本文選題：頸動(dòng)脈斑塊 + 責(zé)任血管��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:利用MRI高分辨技術(shù)對(duì)初發(fā)組與復(fù)發(fā)組急性腦梗死患者的頸動(dòng)脈粥樣硬化斑塊進(jìn)行分析,比較兩組患者責(zé)任側(cè)與非責(zé)任側(cè)頸動(dòng)脈粥樣硬化斑塊的穩(wěn)定性、斑塊內(nèi)部成分、分布部位及頸動(dòng)脈狹窄程度,并對(duì)腦梗死復(fù)發(fā)的多個(gè)相關(guān)危險(xiǎn)因素分析探討,以幫助臨床積極治療并預(yù)防腦卒中的再發(fā)。方法:選取2013.10-2014.10期間于天津醫(yī)科大學(xué)第四中心臨床學(xué)院神經(jīng)內(nèi)科住院的急性前循環(huán)腦梗死患者48例,根據(jù)患者有無腦梗死病史將患者分為初發(fā)組和復(fù)發(fā)組。其中初發(fā)組患者22例,復(fù)發(fā)組患者26例,兩組患者的性別、年齡等一般資料具有可比性。所有患者均接受3.0 MRI雙側(cè)頸動(dòng)脈檢查,分別獲得3D-TOF亮血技術(shù)、T1WI、T2WI和3D MP-RAGE黑血技術(shù)序列圖像。對(duì)兩組患者所得圖像進(jìn)行分析,比較兩組患者的責(zé)任側(cè)與非責(zé)任側(cè)頸血管的動(dòng)脈粥樣硬化斑塊的類型及穩(wěn)定性、斑塊內(nèi)部成分、分布情況及頸動(dòng)脈狹窄程度。記錄兩組患者入院時(shí)的NHISS評(píng)分及血壓、血糖等實(shí)驗(yàn)室檢查結(jié)果,采集兩組患者既往吸煙、高血壓史、短暫性腦缺血發(fā)作史、糖尿病病史、高血脂病史等相關(guān)危險(xiǎn)因素。采用SPSS 21.0統(tǒng)計(jì)軟件,兩組間計(jì)數(shù)資料采用c2檢驗(yàn),兩組間計(jì)量資料采用獨(dú)立樣本t檢驗(yàn),以P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.兩組患者責(zé)任側(cè)頸血管斑塊比較:(1)復(fù)發(fā)組患者責(zé)任側(cè)頸血管的頸動(dòng)脈粥樣硬化不穩(wěn)定斑塊較初發(fā)組患者明顯增多,差異有統(tǒng)計(jì)學(xué)意義(42.9%vs.12.5%,P0.05)。(2)復(fù)發(fā)組患者責(zé)任側(cè)頸血管的斑塊纖維帽破裂(25%vs.4.2,P0.05)和斑塊內(nèi)出血的發(fā)生率(32.1%vs.4.2%,P0.05)較初發(fā)組患者明顯增多。(3)復(fù)發(fā)組患者責(zé)任側(cè)頸血管的斑塊分布情況與初發(fā)組患者比較未見明顯差異。(4)復(fù)發(fā)組患者責(zé)任側(cè)頸動(dòng)脈重度狹窄的發(fā)生率較初發(fā)組患者明顯增多,差異有統(tǒng)計(jì)學(xué)意義(40%vs.9.5%,P0.05)。初發(fā)組患者責(zé)任側(cè)頸動(dòng)脈輕度狹窄的發(fā)生率較復(fù)發(fā)組患者增多,差異有統(tǒng)計(jì)學(xué)意義(66.7%vs.20%,P0.05)。2.兩組患者非責(zé)任側(cè)頸血管斑塊的穩(wěn)定性、斑塊成分、分布情況及頸動(dòng)脈狹窄程度之間的比較未見明顯差異(P0.05)。3.復(fù)發(fā)組患者入院時(shí)NHISS評(píng)分高于初發(fā)組患者(5.23±2.05 vs.3.00±2.43,P0.05)。4.初發(fā)組患者與復(fù)發(fā)組患者在年齡、性別、吸煙史、冠心病史之間的差異無統(tǒng)計(jì)學(xué)意義。兩組患者高血壓病史的患病率比較差異無統(tǒng)計(jì)學(xué)意義,但是復(fù)發(fā)組患者入院時(shí)的收縮壓明顯高于初發(fā)組患者(151.65±1.27 vs.139.10±1.87,P0.05)。復(fù)發(fā)組患者TIA史和糖尿病史的患病率明顯高于初發(fā)組患者(P0.05)。復(fù)發(fā)組患者空腹血糖和糖化血紅蛋白、總膽固醇、低密度脂蛋白、同型半胱氨酸、超敏C反應(yīng)蛋白和葉酸水平明顯高于初發(fā)組(P0.05),復(fù)發(fā)組患者高密度脂蛋白水平明顯低于初發(fā)組(P0.05)。舒張壓、甘油三酯和維生素B12的水平在兩組間無明顯差異(P0.05)。結(jié)論:1.利用3.0T高分辨MRI可對(duì)頸動(dòng)脈粥樣硬化斑塊穩(wěn)定性情況進(jìn)行定性分析,有助于評(píng)估腦梗死再發(fā)的風(fēng)險(xiǎn)。2.復(fù)發(fā)組患者與初發(fā)組患者責(zé)任側(cè)頸血管的頸動(dòng)脈粥樣硬化斑塊成分存在差異,復(fù)發(fā)組患者責(zé)任側(cè)頸血管的不穩(wěn)定斑塊包括斑塊纖維帽破裂和斑塊內(nèi)出血的發(fā)生率高于初發(fā)組患者。復(fù)發(fā)組患者責(zé)任側(cè)頸血管重度狹窄的比例明顯高于初發(fā)組患者。3.初發(fā)組患者與復(fù)發(fā)組患者非責(zé)任側(cè)頸血管的頸動(dòng)脈粥樣硬化斑塊情況和頸動(dòng)脈狹窄程度間無顯著差異。4.復(fù)發(fā)組患者入院時(shí)NIHSS評(píng)分高于初發(fā)組患者。5.糖尿病、TIA史、收縮壓、高血脂、高同型半胱氨酸血癥、高C反應(yīng)蛋白是腦梗死復(fù)發(fā)的危險(xiǎn)因素,對(duì)這些危險(xiǎn)因素加以控制可以預(yù)防腦梗死的復(fù)發(fā)。
[Abstract]:Objective: to analyze the carotid atherosclerotic plaque in the patients with acute cerebral infarction in the primary and recurrent groups by MRI high resolution technique, and compare the stability of the atherosclerotic plaque in the two groups of patients with the responsibility side and the non responsible side of the carotid artery, the internal components of the plaque, the distribution of the plaque and the narrowing of the carotid artery, and the multiple related risks for the recurrence of cerebral infarction. Method: 48 patients with acute anterior cerebral infarction hospitalized in the neurology department of the fourth center of Medical University Of Tianjin, Medical University Of Tianjin, were divided into primary and recurrence groups according to the history of cerebral infarction in the fourth Center Clinical College of Medical University Of Tianjin. 22 cases, 26 cases in the recurrent group, the gender, age and other general data of the two groups were comparable. All patients received 3 MRI bilateral carotid artery examination, respectively obtained the 3D-TOF technique of bright blood, T1WI, T2WI and 3D MP-RAGE black blood technical sequence images. The images of the two groups of patients were analyzed, and the responsibility side and non responsibility of the two groups were compared. The type and stability of atherosclerotic plaque in the lateral cervical vessels, the internal composition of the plaque, the distribution of the plaque and the degree of carotid stenosis. The NHISS scores and blood pressure, blood sugar and other laboratory results were recorded in the two groups of patients, and the previous smoking, hypertension, the history of transient ischemic attack, the history of diabetes, hyperlipidemia and hyperlipidemia were collected in two groups of patients. History and other related risk factors. Using the SPSS 21 statistical software, the two groups of counting data were tested by C2 test, and the two groups used independent sample t test, and the difference was statistically significant with P0.05. Results: 1. two groups of patients were compared with the responsible lateral cervical plaque: (1) the unstable plaque of carotid atherosclerosis in the recurrent group. The difference was statistically significant (42.9%vs.12.5%, P0.05). (2) the incidence of plaque rupture of plaque (25%vs.4.2, P0.05) and plaque bleeding (32.1%vs.4.2%, P0.05) in the recurrent group was significantly higher than that in the primary group. (3) the plaque distribution of the responsible lateral cervical vessels in the recurrent group and the patients in the recurrent group. There was no significant difference in the patients in the primary group. (4) the incidence of severe stenosis in the recurrent carotid artery in the recurrent group was significantly higher than that in the primary group (40%vs.9.5%, P0.05). The incidence of mild carotid artery stenosis in the primary group was more than that of the recurrent group (66.7%vs.20%, P0.05). .2. two groups of patients with non responsible lateral neck vascular plaque stability, plaque composition, distribution and carotid stenosis, there was no significant difference (P0.05) the NHISS score in the patients with.3. recurrence was higher than that of the primary group (5.23 + 2.05 vs.3.00 + 2.43, P0.05) in the early.4. group and the relapsed group in age, sex, smoking history, There was no statistical difference between the history of coronary heart disease. There was no significant difference in the prevalence rate of hypertension in the two groups, but the systolic pressure of the patients in the relapse group was significantly higher than that in the primary group (151.65 + 1.27 vs.139.10 + 1.87, P0.05). The incidence of TIA and diabetes in the recurrent group was significantly higher than that in the primary group (P 0.05). The levels of fasting blood glucose and glycosylated hemoglobin, total cholesterol, low density lipoprotein, homocysteine, hypersensitivity C reaction protein and folic acid were significantly higher in the recurrent group than in the primary group (P0.05). The level of HDL in the recurrent group was significantly lower than that in the primary group (P0.05). The diastolic pressure, triglyceride and vitamin B12 levels were no more in the two groups. Significant differences (P0.05). Conclusion: 1. the stability of carotid atherosclerotic plaques can be qualitatively analyzed with 3.0T high resolution MRI. It is helpful to evaluate the risk of carotid atherosclerotic plaque in the responsible lateral neck of patients with recurrent cerebral infarction and the primary group of.2.. The incidence of plaque rupture and bleeding in the plaque was higher than that in the primary group. The proportion of severe stenosis in the recurrent group was significantly higher than that in the primary.3. group and the non responsible carotid artery atherosclerotic plaque and the degree of carotid stenosis in the patients with the recurrent group and the recurrent group. The NIHSS score of the patients with different.4. recurrence was higher than that of.5. diabetes, TIA, systolic blood pressure, hyperlipidemia, hyperhomocysteinemia, and high C reactive protein as a risk factor for the recurrence of cerebral infarction.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.33;R445.2

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本文編號(hào)：1873018