本文關(guān)鍵詞：H型高血壓與急性腦梗死關(guān)系的研究　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： H型高血壓 腦梗死 高同型半胱氨酸 高血壓

【摘要】：目的:近年來,我國(guó)心腦血管疾病發(fā)病連年攀升,此中腦血管病增加更為突出。流行病學(xué)調(diào)查顯示,與歐美發(fā)達(dá)國(guó)家相比,我國(guó)腦卒中較心臟病更為高發(fā),而歐美國(guó)家心臟病發(fā)病較為突出。針對(duì)此,學(xué)者們調(diào)查發(fā)現(xiàn)歐美國(guó)家高血壓人群多合并高脂血癥,而我國(guó)患者高血壓人群多合并高同型半胱氨酸血癥,其所占比例高達(dá)3/4,這可能為我國(guó)與歐美國(guó)家心腦血管病發(fā)病截然不同的原因。我國(guó)高血壓患者合并同型半胱氨酸增高具有廣泛性,為此,我國(guó)學(xué)者為突出兩者的關(guān)系,將此類情況定義為H型高血壓。相關(guān)研究表明,H型高血壓促進(jìn)急性腦梗死形成的作用遠(yuǎn)大于單純高同型半胱氨酸血癥或單純高血壓。本研究從多個(gè)方面研究分析H型高血壓與急性腦梗死之間的關(guān)系,論述其在急性腦梗死形成中的作用和相互關(guān)系。方法:選取在吉林大學(xué)第二醫(yī)院住院治療的缺血性腦卒中患者319例,分為急性腦梗死組和短暫性腦缺血發(fā)作組,對(duì)兩組進(jìn)行病例對(duì)照研究(急性腦梗死組為觀察組,短暫性腦缺血發(fā)作組為對(duì)照組)。采集患者的一般情況(年齡、性別、既往史、吸煙飲酒史)。記錄其入院后化驗(yàn)(同型半胱氨酸水平、低密度脂蛋白、高密度脂蛋白、總膽固醇、甘油三酯)。按照是否患有高血壓及入院后所測(cè)Hcy水平將急性腦梗死和TIA組均分成H型高血壓組、單純高血壓組、單純高同型半胱氨酸組、全部正常組。應(yīng)用SPSS13.0統(tǒng)計(jì)分析軟件,應(yīng)用t-檢驗(yàn)、X2-檢驗(yàn)進(jìn)行單因素分析,應(yīng)用非條件Logistic回歸分析進(jìn)行多因素分析。結(jié)果:(1)將缺血性腦卒中按性別分為男性組和女性組,男性H型高血壓發(fā)生率(57.36%)明顯高于女性(45.08%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。男性同型半胱氨酸水平(22.53±11.27)umol/L明顯高于女性組(13.50±8.07)umol/L,具有統(tǒng)計(jì)學(xué)意義(t=-7.711 P0.01)。(2)TIA組同型半胱氨酸水平(17.29±11.88)umol/L明顯低于急性腦梗死組(20.34±10.30)umol/L,兩組具有統(tǒng)計(jì)學(xué)意義(t=2.447 P0.05)。(3)將急性腦梗死和TIA組患者均分成H型高血壓、總高血壓、總同型半胱氨酸組三個(gè)亞組,兩組患者亞組發(fā)生率的關(guān)系均為總同型半胱氨酸血癥總H型高血壓總高血壓。兩組間相比總高血壓發(fā)生率急性腦梗死組(66.3%)大于TIA組(56.1%),但無明顯不同(X2=3.453 P0.05)�？傮wH型高血壓的發(fā)生率具有明顯差異(X2=14.143 P0.05),急性腦梗死組(61.5%)高于TIA組(40.2%)�？傮w高同型半胱氨酸血癥的發(fā)生率也有顯著差異(X2=17.232 P0.05),急性腦梗死組(91.4%)高于TIA組(74.2%)。(4)急性腦梗死組H型高血壓115例,發(fā)生率為61.5%,明顯高于TIA組H型高血壓發(fā)生率(40.2%),差異有統(tǒng)計(jì)學(xué)意義(X2=14.143 P0.05)。而對(duì)于單純高血壓發(fā)生率,TIA組有21例,占15.9%,明顯高于急性腦梗死組(4.9%),差異有統(tǒng)計(jì)學(xué)意義(X2=11.183 P0.05)。急性腦梗死組單純Hcy發(fā)生率為29.9%,略小于TIA組(34.1%),統(tǒng)計(jì)學(xué)無明顯差別(X2=0.614P0.05)。急性腦梗死組兩者均正常7例,所占比例3.7%,少于TIA組(9.8%),具有統(tǒng)計(jì)學(xué)差別(X2=4.908 P0.05)。(5)急性腦梗死四個(gè)亞組發(fā)生率的順序是H型高血壓(61.5%)單純高Hcy(29.9%)單純高血壓(4.9%)正常組(3.7%)。對(duì)四個(gè)亞組進(jìn)行兩兩比較,正常組與單純高血壓組相差不大,沒有統(tǒng)計(jì)學(xué)意義(X2=0.261 P0.05)。單純高Hcy56例,占29.9%,明顯高于正常組(X2=45.831 P0.05)及單純高血壓組(X2=41.133 P0.05)。H型高血壓共計(jì)115例,占全部腦梗死61.5%,明顯高于單純高Hcy(X2=37.505 P0.05)、單純高血壓(X2=135.557 P0.05)、正常(X2=141.892 P0.05)。(6)將急性腦梗死組分成H型高血壓組和非H型高血壓組,H型高血壓組共計(jì)115例,內(nèi)膜正常者4例,內(nèi)膜斑塊形成111例。非H型高血壓共72例,內(nèi)膜正常者13例,斑塊形成59例,H型高血壓組頸動(dòng)脈斑塊發(fā)生率(96.64%)明顯高于非H型高血壓組(81.94%)。H型高血壓組復(fù)發(fā)性腦梗死發(fā)生率為49.56%,明顯高于非H型高血壓組(26.397%)。(7)根據(jù)NIHSS評(píng)分將急性腦梗死四個(gè)亞組均分成進(jìn)展性卒中和非進(jìn)展性卒中,四個(gè)亞組進(jìn)展性卒中發(fā)生率的排序是H型高血壓(46.96%)高Hcy(26.79%)單純高血壓組(11.11%)正常組(0%)。對(duì)四個(gè)亞組進(jìn)展性卒中發(fā)生率進(jìn)行兩兩對(duì)照,單純高血壓組與正常組對(duì)比無明顯差別,HHcy組與單純高血壓組、正常組相比也無明顯差別。H型高血壓均高于其他三組,有統(tǒng)計(jì)學(xué)差別。(8)多因素分析示:H型高血壓(OR=2.644),95.0%CI(1.297-5.390)和Hcy(OR=1.744),95.0%CI(1.047-2.903)為急性腦梗死的獨(dú)立危險(xiǎn)因素,H型高血壓的回歸系數(shù)β(0.972)Hcy(0.556)。結(jié)論:1、缺血性腦卒中患者中男性的H型高血壓發(fā)生率及同型半胱氨酸水平均較女性高。2、急性腦梗死患者的同型半胱氨酸水平較TIA組的高。3、H型高血壓可能促進(jìn)腦卒中的進(jìn)展和腦梗死復(fù)發(fā)。4、H型高血壓在腦梗死中發(fā)生率高,可能是急性腦梗死形成的獨(dú)立危險(xiǎn)因素。5、高血壓與高同型半胱氨酸血癥對(duì)急性腦梗死形成具有協(xié)同作用。
[Abstract]:Objective: in recent years, the incidence of cardiovascular and cerebrovascular diseases in China has been increased year after year, and the increase of cerebrovascular disease is more prominent. Epidemiological survey shows that compared with developed countries in Europe and America, cerebral apoplexy in China is more high than that of heart disease, while the heart disease of European and American countries is more prominent. For this, the scholars survey found that hypertension in Europe and the United States more complicated with hyperlipemia, and hypertension in China patients with hyperhomocysteinemia, the proportion of up to 3/4, which may be the reason of cardiovascular and cerebrovascular disease in China and different countries in Europe and america. Hypertension and homocysteine increase is widespread in China. For this reason, Chinese scholars define the relationship between them as H hypertension. Related studies have shown that the role of H type hypertension in the formation of acute cerebral infarction is much greater than that of simple hyperhomocysteinemia or simple hypertension. In this study, the relationship between H type hypertension and acute cerebral infarction was analyzed from several aspects, and its role and relationship in the formation of acute cerebral infarction were discussed. Methods: 319 patients with ischemic stroke hospitalized in the second hospital of Jilin University were selected and divided into acute cerebral infarction group and transient ischemic attack group. Case control study in two groups (acute cerebral infarction group as observation group and transient ischemic attack group as control group). The general situation of the patients (age, sex, history, history of smoking and drinking) was collected. They were recorded after admission (homocysteine level, low density lipoprotein, high density lipoprotein, total cholesterol, triglyceride). Acute cerebral infarction and TIA group were divided into H hypertension group, simple hypertension group, Dan Chungao homocysteine group and all normal group according to whether they had hypertension or Hcy level after admission. SPSS13.0 statistical analysis software was used, single factor analysis was used by t- test and X2- test, and multi factor analysis was carried out by non conditional Logistic regression analysis. Results: (1) according to gender, ischemic stroke was divided into male group and female group. The incidence of male type H hypertension (57.36%) was significantly higher than that of female (45.08%), the difference was statistically significant (P0.05). The level of male homocysteine (22.53 + 11.27) umol/L was significantly higher than that of the female group (13.50 + 8.07) umol/L, which was statistically significant (t=-7.711 P0.01). (2) the level of homocysteine in TIA group (17.29 + 11.88) umol/L was significantly lower than that in the acute cerebral infarction group (20.34 + 10.30) umol/L, and the two group was statistically significant (t=2.447 P0.05). (3) patients with acute cerebral infarction and TIA were divided into three subgroups of H type hypertension, total hypertension and total homocysteine group. The incidence of subgroup in two groups was homocysteinemia, total H type hypertension and total hypertension. The incidence of acute cerebral infarction in the two groups (66.3%) was greater than that in the TIA group (56.1%), but there was no significant difference (X2=3.453 P0.05). The incidence of total H type hypertension was significantly different (X2=14.143 P0.05), and the group of acute cerebral infarction (61.5%) was higher than that in group TIA (40.2%). The overall incidence of hyperhomocysteinemia was also significantly different (X2=17.232 P0.05), and in the acute cerebral infarction group (91.4%) was higher than that in the TIA group (74.2%). (4) 115 cases of type H hypertension in acute cerebral infarction group, the incidence rate was 61.5%, which was significantly higher than that in group TIA (40.2%), and the difference was statistically significant (X2=14.143 P0.05). The incidence of H hypertension in acute cerebral infarction group was significantly higher than that in group A (40.2%). For the incidence of simple hypertension, there were 21 cases in group TIA, which accounted for 15.9%, which was significantly higher than that in the acute cerebral infarction group (4.9%), and the difference was statistically significant (X2=11.183 P0.05). The incidence of simple Hcy in acute cerebral infarction group was 29.9%, slightly less than that in group TIA (34.1%), and there was no significant difference (X2=0.614P0.05). In the acute cerebral infarction group, both of the 7 cases were normal, the proportion of which was 3.7%, less than group TIA (9.8%), with statistical difference (X2=4.908 P0.05). (5) the incidence of four subgroups in acute cerebral infarction was H type hypertension (61.5%) simple high Hcy (29.9%) simple hypertension (4.9%) normal group (3.7%). Compared to the four subgroups, there was no difference between the normal group and the high blood pressure group, and there was no significant difference between the four subgroups (X2=0.261 P0.05). The simple high Hcy56 cases, accounting for 29.9%, was significantly higher than the normal group (X2=45.831 P0.05) and the simple hypertension group (X2=41.133 P0.05). There were 115 cases of type H hypertension, accounting for 61.5% of total cerebral infarction, which was significantly higher than that of high Hcy (X2=37.505 P0.05), simple hypertension (X2=135.557 P0.05), and normal (X2=141.892 P0.05). (6) the group of acute cerebral infarction was divided into H type hypertension group and non H type hypertension group. There were 115 cases of H type hypertension group, 4 cases with normal endometrium and 111 cases of intima plaque formation. There were 72 cases of non H hypertension, 13 cases of normal endometrium, and 59 cases of plaque formation. The incidence of carotid plaques in type H hypertension group (96.64%) was significantly higher than that in non H hypertension group (81.94%). The incidence of recurrent cerebral infarction in H type hypertension group was 49.56%, which was significantly higher than that of non H hypertension group (26.397%). (7) according to the NIHSS score, four subgroups of acute cerebral infarction were divided into progressive stroke and non progressive stroke. The incidence of progressive stroke in four subgroups was H hypertension (46.96%), high Hcy (26.79%), simple hypertension group (11.11%), and normal group (0%). The incidence of progressive stroke in the four subgroups was 22. There was no significant difference between the simple hypertension group and the normal group. There was no significant difference between the HHcy group and the simple hypertension group or the normal group. Type H hypertension was higher than that of the other three groups, with a statistically significant difference. (8) multivariate analysis showed that H type hypertension (OR=2.644), 95.0%CI (1.297-5.390) and Hcy (OR=1.744) and 95.0%CI (1.047-2.903) were independent risk factors for acute cerebral infarction, and the regression coefficient of H type hypertension was 0.972 (0.556) Hcy. Conclusion: 1. The incidence of H type hypertension and the level of homocysteine in the male patients with ischemic stroke are higher than that of the female. 2. The level of homocysteine in patients with acute cerebral infarction is higher than that in group TIA. Type 3, H type hypertension may promote cerebral apoplexy
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R544.1;R743.33

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