本文選題：短暫性腦缺血發(fā)作 + 白質(zhì)疏松　； 參考：《南京醫(yī)科大學》2017年博士論文

【摘要】：[目的]白質(zhì)疏松在頭顱磁共振上是常見的影像表現(xiàn),越來越多文獻報道缺血性卒中患者白質(zhì)疏松發(fā)生率高,程度嚴重;白質(zhì)疏松是缺血性卒中發(fā)生的獨立危險因素,且與卒中病情輕重、進展、治療及預后明顯相關(guān)。但白質(zhì)疏松與短暫性腦缺血發(fā)作之間的相關(guān)性尚不明確,短暫性腦缺血發(fā)作是神經(jīng)科急癥,發(fā)生致死、致殘性血管事件比例高,本研究的目的是測定白質(zhì)疏松對短暫性腦缺血發(fā)作患者的臨床重要性,以指導臨床進行個體化治療。[方法]連續(xù)入組2010年8月至2015年12月住院首發(fā)的癥狀發(fā)生48h之內(nèi)的短暫性腦缺血發(fā)作患者,入院后行頭顱磁共振檢查評估白質(zhì)疏松,合并白質(zhì)疏松患者采用MRIcro軟件定量測定白質(zhì)疏松體積并以全腦體積標準化,后給予四分位數(shù)分層。采集患者臨床資料,入院后給予患者抗栓、他汀類藥物及控制危險因素治療,隨訪1年觀察血管事件發(fā)生情況。單變量研究有統(tǒng)計學意義的變量進入多元logistic回歸,以P0.05為差異具有統(tǒng)計學意義;分析短暫性腦缺血發(fā)作患者白質(zhì)疏松發(fā)生及嚴重程度的相關(guān)危險因素,以及白質(zhì)疏松與再發(fā)血管事件之間的相關(guān)性。[結(jié)果](1)共181例短暫性腦缺血發(fā)作患者被納入本研究,其中104例(57.5%)患者磁共振檢查發(fā)現(xiàn)白質(zhì)疏松,單因素分析顯示年齡、高血壓病、高脂血癥、ABCD2評分及沉默性腦梗死與白質(zhì)疏松發(fā)生相關(guān),而性別、糖尿病史、吸煙、心房顫動、冠心病、臨床表現(xiàn)、癥狀持續(xù)時間及病變定位等與白質(zhì)疏松發(fā)生無關(guān)。多元回歸分析顯示年齡(OR,1.12;95%CI,1.08-1.17;P=0.000)和高血壓病(OR,2.11;95%CI,1.06-4.21;P=0.034)為白質(zhì)疏松發(fā)生的獨立危險因素。(2)104例合并白質(zhì)疏松患者標準化白質(zhì)疏松體積范圍為0.95～49.13 mL,中位數(shù)5.00 mL,按四分位數(shù)分層后單變量及多變量分析發(fā)現(xiàn)年齡(OR,1.07;95%CI,1.03-1.11;P=0.001)和高血壓病(OR,2.21;95%Cl,1.06-4.60;P=0.034)與白質(zhì)疏松體積密切相關(guān)。(3)發(fā)病后隨訪一年發(fā)現(xiàn)共26例(14.4%)患者再發(fā)血管事件,單因素分析發(fā)現(xiàn)年齡、高血壓病、糖尿病、高脂血癥、ABCD2評分和白質(zhì)疏松與再發(fā)血管事件有關(guān)。多元回歸分析顯示年齡(OR,1.05;95%CI,1.00-1.11;P=0.040)、糖尿病(OR,2.92;95%CI,1.13-7.57;P=0.027)、高脂血癥(OR,4.19;95%CI,1.60-11.03;P=0.004)和白質(zhì)疏松(OR,3.71;95%CI,1.09-12.60;P=0.036)與血管事件發(fā)生獨立相關(guān)。合并白質(zhì)疏松患者及不合并白質(zhì)疏松患者血管事件發(fā)生率分別為21.15%(22/104)和5.19%(4/77),合并白質(zhì)疏松患者發(fā)生血管事件的風險是不合并白質(zhì)疏松患者的3倍多(OR,3.71;95%CI,1.09-12.60;P=0.036)。(4)合并白質(zhì)疏松患者白質(zhì)疏松體積和高脂血癥(OR,5.38;95%CI,1.73-16.79;P=0.004)是血管事件發(fā)生的獨立危險因素,且白質(zhì)疏松體積第四四分位發(fā)生血管事件的風險為第一四分位的26倍多(P=0.009)。[結(jié)論]短暫性腦缺血發(fā)作患者白質(zhì)疏松發(fā)生率高,年齡和高血壓病是白質(zhì)疏松的發(fā)生及嚴重程度的獨立危險因素。白質(zhì)疏松的發(fā)生及嚴重程度與一年內(nèi)再發(fā)血管事件密切有關(guān),白質(zhì)疏松可用來作為評估短暫性腦缺血發(fā)作的預后指標。嚴重白質(zhì)疏松與臨床結(jié)局有關(guān),因此,對白質(zhì)疏松的研究不僅評估其發(fā)生,對其嚴重程度的識別更顯重要,積極治療白質(zhì)疏松可調(diào)節(jié)的危險因素如高血壓等有望延緩白質(zhì)疏松的發(fā)生和發(fā)展,改善短暫性腦缺血發(fā)作患者預后。
[Abstract]:[Objective] leukoaraiosis is common imaging findings in magnetic resonance imaging, more and more reports of ischemic stroke patients with leukoaraiosis in high incidence and severity of leukoaraiosis; is the independent risk factor for ischemic stroke, and with the progress of stroke severity, treatment and prognosis, but the correlation between the significant correlation. Leukoaraiosis and transient ischemic attack is not clear, transient ischemic attack is a neurological emergency, fatal, disabling cerebrovascular events in a high proportion, the purpose of this study is to determine the clinical importance of leukoaraiosis in patients with transient ischemic attack, in order to guide the clinical individualized treatment method. Continuous group in August 2010 to December 2015 were the first symptoms of 48h in patients with transient ischemic attack, the patient underwent MRI evaluation of leukoaraiosis patients with leukoaraiosis. Determination of leukoaraiosis volume and whole brain volume standardized by MRIcro software quantitative, given after the four percentile stratification. The clinical data of patients were collected after admission, patients were given anticoagulant, statins and control of risk factors for the occurrence of 1 years of follow-up, observation of vascular events. The single variable was statistically significant amount of variables into multivariate logistic regression with P0.05 difference was statistically significant; analysis of the risk and severity of leukoaraiosis in patients with the risk factors of transient ischemic attack, as well as between leukoaraiosis and recurrent vascular events related. Results (1) a total of 181 patients with transient ischemic attack were enrolled in this study. Of which 104 cases (57.5%) patients with MRI found leukoaraiosis, univariate analysis showed that age, hypertension, hyperlipidemia, ABCD2 score and silent cerebral infarction and leukoaraiosis occurred, and gender And the history of diabetes, smoking, atrial fibrillation, coronary heart disease, clinical manifestation, symptom duration and lesion location and leukoaraiosis occurred. Multiple regression analysis showed that age (OR, 1.12; 95%CI, 1.08-1.17; P=0.000) and hypertension (OR, 2.11; 95%CI, 1.06-4.21; P=0.034) were the independent risk of leukoaraiosis the factors. (2) of 104 patients with leukoaraiosis in patients with standardized leukoaraiosis volume ranged from 0.95 to 49.13 mL, median 5 mL, according to the analysis of univariate and multivariate quantile stratified four age (OR, 1.07; 95%CI, 1.03-1.11; P=0.001) and hypertension (OR, 2.21; 95%Cl, 1.06-4.60; P=0.034) is closely associated with leukoaraiosis volume. (3) after the onset of one year of follow-up were found in 26 cases (14.4%) of patients with recurrent vascular events, univariate analysis showed that age, hypertension, diabetes, hyperlipidemia, ABCD2 score and leukoaraiosis associated with multiple recurrent vascular events. Regression analysis showed that age (OR, 1.05; 95%CI, 1.00-1.11; P=0.040), diabetes (OR, 2.92; 95%CI, 1.13-7.57; P=0.027), hyperlipidemia (OR, 4.19; 95%CI, 1.60-11.03; P=0.004) and leukoaraiosis (OR, 3.71; 95%CI, 1.09-12.60; P=0.036) and blood vessels occurred independently related. With leukoaraiosis patients and patients without leukoaraiosis in patients with vascular events were 21.15% (22/104) and 5.19% (4/77), with the risk of leukoaraiosis in patients with vascular events is not associated with leukoaraiosis in patients with more than 3 times (OR, 3.71; 95%CI, 1.09-12.60; (P=0.036). 4) with leukoaraiosis in patients with leukoaraiosis volume and hyperlipidemia (OR, 5.38; 95%CI, 1.73-16.79; P=0.004) is an independent risk factor for vascular events, and leukoaraiosis volume the 44 percentile risk for vascular events occurred more than 26 times the first four points (P=0.009) patients. Conclusion: transient ischemic attack The high incidence of osteoporosis, age and hypertension were independent risk factors and severity of leukoaraiosis. Occurrence and severity of leukoaraiosis occurred within one year of recurrent vascular events related to leukoaraiosis may be used as a prognostic indicator in patients with transient ischemic attack. Severe leukoaraiosis related therefore, with the clinical outcome of osteoporosis, with not only the evaluation, more important to recognize the severity of the risk factors of aggressive treatment of leukoaraiosis can be adjusted such as the occurrence and development of hypertension is expected to delay the leukoaraiosis, improve the prognosis of patients with transient ischemic attack.

【學位授予單位】：南京醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R743.3

【參考文獻】

相關(guān)期刊論文 前10條

1 王擁軍;王春雪;繆中榮;;中國缺血性腦卒中和短暫性腦缺血發(fā)作二級預防指南2014[J];中華神經(jīng)科雜志;2015年04期

2 王晏雯;劉小利;王俊俊;鄭超波;李雅國;;長時血壓變異性與腦白質(zhì)疏松的相關(guān)性研究[J];解放軍醫(yī)學雜志;2015年02期

3 劉偉;于逢春;朱慧萍;馮浩;;晝夜動態(tài)血壓變化與腦白質(zhì)疏松癥的關(guān)系[J];中國腦血管病雜志;2013年03期

4 趙瑞杰;張楠;程焱;;急性缺血性卒中患者膽堿能通路損傷與血管性認知障礙的相關(guān)性研究[J];中風與神經(jīng)疾病雜志;2012年04期

5 趙曉暉;周媛;陳娟;白青科;;不同類型腦白質(zhì)疏松與頸動脈粥樣硬化斑塊相關(guān)性研究[J];腦與神經(jīng)疾病雜志;2010年01期

6 李花;方燕南;朱凱云;陳暉;鐘水生;包澤巖;;白質(zhì)疏松對腦梗死患者認知功能的影響[J];卒中與神經(jīng)疾病;2008年03期

7 方燕南;張愛武;李花;任麗;李現(xiàn)亮;;腦缺血相關(guān)的白質(zhì)疏松對腦梗死后意識障礙的影響[J];中華流行病學雜志;2007年09期

8 Sachdev P.S,鄧劍平;悉尼中風研究:中風患者白質(zhì)高密度的分布和程度[J];世界核心醫(yī)學期刊文摘(神經(jīng)病學分冊);2005年04期

9 李慶華,王玉敏,唐靜怡,歐陽文,齊麗娟;心房顫動與腦白質(zhì)疏松癥的關(guān)系[J];臨床軍醫(yī)雜志;2001年03期

10 王偉;高山;;大腦中動脈狹窄與其深穿支供血區(qū)單發(fā)腦梗死的關(guān)系[J];中華神經(jīng)科雜志;2008年12期

，

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