本文關(guān)鍵詞： 腦分水嶺梗死 危險因素 病灶側(cè) 血管狹窄 不穩(wěn)定斑塊　出處：《河北聯(lián)合大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討腦分水嶺梗死（CWI）發(fā)生的相關(guān)危險因素，分析不同亞型間病灶側(cè)頸動脈斑塊性質(zhì)、病灶側(cè)責(zé)任血管及其狹窄程度差異，為臨床的個體化治療及二級預(yù)防提供理論依據(jù)。 方法收集我院經(jīng)核磁共振彌散加權(quán)成像（DWI）檢查明確診斷的急性腦梗死患者403例，依據(jù)影像學(xué)特點分為腦分水嶺梗死組與非分水嶺梗死組，分析腦分水嶺梗死患者的臨床特點，并依據(jù)經(jīng)典的Bogousslavsky分類將CWI分為3種亞型，觀察病灶側(cè)頸部斑塊性質(zhì)及頸內(nèi)動脈、大腦中動脈血管狹窄程度在亞型間差異。 結(jié)果1腦分水嶺梗死組與非分水嶺梗死組相比，兩組間性別、年齡、吸煙史、飲酒史、卒中史、高血壓病史、糖尿病病史、冠心病病史、血脂異常、WBC、RBC、HGB、PLT、FIB、UA、GLU、病灶側(cè)頸動脈斑塊性質(zhì)及ACA、PCA狹窄程度間差異無顯著性（P0.05），入院時收縮壓、舒張壓、平均動脈壓、NIHSS評分以及病灶側(cè)頸動脈斑塊檢出率、ICA、MCA狹窄程度及病灶側(cè)病變血管支數(shù)間比較，兩組間差異存在統(tǒng)計學(xué)意義（P0.05）。2經(jīng)多因素Logistic回歸分析得到結(jié)果顯示入院時平均動脈壓（OR=0.976，95%CI0.958~0.994，P=0.010）為CWI保護(hù)因素；病灶側(cè)ICA重度狹窄（OR=6.415，95%CI3.096~13.291，P0.001）、病灶側(cè)MCA重度狹窄（OR=2.954，95%CI1.615~5.404，P0.001）及病灶側(cè)多支（OR=3.142，95%CI1.709~5.775， P0.001）為CWI危險因素。3185例CWI中皮質(zhì)型45例、皮質(zhì)下型107例、混合型33例，各亞型所占比例分別為24.3%、57.8%、17.9%。4CWI3亞型間入院時收縮壓、舒張壓、平均動脈壓間無差異（P0.05）。3亞型在病灶側(cè)ICA及MCA狹窄程度間差異存在統(tǒng)計學(xué)意義（P0.05）。皮質(zhì)型分水嶺梗死ICA狹窄程度重于其他兩型（P=0.041），皮質(zhì)下型梗死者M(jìn)CA狹窄程度較重（P=0.034）；伴有嚴(yán)重病灶側(cè)ICA狹窄的3亞型頸動脈斑塊性質(zhì)比較，存在差異（P0.05），26例皮質(zhì)型分水嶺梗死患者多伴頸動脈不穩(wěn)定斑塊（80.8%）；3亞型在病變血管支數(shù)間比較差異存在統(tǒng)計學(xué)意義（P=0.019），混合型多伴有多支血管病變。 結(jié)論1CWI多伴有病灶側(cè)嚴(yán)重的血管狹窄，尤其與ICA或MCA重度狹窄有關(guān)。2皮質(zhì)型分水嶺梗死ICA狹窄較重，，皮質(zhì)下型分水嶺梗死以MCA狹窄程度較重；伴嚴(yán)重血管狹窄的皮質(zhì)型分水嶺梗死頸動脈以不穩(wěn)定斑塊常見多見；混合型多伴有病灶側(cè)多支血管病變。3CWI患者入院時血壓低于非分水嶺腦梗死，且神經(jīng)功能缺損癥狀較輕，患者入院后血壓偏高對CWI為有利因素。
[Abstract]:Objective to investigate the risk factors associated with CWI in cerebral watershed infarction, and to analyze the characteristics of carotid plaques, responsible vessels and the degree of stenosis between different subtypes of the lesions, so as to provide a theoretical basis for individualized treatment and secondary prevention. Methods 403 patients with acute cerebral infarction diagnosed by diffusion weighted imaging (DWI) were divided into watershed infarction group and non-watershed infarction group according to their imaging characteristics. The clinical features of cerebral watershed infarction patients were analyzed. According to the classical Bogousslavsky classification, CWI was divided into three subtypes. The characteristics of plaque and internal carotid artery were observed. The degree of stenosis of middle cerebral artery was different among the subtypes. Results 1 gender, age, smoking history, drinking history, stroke history, hypertension history, diabetes history, coronary heart disease history were compared between the cerebral watershed infarction group and the non-watershed infarction group. There was no significant difference in the character of carotid plaques and the stenosis degree of ACAA PCA in the lesion side. The systolic blood pressure and diastolic blood pressure at admission were not significantly different between the patients with dyslipidemia and the patients with dyslipidemia. The mean arterial pressure and NIHSS scores and the detection rate of carotid plaques in the lesion side were compared between the stenosis degree of ICA and MCA and the number of vessel branches in the lesion side. The difference between the two groups was statistically significant. The results of multivariate Logistic regression analysis showed that the mean arterial pressure at admission was 0.97695 CI 0.958 and 0.994Pao 0.010) as a protective factor for CWI. There were 45 cases of cortical type, 107 cases of subcortical type, 33 cases of mixed type and 24.37.817.97.97.97.99.4CWI3 subtype of ICA in the lesion side. The risk factors of CWI were 6.415995 CI3.0969CI13.291t P 0.001g, 2.954-95CI1.6155.404p0.001) and the risk factors of CWI were 45 cases of cortical type, 107 cases of subcortical type and 33 cases of mixed type. The proportion of each subtype was 24.37.817.917.9. 4CWI3 subtype had systolic blood pressure on admission, and 3185 cases of CWI were classified as cortical type, subcortical type and mixed type, and the proportion of each subtype was 24.37.817.99.4CWI3. Diastolic pressure, There was no significant difference in the mean arterial pressure between the subtypes of P0.05. 3 and the degree of stenosis of MCA and ICA. The degree of ICA stenosis in cortical watershed infarction was more serious than that in the other two types, and the degree of MCA stenosis in patients with subcortical infarction was more severe than that in patients with subcortical infarction. The characteristics of carotid plaques in three subtypes with severe lesion side ICA stenosis were compared. In 26 patients with cortical watershed infarction, there was a significant difference in the number of diseased vessels between the two subtypes, and the mixed type was associated with multiple vessel lesions. Conclusion 1CWI is usually accompanied by severe stenosis in the lesion side, especially in patients with severe stenosis of ICA or MCA. The severity of ICA stenosis in cortical watershed infarction is more serious than that in subcortical watershed infarction, and the degree of MCA stenosis is more severe in subcortical watershed infarction. The carotid artery of cortical watershed infarction with severe vascular stenosis is more common in unstable plaque, and the blood pressure of patients with mixed type is lower than that of non-watershed cerebral infarction on admission, and the symptom of nerve function defect is mild, and the blood pressure of mixed type patients is lower than that of non-watershed cerebral infarction on admission. High blood pressure was a favorable factor for CWI after admission.
【學(xué)位授予單位】：河北聯(lián)合大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3

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