本文關(guān)鍵詞：皮質(zhì)下缺血性血管病患者平均血小板體積水平變化及其意義　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 皮質(zhì)下缺血性血管病 平均血小板體積 腔隙性腦梗死 腦白質(zhì)疏松

【摘要】：背景與目的 隨著社會人口老齡化的加速與腦血管疾病危險(xiǎn)因素的高發(fā),皮質(zhì)下缺血性血管病(SIVD)日益增多。SIVD發(fā)病隱匿,容易被患者、家庭以及醫(yī)務(wù)工作者所忽視,但是其有發(fā)展成腦卒中和癡呆的風(fēng)險(xiǎn),會使患者的生活質(zhì)量明顯降低并給家庭以及社會帶來繁重的負(fù)擔(dān)。近年來,血小板功能與各種疾病的關(guān)系也日益引起重視,平均血小板體積(MPV)的異常作為很多疾病一種可能的新生危險(xiǎn)因素,越來越受到研究者的青睞。既往研究顯示,MPV變化與腦卒中、阿爾茨海默病(AD)、糖尿病、冠心病等多種疾病密切相關(guān),而目前有關(guān)SIVD和MPV關(guān)系的研究較少。本研究通過檢測SIVD患者M(jìn)PV水平的大小,目的在于探討SIVD患者M(jìn)PV水平的變化及其臨床意義。材料與方法 選取340例SIVD患者(SIVD組)和同期健康體檢者(對照組)160例,根據(jù)頭顱磁共振(MRI)將SIVD組分為多發(fā)性腔隙性腦梗死(LI)組(n=124)和腦白質(zhì)疏松(LA)組(n=216),按照Fazekas的評分標(biāo)準(zhǔn)將LA組腦白質(zhì)疏松嚴(yán)重程度分為3級;采用血液分析儀檢測所有受試者M(jìn)PV值,比較SIVD組及其亞組與正常照組之間MPV水平的變化,并分析MPV與腦白質(zhì)疏松程度的相關(guān)性。結(jié)果 SIVD組年齡較對照組大、高血壓比例較對照組高,差異有統(tǒng)計(jì)學(xué)意義(P0.01);SIVD組MPV、血小板分布寬度(PDW)水平顯著高于對照組,血小板計(jì)數(shù)(PLT)水平顯著低于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。在校正年齡因素后,LI組和LA組MPV、PDW水平均顯著高于對照組,PLT均顯著低于正常對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.01);且LA組MPV、PDW水平顯著高于LI組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。將LA組進(jìn)一步分組后發(fā)現(xiàn),LA等級越高者,MPV水平越高(1級、2級、3級MPV分別為11.06±0.76fl、12.13±0.88fl、12.64±1.02fl),差異具有統(tǒng)計(jì)學(xué)意義(P0.01);相關(guān)分析顯示,MPV水平與LA等級成顯著正相關(guān)性(rs=0.596,P0.01)。將年齡、性別、高血壓、糖尿病、冠狀動脈粥樣硬化性心臟病、吸煙、飲酒及MPV水平等作為自變量,是否SIVD作為因變量進(jìn)行多元Logistic回歸分析發(fā)現(xiàn),在控制各項(xiàng)因素后MPV水平的增高仍是SIVD的危險(xiǎn)因素。(OR=3.461,95%CI:2.653-4.515,P0.01)。結(jié)論 SIVD患者M(jìn)PV水平顯著高于健康人群,MPV的增高可能是SIVD發(fā)生的一項(xiàng)重要的獨(dú)立危險(xiǎn)因素,且與腦白質(zhì)病變的等級有著密切的聯(lián)系。MPV的升高可以通過多種機(jī)制導(dǎo)致SIVD的發(fā)生,但是對于大體積血小板如何產(chǎn)生的機(jī)制目前尚不十分明確,有待于相關(guān)的基礎(chǔ)和臨床研究來進(jìn)一步明確。在SIVD的臨床診治過程中,應(yīng)重視MPV水平的檢測,并積極應(yīng)用抗血小板藥物,以改善患者的預(yù)后。SIVD患者M(jìn)PV水平顯著增高,是SIVD尤其是腦白質(zhì)疏松的重要危險(xiǎn)因素,其升高水平與腦白質(zhì)疏松的程度存在顯著正相關(guān)。臨床上應(yīng)重視觀察MPV的變化,積極應(yīng)用抗血小板藥物可能改善SIVD患者預(yù)后。
[Abstract]:Background and objective: with the risk of accelerated aging of population and the risk factors of cerebrovascular disease, subcortical ischemic vascular disease (SIVD) increased.SIVD incidence of occult, easy to be ignored by the patients, families and medical workers, but the development of stroke and dementia risk, will make the life quality of patients obviously reduce and bring heavy burden to the family and society. In recent years, the relationship between platelet function and various diseases are caused by the growing importance of mean platelet volume (MPV) anomaly as many diseases may be a new risk factor, more and more favored by researchers. Previous studies showed that the change of MPV and stroke, Alzheimer's disease (AD), diabetes mellitus, coronary heart disease and other diseases are closely related, and the current research about the relationship between MPV and SIVD is less. This study size by the level of MPV in patients with SIVD detection, purpose To investigate the changes of MPV level in SIVD patients and its clinical significance. Materials and methods 340 cases of SIVD patients (SIVD group) and healthy people (control group) 160 cases, according to the magnetic resonance imaging (MRI) of SIVD were divided into multiple lacunar infarction (LI) group (n=124) and white osteoporosis (LA) group (n=216), in accordance with the standard for evaluation of Fazekas LA group the severity of leukoaraiosis is divided into 3 levels; all subjects were detected by MPV blood analyzer, SIVD group and sub group and normal control group MPV level changes, and to analyze the correlation between MPV and cerebral white matter the degree of osteoporosis. Results the age of the SIVD group compared with the control group, the proportion of hypertension was higher than that in control group, the difference was statistically significant (P0.01); group SIVD MPV, platelet distribution width (PDW) were significantly higher than the control group, the platelet count (PLT) was significantly lower than that of control group, the difference was statistically significant (P0.01). In After adjustment for age, LI group and LA group MPV, PDW levels were significantly higher than the control group, PLT was significantly lower than the normal control group, the difference was statistically significant (P0.01); group LA and MPV, the level of PDW was significantly higher than that in LI group, the difference was statistically significant (P0.05). The LA group was further grouped after that the higher the LA level, the higher the MPV level (1 grade, 2 grade, 3 grade MPV were 11.06 + 0.76fl, 12.13 + 0.88fl, 12.64 + 1.02fl), the difference was statistically significant (P0.01); correlation analysis showed that the MPV level and LA level significantly positive correlation (rs=0.596, P0.01). The age, gender, hypertension, diabetes, coronary heart disease, smoking, alcohol drinking and MPV level as the independent variables, whether SIVD as the dependent variable, multivariate Logistic regression analysis showed that the factors in risk control after the increase of MPV level is still a factor of SIVD. (OR=3.461,95%CI:2.653-4.515, P0.01) conclusion. The level of MPV in patients with SIVD were significantly higher than that of healthy people, the increase of MPV may be an important independent risk factors of SIVD, and the level of cerebral white matter lesions are closely related to elevated.MPV can lead to the occurrence of SIVD through a variety of mechanisms, but the mechanism for the large volume of blood in how it is not very clear, need to be related to the basic and clinical research to further clarify the clinical diagnosis and treatment. In the process of SIVD, we should pay attention to detect the level of MPV, and the positive application of antiplatelet drugs, to improve the level of MPV in patients with the prognosis of patients with.SIVD significantly increased, especially SIVD is an important risk factor for leukoaraiosis, there was a significant positive the increasing level of leukoaraiosis. Clinical attention should be paid to observe the change of MPV, the positive application of antiplatelet drugs may improve the prognosis of patients with SIVD.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743

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本文編號：1358885