.663)、10.800(95%CI：3.867-30.159)、6.333(95%CI：2.733-14.676)、4.668(95%CI：2.471-8.820)、3.080(95%CI：1.342-7.070)。4.卡方检验显示,就脑卒中组中医分型而言,无论从缺血性脑卒中整体方面还是从急性期或恢复期方面研究,火热证组较非火热证组均所占比例较大,差异具有统计学意义(P0.01)。5. Mann-Whitney U检验显示,就平均血小板体积水平而言,无论从缺血性脑卒中整体方面还是从急性期或恢复期方面研究,火热证组较非火热证组均明显升高,差异具有统计学意义(P0.01)。就血小板计数水平和血小板压积水平而言,无论从缺血性脑卒中整体方面还是从急性期或恢复期方面研究,火热证组与非火热证组间均无明显差异性(P0.01)。6. Spearman秩相关分析显示,对120例患者进行火热证量化评分,最低分8分,最高分15分,平均10.77±1.99分。就平均血小板体积水平而言,无论从缺血性脑卒中整体方面还是从急性期或恢复期方面研究,均与火热证有明显的正相关性,差异具有统计学意义(P0.01)。就血小板计数水平和血小板压积水平而言,无论从缺血性脑卒中整体方面还是从急性期或恢复期方面研究,均与火热证无明显的相关性,差异无统计学意义(P0.01)。结论1.吸烟、饮酒、高血压、肥胖症、高MPV水平是缺血性脑卒中的危险因素。2.缺血性脑卒中中火热证相较非火热证而言是较为常见的一个中医证型。3.CIS患者的MPV水平与火热具有明显的正相关性,可考虑将其作为相应证候类型的辨证依据。4.对于CIS中MPV水平相对较高的患者,可考虑联合中医药活血化瘀、清热凉血辨证治疗,提高临床疗效。
[Abstract]:Objective 1. Logistic regression analysis of the data of ischemic stroke group and control group was carried out by two classified variables, and the risk factor of ischemic stroke patients.2. was discussed by summarizing the difference between the changes of the level of the parameters of the blood plate in the heat syndrome group and the non fire syndrome group. The correlation between the fire and heat syndrome of sexual apoplexy, and the possibility of using platelet parameters as the basis of TCM to judge the syndrome of ischemic stroke and heat syndrome, to provide reference for the objective of TCM clinical syndrome type of ischemic stroke and to explore the appropriate treatment methods of traditional Chinese medicine in the future. Methods screening in December 31st, 2015, -2015, -2015 year, in December 31st At the Dongzhimen Hospital of Beijing University of Chinese Medicine, 120 cases of ischemic stroke were collected as cerebral apoplexy in the group of cerebral apoplexy according to the corresponding standard, excluding standard and elimination standard. Among them, 80 cases were in the acute period group (2 weeks of onset). There were 45 cases of heat syndrome after syndrome differentiation, 35 cases in non fire syndrome group, and 2 in the recovery period (2 of the onset of disease). There were 40 cases in the week to 6 months. There were 25 cases of heat syndrome after syndrome differentiation and 15 cases of non fire syndrome group. There were 32 cases of non cerebral apoplexy (only hypertension, dyslipidemia, diabetes, coronary heart disease and obesity basic disease) in the same hospital at the same time, and there was no statistical difference between the sex, age and age of the stroke group, which was comparable to that of the stroke group. Sex. Sign the informed consent form with the patient, fill out the case questionnaire, content including the patient's medical records, name, sex, age, past medical history, personal history, and other related information. Leave the group of venous blood, test the average platelet volume, platelet count and platelet pressure level of each group. After collecting data, the data are collected with SPASS21.0 Results 1. general statistics showed that there were no significant differences in sex, age and age (P0.01) in 120 cases of stroke group and 32 cases in control group. There were significant differences in smoking and drinking (P0.01).2. chi square test or Mann-Whitney U test, and 120 cases of stroke group were smoking, drinking, hypertension and obesity. Compared with the control group, the proportion of 32 cases was higher or higher than that of the control group. The difference was statistically significant (P0.01), but there was no significant difference in blood lipid, diabetes, coronary heart disease, PLT and PCT (P0.01).3. two classification variable Logistic regression analysis showed that the risk factors of stroke were according to the intensity of smoking, drinking, hypertension, MPV level, and obesity according to the intensity. The 0R and 95%C1 values were 14 (95%CI:4.594-42.663), 10.800 (95%CI:3.867-30.159), 6.333 (95%CI:2.733-14.676), 4.668 (95%CI:2.471-8.820), and 3.080 (95%CI:1.342-7.070).4. chi square test showed, as far as the TCM classification of the cerebral apoplexy was concerned, whether from the whole aspect of the hemorrhagic stroke or from the acute stage or the recovery period. The proportion of heat syndrome group was larger than that of non fire syndrome group, and the difference was statistically significant (P0.01).5. Mann-Whitney U test showed that, as far as the average platelet volume level was concerned, both from the overall aspect of the ischemic stroke and from the acute stage or the recovery period, the heat syndrome group was significantly higher than the non fire syndrome group, and the difference had a significant difference. Statistical significance (P0.01). As far as the platelet count level and the platelet pressure level were concerned, no matter from the overall aspect of the ischemic stroke or from the acute stage or the recovery period, there was no significant difference between the heat syndrome group and the non fire syndrome group (P0.01).6. Spearman rank correlation analysis, which showed that the fire heat syndrome was quantified in 120 patients. The lowest score was 8, the highest score was 15, and the average was 10.77 + 1.99. As far as the average platelet volume was concerned, both from the overall aspect of the ischemic stroke and from the acute stage or the recovery period, there was a significant positive correlation with the heat syndrome. The difference was statistically significant (P0.01). No matter from the overall aspect of ischemic stroke or from the acute stage or the recovery period, there is no significant correlation with the heat syndrome, the difference is not statistically significant (P0.01). Conclusion 1. smoking, drinking, hypertension, obesity, and high MPV level are the risk factors of ischemic stroke in.2. ischemic stroke than non fire syndrome The MPV level of a common TCM syndrome type.3.CIS patient has obvious positive correlation with the fire and heat, and can consider it as the syndrome differentiation basis of the corresponding syndrome type.4. for the patients with relatively high MPV level in CIS, which can consider the combination of traditional Chinese medicine to promote blood circulation and dissipate blood stasis, remove heat and cool blood, and improve the clinical efficacy.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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