本文選題：急性腦梗死　切入點：高同型半胱氨酸血癥　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:頸動脈易損斑塊是腦梗死的重要病理基礎(chǔ),高血壓和高同型半胱氨酸血癥是腦梗死發(fā)生、發(fā)展的兩個獨立危險因子。H型高血壓與腦梗死及動脈粥樣硬化斑塊性質(zhì)的關(guān)系逐漸成為研究的熱點。本課題主要探討急性腦梗死患者頸動脈粥樣硬化斑塊易損性與H型高血壓的相關(guān)性。方法:收集2014年12月~2016年12月忻州市人民醫(yī)院符合納入標(biāo)準(zhǔn)的230例急性腦梗死患者,根據(jù)頸動脈彩色超聲檢查結(jié)果將患者分為易損斑塊組和非易損斑塊組,比較兩組血漿同型半胱氨酸水平和相關(guān)指標(biāo)的差異。將所有入選對象根據(jù)同型半胱氨酸檢查結(jié)果和有無高血壓病史分為四組,H型高血壓組、單純高血壓組、高同型半胱氨酸組和正常組(血壓和同型半胱氨酸均正常),觀察4個亞組頸動脈易損斑塊的發(fā)生率,比較H型高血壓組和其余三組頸動脈易損斑塊發(fā)生率的差異,進(jìn)一步分析高血壓和高同型半胱氨酸血癥在急性腦梗死患者頸動脈易損斑塊形成中的相互作用。結(jié)果:1.易損斑塊組與非易損斑塊組一般資料及實驗室指標(biāo)對比顯示:兩組間高血壓、同型半胱氨酸、CRP、LDL-C、HDL-C、ApoA等方面差異有統(tǒng)計學(xué)意義,其他危險因素(年齡、性別、糖尿病、吸煙史、飲酒史、TC、TG、ApoB、FIB)差異無統(tǒng)計學(xué)意義。2.以頸動脈易損斑塊為因變量,單因素分析中差異明顯的指標(biāo)為自變量,進(jìn)行多因素logistic回歸分析,結(jié)果顯示:高血壓、高同型半胱氨酸血癥、LDL-C是頸動脈易損斑塊形成的獨立危險因素,HDL-C是獨立保護因素。3.四個亞組頸動脈易損斑塊的發(fā)生率:H型高血壓組單純高血壓組HHcy組正常組。4.相互作用分析:高血壓和高同型半胱氨酸血癥在急性腦梗死患者頸動脈易損斑塊形成中起協(xié)同作用(S=71),其中63.2%的急性腦梗死患者頸動脈易損斑塊是由高血壓和高同型半胱氨酸血癥相互作用引起。結(jié)論:1.高血壓及高同型半胱氨酸血癥與急性腦梗死患者頸動脈易損斑塊的形成密切相關(guān)。2.H型高血壓更易導(dǎo)致頸動脈易損斑塊的發(fā)生,高血壓和高同型半胱氨酸血癥在頸動脈易損斑塊形成中起協(xié)同作用。
[Abstract]:Objective: carotid artery plaque is an important pathological basis of cerebral infarction, hypertension and hyperhomocysteinemia is the occurrence of cerebral infarction, the relationship between the development of two independent risk factors of.H type hypertension and cerebral infarction and atherosclerosis plaque has become a hot research topic. This thesis mainly discuss the relationship between acute cerebral infarction patients with carotid atherosclerotic plaque vulnerability and type H hypertension. Methods: the collection of Xinzhou City People's Hospital in December 2014 ~2016 year in December with 230 cases of acute cerebral infarction were included in the standard, according to the carotid artery color Doppler ultrasound examination results were divided into plaque group and non plaque group, the difference between the two groups of plasma homocysteine levels and related indicators. All subjects were according to the homocysteine examination results and have no history of hypertension were divided into four groups, H type hypertension group, hypertension Group, high homocysteine group and normal group (blood pressure and homocysteine were normal), observe 4 groups of vulnerable carotid plaque incidence, H type hypertension group and other three groups of vulnerable carotid artery plaque incidence rate difference, further analysis of interaction between hypertension and hyperhomocysteinemia in vulnerable plaque formation Gao Tongxing the carotid artery in patients with acute cerebral infarction. Results: comparison of 1. vulnerable plaque group and the group of general information and laboratory index of non vulnerable plaque between two groups of hypertension, homocysteine, CRP, LDL-C, HDL-C, ApoA was significantly higher in other aspects, other risk factors (age, gender, diabetes, smoking history. The history of drinking, TC, TG, ApoB, FIB) there was no significant difference between.2. with carotid artery plaque as the dependent variable, the single factor index analysis in difference as independent variables, multivariate logistic regression analysis, the results show Show: hypertension, high homocysteine, LDL-C are independent risk factors for the formation of carotid artery atherosclerotic plaque, HDL-C was an independent protective factor.3. four subgroup of carotid artery atherosclerotic plaque incidence: H type hypertension group, hypertension group HHcy group normal group.4. interaction analysis: hypertension and hyperhomocysteinemia in in the synergistic effect of vulnerable atherosclerotic plaque of carotid artery in patients with acute cerebral infarction (S=71), the vulnerable plaque of carotid artery in patients with acute cerebral infarction in 63.2% is caused by hypertension and hyperhomocysteinemia interaction. Conclusion:.2.H is closely related to hypertension are more likely to result in the occurrence of carotid artery plaque formation of vulnerable plaque of carotid artery in patients with hypertension and 1. hyperhomocysteinemia and acute cerebral infarction, hypertension and hyperhomocysteinemia play a synergistic role in the carotid artery atherosclerotic plaque formation.

【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】：2017
【分類號】：R743.3;R544.1

【參考文獻(xiàn)】

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1 張楠;高政南;牛敏;李s，

本文編號：1673576