本文選題：腦白質(zhì)病變　切入點(diǎn)：腦梗死　出處：《山西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 通過對(duì)合并腦白質(zhì)病變腦梗死患者的危險(xiǎn)因素的研究，，明確是否有促發(fā)因素使腦白質(zhì)病變發(fā)生急性腦梗死或腔隙性腦梗死的風(fēng)險(xiǎn)增加，并探討是否有促發(fā)因素使靜息腔隙性梗死發(fā)生急性腦梗死的風(fēng)險(xiǎn)增加，從而為臨床缺血性腦血管病的治療和預(yù)防提供一定的依據(jù)。 方法 收集2012年3月至2013年12月山西醫(yī)科大學(xué)第二臨床醫(yī)學(xué)院神經(jīng)內(nèi)科的缺血性腦血管病患者，共252例，依據(jù)頭顱核磁共振成像和磁共振彌散成像技術(shù)表現(xiàn)分為腦白質(zhì)病變組(WML,125例)、伴有腦白質(zhì)病變的急性腦梗死組(aCI+WML,32例)、伴有腦白質(zhì)病變的腔隙性梗死組(LI+WML,43例)、腔隙性梗死組(LI,28例)、伴有靜息腔隙性梗死的急性腦梗死組(aCI+LI,24例)，了解患者的年齡、性別、吸煙、飲酒、糖尿病、高血壓、H型高血壓、膽固醇、低密度脂蛋白、高密度脂蛋白、甘油三脂的情況，利用卡方檢驗(yàn)及二元Logistic回歸模型對(duì)這些因素在WML組與aCI+WML組、WML組與LI+WML組、LI組與aCI+LI組進(jìn)行組間的比較，分析危險(xiǎn)因素對(duì)腦白質(zhì)病變和腔隙性梗死發(fā)生腦梗死的影響情況；除外WML+LI共存的病例后，將以上病例分為急性腦梗死（aCI，56例）和非急性腦梗死（nCI，153例），通過卡方檢驗(yàn)分析腦白質(zhì)病變和腔隙性梗死在兩組的分布情況；所有數(shù)據(jù)采用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)分析，以P＜0.05為差異具有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.WML組與aCI+WML組行卡方檢驗(yàn)后發(fā)現(xiàn)，年齡、性別、高血壓、H型高血壓、膽固醇升高在兩組間差別具有統(tǒng)計(jì)學(xué)意義（P＜0.05），行二元Logistic回歸模型分析后發(fā)現(xiàn)，膽固醇、低密度脂蛋白升高在兩組間差別具有統(tǒng)計(jì)學(xué)意義（P＜0.05）；膽固醇升高使腦白質(zhì)病變發(fā)生急性梗死的風(fēng)險(xiǎn)增加12倍以上（OR=12.677）；低密度脂蛋白升高使腦白質(zhì)病變發(fā)生急性腦梗死的風(fēng)險(xiǎn)增加3倍以上（OR=3.459）。 2.WML組與LI+WML組行卡方檢驗(yàn)后發(fā)現(xiàn)，高血壓、膽固醇升高在兩組間的差別具有統(tǒng)計(jì)學(xué)意義（P＜0.05）；行二元Logistic回歸模型分析后發(fā)現(xiàn)，高血壓、膽固醇升高在兩組間的差別具有統(tǒng)計(jì)學(xué)意義（P＜0.05），膽固醇使腦白質(zhì)病變患者發(fā)生腔隙性腦梗死的風(fēng)險(xiǎn)增加18倍以上（OR=18.219），高血壓使腦白質(zhì)病變發(fā)生腔隙性腦梗死的風(fēng)險(xiǎn)增加7倍以上（OR=7.120）。 3.LI組與LI+aCI組行卡方檢驗(yàn)和二元Logistic回歸模型分析發(fā)現(xiàn)各危險(xiǎn)因素在兩組間的差別無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 4.靜息腔隙性梗死與腦白質(zhì)病變?cè)诩毙阅X梗死和非急性腦梗死組的分布差別具有統(tǒng)計(jì)學(xué)意義（P＜0.05），靜息腔隙性梗死發(fā)生急性腦梗死的風(fēng)險(xiǎn)更大，約為腦白質(zhì)病變的3.348倍（OR=3.348）。 結(jié)論：膽固醇升高是腦白質(zhì)病變患者發(fā)生急性腦梗死和腔隙性梗死的獨(dú)立危險(xiǎn)因素，低密度脂蛋白升高是腦白質(zhì)病變患者發(fā)生急性腦梗死的獨(dú)立危險(xiǎn)因素，高血壓是腦白質(zhì)病變患者發(fā)生腔隙性腦梗死的獨(dú)立危險(xiǎn)因素； 與腦白質(zhì)病變比較，靜息腔隙性梗死與急性腦梗死的關(guān)系更為密切，發(fā)生急性梗死的風(fēng)險(xiǎn)越高。
[Abstract]:objective
By studying the risk to patients with cerebral white matter lesions of cerebral infarction, to determine whether a precipitating factor to increase the risk of cerebral white matter lesions in acute cerebral infarction or lacunar infarction, and to explore whether there is a risk factor to promote the rest of lacunar infarction occurred in the patients with acute cerebral infarction, so as to provide a basis for treatment and prevention and treatment of ischemic cerebrovascular disease.
Method
Department of Neurology, Clinical Medical College of Shanxi Medical University from March 2012 to December 2013, second patients with ischemic cerebrovascular disease, a total of 252 cases, on the basis of cranial magnetic resonance imaging and magnetic resonance diffusion imaging were divided into cerebral white matter lesions (group WML, 125 cases), acute cerebral infarction with cerebral white matter lesions (32 cases of aCI+WML). With cerebral white matter lesions in lacunar infarction group (LI+WML, n = 43), lacunar infarction group (LI, n = 28), acute cerebral infarction accompanied by resting lacunar infarction (aCI+LI, n = 24), understand the patient's age, gender, smoking, drinking, diabetes, hypertension, type H hypertension, cholesterol, low density lipoprotein, high density lipoprotein, glycerin three greases, using the chi square test and Logistic regression model of these two factors in WML group and aCI+WML group, WML group and LI+WML group, LI group and aCI+LI group were compared between the groups, analysis of risk factors for brain The effect of white matter lesions of cerebral infarction and lacunar infarction; except the coexistence of the WML+LI cases, the patients were divided into acute cerebral infarction (aCI, n = 56) and non acute cerebral infarction (nCI, n = 153), through the analysis of cerebral white matter lesions and lacunar infarction in the distribution in the two groups by chi square test; all data were analyzed by SPSS17.0 software, with P < 0.05, the difference was statistically significant.
Result
1.WML group and aCI+WML group were analyzed by chi square test revealed that age, gender, hypertension, type H hypertension, elevated cholesterol in a statistically significant difference between the two groups (P < 0.05), two Logistic regression model analysis showed that elevated cholesterol, low density lipoprotein in a statistically significant difference between the two groups (P < 0.05); cholesterol increased the risk of cerebral white matter lesions of acute infarction increases more than 12 times (OR=12.677); low density lipoprotein increased the risk of cerebral white matter lesions in acute cerebral infarction (OR=3.459) increased by more than 3 times.
2.WML group and LI+WML group were analyzed by chi square test revealed that high blood pressure, cholesterol levels between the two groups was statistically significant difference (P < 0.05); model analysis for two yuan Logistic regression showed that hypertension, cholesterol levels between the two groups was statistically significant difference (P < 0.05), the risk of brain cholesterol patients with white matter lesions of lacunar infarction (OR=18.219) increased by more than 18 times the risk of hypertension, cerebral white matter lesions occurred in lacunar infarction (OR=7.120) increased by more than 7 times.
The chi square test and two yuan Logistic regression model of group LI+aCI and group 3.LI found no significant difference in the difference between the two groups (P > 0.05).
4. there was a significant difference in the distribution of resting lacunar infarcts and white matter lesions in acute cerebral infarction and non acute cerebral infarction group (P < 0.05). The risk of acute cerebral infarction in resting lacunar infarction was greater than that in white matter lesions, which was 3.348 times higher than that in white matter lesions (OR=3.348).
Conclusion: cholesterol is an independent risk factor in patients with cerebral white matter lesions in acute cerebral infarction and lacunar infarction, elevated low density lipoprotein is an independent risk factor in patients with cerebral white matter lesions in acute cerebral infarction and hypertension were independent risk factors of cerebral white matter lesions in patients with lacunar cerebral infarction;
Compared with white matter lesions, the relationship between resting lacunar infarction and acute cerebral infarction is closer, and the risk of acute infarction is higher.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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