本文選題：急性腦梗死　切入點(diǎn)：頸動(dòng)脈粥樣硬化斑塊　出處：《山西醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：據(jù)現(xiàn)代流行病學(xué)研究，腦卒中是一種嚴(yán)重危害人類生命和健康的常見疾病，是目前我國人口三大死亡原因之一，具有高發(fā)病率、高死亡率、高致殘率、預(yù)后差等特點(diǎn)，給家庭、社會(huì)及國家造成嚴(yán)重的經(jīng)濟(jì)負(fù)擔(dān)和精神損失，其中以缺血性腦血管疾病即腦梗死多見。近幾年研究，頸動(dòng)脈粥樣硬化是引起腦梗死的危險(xiǎn)因素之一：頸動(dòng)脈粥樣硬化斑塊形成，造成血管管腔狹窄、閉塞、血栓形成或者斑塊脫落，為腦梗死的發(fā)生提供了病理基礎(chǔ)。高血壓和HHcy作為腦梗死發(fā)生、發(fā)展的兩個(gè)獨(dú)立危險(xiǎn)因素，兩者在心腦血管疾病的發(fā)生中具有協(xié)同作用。本文探討急性腦梗死患者頸動(dòng)脈粥樣硬化斑塊與H型高血壓的相關(guān)性和急性腦梗死患者頸動(dòng)脈粥樣硬化斑塊形成的危險(xiǎn)因素；同時(shí)，頸動(dòng)脈粥樣硬化斑塊作為腦梗死發(fā)生的重要危險(xiǎn)因素之一，，為腦梗死的預(yù)防提供切實(shí)可行的科學(xué)依據(jù)。 方法：收集山西醫(yī)科大學(xué)第二醫(yī)院神經(jīng)內(nèi)二科2011年2月1日至2013年1月31日的新發(fā)急性腦梗死住院患者115例，所有患者均符合1995年第四次全國腦血管病學(xué)術(shù)會(huì)議制定的各類腦血管疾病診斷標(biāo)準(zhǔn)，并經(jīng)頭顱CT和頭顱核磁DWI確診為急性腦梗死，病程小于72小時(shí)，年齡38-79歲，平均年齡56.80±9.69歲。所有病例均排除風(fēng)濕性心臟病、心房顫動(dòng)、嚴(yán)重心力衰竭、惡性腫瘤、全身嚴(yán)重感染、自身免疫性疾病、肝腎功能不全和近一月來服用葉酸和多種維生素及干擾同型半胱氨酸（tHcy）代謝的藥物。步驟一：詳細(xì)記錄所有患者一般臨床資料（性別、年齡、高血壓病史、糖尿病史、吸煙史和飲酒史）和實(shí)驗(yàn)室指標(biāo)結(jié)果（空腹血脂水平）；步驟二：應(yīng)用山西醫(yī)科大學(xué)第二醫(yī)院超聲科ATL5000型超聲診斷儀，探頭頻率5-10Mhz，對所有患者沿頸動(dòng)脈由下而上進(jìn)行縱向和橫向掃查，觀察頸部動(dòng)脈內(nèi)中膜厚度、粥樣硬化斑塊有無，根據(jù)超聲結(jié)果分為斑塊組和對照組，并對各組進(jìn)行一般資料和實(shí)驗(yàn)室指標(biāo)方面的比較。步驟三：應(yīng)用酶聯(lián)免疫法(ELISA)測定tHcy，并根據(jù)tHcy檢驗(yàn)結(jié)果和有無高血壓病史，分為H型高血壓組，單純高血壓組，HHcy組和兩者均正常組（無高血壓病史和tHcy正常）4個(gè)亞組，對斑塊組和對照組進(jìn)行4個(gè)亞組檢出率方面的比較。所有數(shù)據(jù)均應(yīng)用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析，計(jì)量資料單因素分析采用t檢驗(yàn)，計(jì)數(shù)資料采用卡方檢驗(yàn)，全部為雙側(cè)檢測，以p0.05水平為差異具有統(tǒng)計(jì)學(xué)意義；以斑塊組和對照組分組為因變量，對急性腦梗死患者頸動(dòng)脈粥樣硬化形成的可能危險(xiǎn)因素設(shè)為自變量，進(jìn)行多因素logistic回歸分析；高血壓和HHcy對急性腦梗死患者頸動(dòng)脈粥樣硬化斑塊形成的聯(lián)合作用采用交互作用分析相加模型。 結(jié)果：1，斑塊組與對照組各組危險(xiǎn)因素分析：2組間年齡、高血壓病史、吸煙史、tHcy、LDL差異有顯著性，余危險(xiǎn)因素間差異不明顯；進(jìn)一步行多因素logistic回歸分析顯示：年齡、高血壓病史、LDL是急性腦梗死患者頸動(dòng)脈粥樣硬化斑塊形成的獨(dú)立危險(xiǎn)因素。 2，斑塊組內(nèi)4個(gè)亞組的發(fā)生率：H型高血壓發(fā)生率高血壓發(fā)生率HHcy發(fā)生率兩組均正常發(fā)生率。 3，交互作用分析：高血壓、HHcy血癥在急性腦梗死患者頸動(dòng)脈粥樣硬化斑塊形成中起協(xié)同作用，起效應(yīng)大于兩者之和。結(jié)論：1，H型高血壓在急性腦梗死患者頸動(dòng)脈粥樣硬化形成的危險(xiǎn)性均大于高血壓、高同型半胱氨酸血癥和兩者之和。 2，logistic回歸分析顯示：年齡、高血壓病史、LDL是急性腦梗死患者頸動(dòng)脈粥樣硬化斑塊形成的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: according to the epidemiological study, stroke is a serious harm to human life and health of the common diseases, the population of our country is one of the three major causes of death at present, with high morbidity, high mortality, high disability rate, poor prognosis, to the family, society and country caused serious economic burden and mental loss among them, ischemic cerebrovascular disease cerebral infarction is rare. In recent years, carotid atherosclerosis is one of the risk factors of cerebral infarction, carotid atherosclerotic plaque, resulting in vascular stenosis, occlusion, or plaque off the formation of thrombus, provide the pathological basis for the occurrence of cerebral infarction. Hypertension and HHcy as cerebral infarction, two independent risk factors for the development, they have synergistic effect in the occurrence of cardiovascular and cerebrovascular diseases. This paper discusses the acute cerebral infarction patients with carotid atherosclerosis and H Correlation between type 2 hypertension and risk factors of carotid atherosclerotic plaques in patients with acute cerebral infarction. Meanwhile, carotid atherosclerotic plaques, as an important risk factor for cerebral infarction, provide a scientific basis for prevention of cerebral infarction.
Methods: new onset acute cerebral infarction collected nerve Second Hospital of Shanxi Medical University from February 1, 2011 to January 31, 2013 in two of 115 cases of patients, all patients were diagnosed with various cerebrovascular diseases standard in 1995 fourth national cerebrovascular disease conference established, and by brain CT and cranial DWI were diagnosed as acute cerebral infarction, duration less than 72 hours of age 38-79 years old, the average age of 56.80 + 9.69 years. All the cases were excluded from rheumatic heart disease, atrial fibrillation, severe heart failure, malignant tumor, severe systemic infection, autoimmune disease, liver and kidney dysfunction and nearly January to take folic acid and vitamins and interference of homocysteine (tHcy) metabolism of drugs. Step a detailed record of all patients with clinical data (gender, age, history of hypertension, history of diabetes, history of smoking and alcohol drinking) and laboratory index results. (fasting blood lipid levels); step two: the application of the second hospital of Shanxi Medical University Department of ultrasound ATL5000 type ultrasonic diagnostic instrument, probe frequency 5-10Mhz, all patients were from the carotid artery along the longitudinal and transverse scanning, observe the carotid artery intima-media thickness, atherosclerosis plaque or not, according to the ultrasound results were divided into plaque group and control group. And compare the general information and laboratory indicators of each group. Step three: using enzyme linked immunosorbent assay (ELISA) determination of tHcy and tHcy, according to the test result and there is no history of hypertension, divided into H type hypertension group, hypertension group, HHcy group and both normal group (without hypertension and normal tHcy) 4 subgroups of plaque group and the control group of 4 sub group detection rate comparison. All data were analyzed by SPSS17.0 statistical analysis, single factor analysis of measurement data using t test, counting. The material using a chi square test, all bilateral detection on the level of P0.05, the difference was statistically significant; plaque group and the control group as the dependent variable, the formation of carotid atherosclerosis in patients with acute cerebral infarction and the risk factors as independent variables, multivariate logistic regression analysis; the combined effect of HHcy on hypertension and carotid atherosclerosis plaque in patients with acute the formation of cerebral infarction the interaction analysis of additive model.
Results: 1. The analysis of plaque group and control group each group of risk factors between 2 groups of age, history of hypertension, smoking history, tHcy, LDL had significant difference between residual risk factors is not obvious; further multivariate logistic regression analysis showed that age, history of hypertension, LDL is an independent risk factor for patients with acute neck formation atherosclerosis of cerebral infarction.
2, the incidence of 4 subgroups in the plaque group: H type hypertension incidence rate of hypertension, the incidence of HHcy in two groups was normal.
3, the interaction analysis: hypertension, hyperlipidemia HHcy synergistic role in carotid atherosclerotic plaque in patients with acute cerebral infarction, which effect is greater than the sum of both. Conclusion: 1, the risk of H type hypertension in the formation of carotid atherosclerosis in patients with acute cerebral infarction were higher than that of high blood pressure, high homocysteine and the sum of both.
2, logistic regression analysis showed that age, history of hypertension, and LDL were independent risk factors for the formation of carotid atherosclerotic plaque in patients with acute cerebral infarction.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R743.33

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