本文選題：腦白質(zhì)病變　切入點(diǎn)：高血壓　出處：《皖南醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:腦白質(zhì)病變(White matter lesions,WML)造成腦部組織損傷的病理過程有很強(qiáng)的異質(zhì)性,發(fā)病的危險(xiǎn)因素多種多樣,患者表現(xiàn)出來的臨床癥狀和體征也可不盡相同。目前該病的具體發(fā)病機(jī)制和有關(guān)危險(xiǎn)因素尚處于研究階段。本研究主要對(duì)與WML部位及程度相關(guān)的血管危險(xiǎn)因素進(jìn)行分析的基礎(chǔ)上,強(qiáng)調(diào)高血壓患者血壓動(dòng)態(tài)變化的血壓變異性(Blood pressure variability,BPV)對(duì)WML的影響,對(duì)高血壓患者腦白質(zhì)病變部位及嚴(yán)重程度與BPV的相關(guān)性進(jìn)行了詳細(xì)探討,對(duì)WML可能的病理生理機(jī)制進(jìn)行初步探索。方法:選擇2014年09月到2016年10月之間,在蕪湖市第二人民醫(yī)院神經(jīng)內(nèi)科、急診內(nèi)科住院的病人,進(jìn)行過腦血管病危險(xiǎn)因素篩查且年齡為50歲及其以上的高血壓患者作為研究對(duì)象。收集所有研究對(duì)象的臨床病歷資料,并對(duì)其進(jìn)行24h動(dòng)態(tài)血壓監(jiān)測(cè)(Ambulatory blood pressuremonitoring,ABPM)和腦部磁共振(MRI)檢查。其中臨床病歷資料完整的共178例,以顱腦MRI結(jié)果為依據(jù)分為兩組:一組為腦白質(zhì)病變組(WML組),共計(jì)112例;另一組為無腦白質(zhì)病變組(無WML組),共計(jì)66例。再依據(jù)Fazekas評(píng)分將WML組患者分為兩種類型,即腦室旁白質(zhì)病變(Periventricular lesions,PVL)和皮質(zhì)下深部白質(zhì)病變(Deep white matter lesions DWML),同時(shí)還要對(duì)每種類型的病變程度進(jìn)行評(píng)估。此外,還應(yīng)對(duì)每位患者的血壓變化進(jìn)行24h動(dòng)態(tài)監(jiān)測(cè),并對(duì)其白天(day)、夜間(night)、晝夜的血壓平均值[收縮壓(Systolic blood pressure,SBP)、舒張壓(Diastolic blood pressure,DBP)]及血壓變異系數(shù)(Coefficient of variability,CV)進(jìn)行詳細(xì)記錄,對(duì)其24hSBP及24hDBP的峰谷數(shù)值進(jìn)行統(tǒng)計(jì),以此作為動(dòng)態(tài)血壓參數(shù)。使用單因素和多因素logistic回歸分析方法,研究動(dòng)態(tài)血壓參數(shù)及傳統(tǒng)血管危險(xiǎn)因素對(duì)腦白質(zhì)病變部位是否有影響;對(duì)各部位危險(xiǎn)因素及動(dòng)態(tài)血壓參數(shù)與具體病變程度進(jìn)行pearson或spearman相關(guān)分析,重點(diǎn)觀察動(dòng)態(tài)血壓參數(shù)對(duì)腦白質(zhì)各部位病變程度的影響。結(jié)果:1.wml組與無wml組臨床病歷資料的比較:與無wml組相比,wml組患者平均年齡更大,有更長的高血壓病史,同型半胱氨酸(homocysteine,hcy)水平更高(p0.05);兩組患者動(dòng)態(tài)血壓參數(shù)相比較:wml組的24hdbp,24hsbp,dsbp,nsbp,24hsbp-cv,dsbp-cv,24hsbp谷峰值都比無wml組更高(p0.05)。2.pvl危險(xiǎn)因素分析:以動(dòng)態(tài)血壓參數(shù)以及傳統(tǒng)血管危險(xiǎn)因素(如性別、年齡、高脂血癥、高血壓病程等)為協(xié)變量,pvl為因變量,進(jìn)行單因素分析可得出:年齡、同型半胱氨酸、高血壓病程、nsbp、dsbp、24hsbp、24hsbp-cv、dsbp-cv、24hsbp-谷峰值共9個(gè)指標(biāo)均是pvl的可能影響因素,且具有統(tǒng)計(jì)學(xué)意義(p0.05);再將這9個(gè)指標(biāo)進(jìn)行多因素logistic回歸分析發(fā)現(xiàn):年齡、高同型半胱氨酸、dsbp-cv、24hsbp-谷峰值這4個(gè)指標(biāo)均是pvl的危險(xiǎn)因素,其計(jì)算出的or值分別為1.719、1.046、4.093、1.079,其中dsbp-cv是pvl的最重要的危險(xiǎn)因素。3.dwml的危險(xiǎn)因素:以動(dòng)態(tài)血壓參數(shù)以及傳統(tǒng)血管危險(xiǎn)因素(如性別、年齡、飲酒、高脂血癥、高血壓病程等)為協(xié)變量,dwml為因變量,進(jìn)行單因素分析可得出:年齡、高同型半胱氨酸血癥、飲酒、高血壓病程、nsbp、dsbp、24hsbp、24hsbp-cv、dsbp-cv,24hsbp-谷峰值共10個(gè)指標(biāo)均是dwml的可能影響因素,且具有統(tǒng)計(jì)學(xué)意義(p0.05);再將這10個(gè)指標(biāo)進(jìn)行多因素logistic回歸分析可發(fā)現(xiàn):飲酒、dsbp-cv、24hdbp、24hsbp-谷峰值這4個(gè)指標(biāo)均是dwml的危險(xiǎn)因素,其計(jì)算出的or值分別為3.167、6.571、1.062、1.079,其中dsbp-cv是dwml的最重要的危險(xiǎn)因素。4.與pvl程度相關(guān)的因素分析:將pvl的危險(xiǎn)因素與其病變程度分級(jí)進(jìn)行相關(guān)分析可發(fā)現(xiàn):pvl1級(jí)病變與24hsbp-谷峰值有相關(guān)性;而pvl2級(jí)、3級(jí)病變與年齡、高同型半胱氨酸血癥、dsbp-cv、24hsbp-谷峰值均有相關(guān)性。5.與DWML程度相關(guān)的多危險(xiǎn)因素分析:將DWML的危險(xiǎn)因素與其病變程度分級(jí)進(jìn)行相關(guān)分析,可發(fā)現(xiàn):DWML1級(jí)病變與24hSBP-谷峰值有相關(guān)性;而2級(jí)病變與dSBP-CV,24hSBP-谷峰值均有相關(guān)性;3級(jí)病變與24hDBP、dSBP-CV、24hSBP-谷峰值均有相關(guān)性。結(jié)論:1?不同部位及不同程度的WML,其危險(xiǎn)因素并不完全相同;2?與PVL及DWML相關(guān)的動(dòng)態(tài)血壓參數(shù)具有重疊性和差異性;3?高血壓的動(dòng)態(tài)血壓參數(shù)與各級(jí)PVL及DWML均存在相關(guān)性,動(dòng)態(tài)血壓參數(shù)的上升,其病變等級(jí)逐漸升高。
[Abstract]:Objective: cerebral white matter lesions (White matter, lesions, WML) caused by the pathological process of brain injury is very heterogeneous, the risk factors of various clinical symptoms and signs shown can be not the same. At present the specific mechanisms of the disease and related risk factors is still in the research stage the purpose of this study. Based on the analysis of related WML site and degree of vascular risk factors, blood pressure variability on the dynamic changes of blood pressure in hypertensive patients (Blood pressure, variability, BPV) on the WML, the correlation between cerebral white matter lesions in patients with hypertension location and severity and BPV are discussed in detail, for to explore the pathophysiological mechanism of WML. Methods: in 2014 09 months to October 2016, in the Department of Neurology Wuhu Second People's Hospital, emergency internal medicine hospital patient, too The risk factors for cerebrovascular disease screening and the age of 50 and older hypertension patients as the research object. The clinical data were collected from all participants, and 24h ambulatory blood pressure monitoring on the (Ambulatory blood pressuremonitoring, ABPM) and brain magnetic resonance imaging (MRI) examination. The clinical data of 178 cases with complete. Based on the results of brain MRI were divided into two groups: one group of cerebral white matter lesion group (WML group), a total of 112 cases; another group without cerebral white matter lesion group (WML group), 66 cases in total. According to the Fazekas score of WML group were divided into two types, namely periventricular white (Periventricular lesions, PVL matter lesions) and subcortical white matter lesions (Deep white matter lesions DWML), but also on the severity of each type were evaluated. In addition, the change of blood pressure also respond to each patient's 24h dynamic monitoring, and the daytime (DA Y (night)), the night, day and night average systolic blood pressure [(Systolic blood pressure, SBP), diastolic blood pressure (Diastolic blood, pressure, DBP) and blood pressure variability (Coefficient of, variability, CV) were recorded, the peak and valley of its 24hSBP and 24hDBP numerical statistics, as a dynamic the blood pressure parameters. Using univariate and multivariate logistic regression analysis method to study whether ambulatory blood pressure parameters and traditional vascular risk factors have influence on cerebral white matter lesions; Pearson or Spearman correlation analysis of each part of the risk factors and the parameters of ambulatory blood pressure and specific lesions, observed the influence on ambulatory blood pressure parameters on the degree of brain parts white matter lesions. Results: compared with 1.wml group and non WML group of clinical data: compared with non WML group, the average age of WML group were larger, have a longer history of high blood pressure, homocysteine (Homo Cysteine, Hcy) higher level (P0.05); the two groups were compared: the parameters of ambulatory blood pressure in group WML, 24hdbp, 24hsbp, dsbp, nsbp, 24hsbp-cv, dsbp-cv, 24hsbp and Gu Feng were higher than no WML group (P0.05):.2.pvl analysis of risk factors on ambulatory blood pressure parameters and traditional vascular risk factors (such as gender, age, hyperlipidemia, hypertension etc.) as covariates, PVL as the dependent variable, the single factor analysis: age, homocysteine, duration of hypertension, nsbp, dsbp, 24hsbp, 24hsbp-cv, dsbp-cv, 24hsbp- Valley peak a total of 9 indicators are factors that may affect PVL, and has statistical significance (P0.05); then logistic regression analysis found that the factors of the 9 indexes: age, high homocysteine, dsbp-cv Gu Feng, 24hsbp- value of the 4 indicators are the risk factors of PVL, the calculated or = 1.719,1.046,4.093,1.079, where dsbp-cv is PVL The risk factors of.3.dwml the most important risk factors: the ambulatory blood pressure parameters and traditional vascular risk factors (such as gender, age, alcohol, hyperlipidemia, hypertension etc.) as covariates, DWML as the dependent variable, the single factor analysis: age, hyperhomocysteinemia, drinking, hypertension duration. Nsbp, dsbp, 24hsbp, 24hsbp-cv, dsbp-cv, 24hsbp- and Gu Feng value of a total of 10 indicators are all factors that may affect the DWML, which has statistical significance (P0.05); then logistic regression analysis can be found by multiple factors and the 10 indexes: dsbp-cv, 24hdbp, 24hsbp- alcohol, Gu Feng value of the 4 indicators are dangerous DWML, the calculated or = 3.167,6.571,1.062,1.079, where dsbp-cv is the DWML analysis of the most important risk factors related to.4. and PVL factors: PVL risk classification for hormone and disease severity related analysis Found: Gu Feng disease and 24hsbp- pvl1 value and correlation; grade pvl2, grade 3 lesions with age, hyperhomocysteinemia, dsbp-cv,.5. and DWML correlation analysis showed the degree of multiple risk factors in 24hsbp- Gu Feng: the risk factors of DWML and severity level correlation analysis, it can be found that Gu Feng grade lesions of 24hSBP- and DWML1 value and correlation; 2 lesions were correlated with dSBP-CV, 24hSBP- and Gu Feng; 3 lesions with 24hDBP, dSBP-CV and 24hSBP- were correlated with Gu Feng value. Conclusion: 1? Different parts and different degree of WML, the risk factors are not the same; 2? Ambulatory blood pressure parameters associated with PVL and DWML has overlapping and differences; 3? Hypertension ambulatory blood pressure and the levels of PVL and DWML there was a correlation between increased ambulatory blood pressure parameters, the lesion level gradually increased.

【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R544.1;R742

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