本文選題：急性腦梗死 + 腦微出血�。� 參考：《華北理工大學(xué)》2017年碩士論文

【摘要】：目的利用磁敏感加權(quán)成像(Susceptibility weighted imaging,SWI)序列對(duì)急性腦梗死患者進(jìn)行腦微出血(Cerebral microbleeds,CMBs)掃描檢查,了解CMBs在急性腦梗死患者中的患病及分布情況,并探討急性腦梗死患者中CMBs發(fā)生的相關(guān)因素。方法收集2015年12月至2016年11月在唐山工人醫(yī)院神經(jīng)內(nèi)科診斷為急性腦梗死,且經(jīng)SWI序列掃描檢查的患者124例。依據(jù)SWI掃描結(jié)果分為CMBs組和無(wú)CMBs組。患者均行T1WI、T2WI、FLAIR、DWI、SWI序列及MRA檢查。記錄檢出CMBs組的人數(shù)、數(shù)目、分布情況。記錄腦白質(zhì)疏松嚴(yán)重程度及腔隙性梗死病灶個(gè)數(shù)。詳細(xì)記錄患者臨床資料,包括年齡、性別、吸煙史、飲酒史、收縮壓、舒張壓、高血壓病史、糖尿病史、卒中史、頸動(dòng)脈硬化斑塊情況等�；�(yàn)空腹血糖、甘油三酯、總膽固醇、低密度脂蛋白膽固醇、高密度脂蛋白膽固醇、凝血酶原時(shí)間、纖維蛋白原、尿酸、高同型半胱氨酸等相關(guān)血液生化。參考TOAST標(biāo)準(zhǔn),對(duì)急性腦梗死行亞型分組,記錄各亞型中CMBs的例數(shù)。采用t檢驗(yàn)或ManneWhitney U檢驗(yàn)比較計(jì)量資料,計(jì)數(shù)資料的比較采用卡方檢驗(yàn)或連續(xù)校正的卡方檢驗(yàn)。運(yùn)用單因素和多因素的二分類(lèi)Logistic回歸方法行急性腦梗死伴CMBs的相關(guān)因素分析。雙向有序變量做Spearman相關(guān)性分析。結(jié)果1在124例急性腦梗死患者中,發(fā)現(xiàn)伴CMBs患者69例,占55.6%。共統(tǒng)計(jì)出CMBs的個(gè)數(shù)為548個(gè),平均為7.94個(gè)。其中基底節(jié)/丘腦區(qū)CMBs的病灶個(gè)數(shù)最多,共217個(gè),病例數(shù)也最多47例;其次為腦葉-皮層下CMBs的病灶個(gè)數(shù)為200個(gè),病例數(shù)43例;最后是幕下區(qū)CMBs的病灶個(gè)數(shù)為131個(gè),病例數(shù)38例。2 TOAST分型中小動(dòng)脈閉塞型中CMBs患者有28例(40.6%),大動(dòng)脈粥樣硬化型種CMBs患者有27例(39.1%),心源性栓塞型中CMBs患者4例(5.8%),未明確原因型中CMBs患者10例(14.5%),在小動(dòng)脈閉塞型中CMBs的發(fā)現(xiàn)率最高。3兩組間在收縮壓、高血壓、卒中史、腔隙性梗死、腦白質(zhì)疏松、頸動(dòng)脈硬化斑塊比較時(shí),差異具有統(tǒng)計(jì)學(xué)意義(P㩳0.05)。4單因素的Logistic回歸分析顯示急性腦梗死患者中CMBs與收縮壓(OR:1.639,95%CI:1.323-2.030,P0.001)、高血壓病(OR:3.412,95%CI:1.593-7.307,P=0.002)、卒中史(OR:3.269,95%CI:1.121-9.531,P=0.030)、頸動(dòng)脈硬化斑塊(OR:2.215,95%CI:1.066-4.606,P=0.033)、腔隙性腦梗死(OR:3.575,95%CI:1.174-10.867,P=0.025)、腦白質(zhì)疏松(OR:2.812,95%CI:1.352-5.850,P=0.006)存在相關(guān)性。5多因素Logistic回歸分析結(jié)果表明,收縮壓(調(diào)整OR:1.668,95%CI:1.320-2.108,P㩳0.001)、腔隙性梗死(調(diào)整OR:4.085,95%CI:1.027-16.246,P=0.046)、腦白質(zhì)疏松(調(diào)整OR:2.681,95%CI:1.153-6.232,P=0.022)與急性腦梗死患者CMBs病變相關(guān)。6采用Spearman相關(guān)性分析結(jié)果表明,CMBs嚴(yán)重程度與腔隙性梗死分級(jí)及腦白質(zhì)疏松嚴(yán)重程度均呈顯著相關(guān)性關(guān)系(r=0.353,P㩳0.001;r=0.352,P㩳0.001)。結(jié)論1在急性腦梗死患者中,出現(xiàn)CMBs最多的部位是基底節(jié)/丘腦區(qū)。2急性腦梗死各亞型中,在小動(dòng)脈閉塞型中CMBs的檢出率最高。3收縮壓、腔隙性梗死、腦白質(zhì)疏松與急性腦梗死患者CMBs病變相關(guān)。4 CMBs嚴(yán)重程度與腔隙性梗死分級(jí)及腦白質(zhì)疏松嚴(yán)重程度有關(guān),且呈正相關(guān)性。
[Abstract]:Objective to investigate the incidence and distribution of CMBs in patients with acute cerebral infarction by using Susceptibility weighted imaging (SWI) sequence to scan the cerebral microhemorrhage (Cerebral microbleeds, CMBs) in patients with acute cerebral infarction, and to explore the related factors of CMBs in patients with acute cerebral infarction. Methods collect 2015 1. From February to November 2016, 124 cases of acute cerebral infarction were diagnosed as acute cerebral infarction in the Department of Neurology in Tangshan workers' hospital and were examined by SWI sequence scan. The results were divided into CMBs group and no CMBs group according to the results of SWI scan. The patients were all performed T1WI, T2WI, FLAIR, DWI, SWI sequence and MRA examination. The number, number and distribution of CMBs group were recorded. The serious leukoaraiosis was recorded. The number of degree and lacunar infarction focus. Detailed records of the patient's clinical data, including age, sex, smoking history, drinking history, systolic pressure, diastolic pressure, hypertension history, diabetes history, stroke history, carotid atherosclerotic plaque. Prothrombin time, fibrinogen, uric acid, high homocysteine and other related blood biochemistry. Refer to TOAST standard, subgroup of acute cerebral infarction, record the number of CMBs in each subtype. Use t test or ManneWhitney U test to compare the measurement data, the count data are compared with chi square test or continuous correction of Chi Square test. The correlation factors of acute cerebral infarction with CMBs were analyzed with two classified Logistic regression methods with single factor and multiple factors. Spearman correlation analysis was done with bidirectional ordered variables. Results in 1 of 124 patients with acute cerebral infarction, 69 patients with CMBs were found, accounting for a total of 548 CMBs, with an average of 7.94. The basal ganglia / thalamus was in the 124 cases of acute cerebral infarction. The number of lesions in the area CMBs was the most, a total of 217, and the number of cases was 47. The number of lesions in the subcortical CMBs was 200, the number of cases was 43, and the number of the lesions in the subscreen CMBs was 131, the number of cases 38 cases of.2 TOAST type middle and small artery occlusion was 28 cases (40.6%), and the large atherosclerotic CMBs patients had 27. Cases (39.1%), 4 cases (5.8%) of CMBs patients with cardiogenic embolism, 10 cases (14.5%) of undefined cause type CMBs patients, and the highest detection rate of CMBs in the occlusion type of arterioles was of systolic pressure, hypertension, stroke history, lacunar infarction, leukoaraiosis, and carotid arteriosclerosis plaque comparison, the difference was statistically significant (P? 0.05).4 single factor Logistic regression analysis showed that CMBs and OR:1.639,95%CI:1.323-2.030 (P0.001) in patients with acute cerebral infarction, hypertension (OR:3.412,95%CI:1.593-7.307, P=0.002), stroke history (OR:3.269,95%CI:1.121-9.531, P=0.030), carotid atherosclerotic plaque (OR: 2.215,95%CI:1.066-4.606, P=0.033), lacunar cerebral infarction (OR:3.575,95%CI:1.174-10.8) 67, P=0.025), OR:2.812,95%CI:1.352-5.850 (P=0.006) associated.5 multiple factor Logistic regression analysis showed that systolic pressure (adjusted OR:1.668,95%CI:1.320-2.108, P? 0.001), lacunar infarction (adjusted OR:4.085,95%CI:1.027-16.246, P= 0.046), leukoaraiosis (OR:2.681,95%CI:1.153-6.232, P=0.022) and acute The Spearman correlation analysis of CMBs pathological changes in cerebral infarction patients showed that the severity of CMBs was significantly correlated with the severity of lacunar infarction and the severity of leukoaraiosis (r=0.353, P? 0.001; r=0.352, P? 0.001). Conclusion 1 in patients with acute cerebral infarction, the most CMBs is the acute brain of the basal ganglia / thalamus region. Among the infarct subtypes, the detection rate of CMBs in the arteriole occlusion was the highest.3 systolic pressure, lacunar infarction, and leukoaraiosis associated with CMBs lesions in patients with acute cerebral infarction, the severity of.4 CMBs was related to the severity of lacunar infarction and the severity of leukoaraiosis.

【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R743.3

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