本文選題：急性缺血性腦梗死　切入點：梗死復發(fā)　出處：《天津醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的探討MR成像在預測腦卒中復發(fā)中的價值,評估并確定腦卒中復發(fā)的高危人群。 材料與方法本研究共納入57例初發(fā)腦卒中患者,均于2012年3月至2013年8月期間行MRI檢查。其中19例患者納入腦梗死復發(fā)組,均于首次發(fā)病至少一個月后再次發(fā)生新的急性梗死,且經(jīng)DWI證實。如患者臨床癥狀惡化或DWI顯示在原梗死灶附近新發(fā)急性梗死,但距離首次發(fā)病時間不超過1個月,則認為卒中進展而不是復發(fā)。余下的38例患者納入對照組,均經(jīng)電話隨訪至少1年,未發(fā)現(xiàn)任何新的神經(jīng)損害癥狀,并否認再次梗死。匯總并分析兩組患者的首診數(shù)據(jù),包括頭顱MRI平掃、MRA及頸部血管多普勒超聲。8例對照組和2例復發(fā)組患者未獲得頸部多普勒數(shù)據(jù)。5例對照組和3例復發(fā)組患者未獲得MRA數(shù)據(jù)。比較病灶的大小、數(shù)目、位置、責任血管,Willis環(huán)的完整性,顱內(nèi)大動脈狹窄,腦白質(zhì)稀疏程度,頸內(nèi)動脈粥樣硬化斑塊,糖尿病及高血壓病史的兩組間差異。應用SPSS17.0軟件包進行數(shù)據(jù)分析,PO.05為差異有統(tǒng)計學意義。 結(jié)果復發(fā)組患者初次發(fā)病時的平均年齡較對照組高9歲,獨立樣本t檢驗顯示組間差異具有統(tǒng)計學意義(t=3.2,P=0.002)。根據(jù)不同年齡段分組后再次比較,兩組仍存在顯著性差異(P=0.003),≥65歲組有66.7%(12/18)的患者出現(xiàn)腦卒中復發(fā)。兩組患者初發(fā)病灶的數(shù)目、位置、Willis環(huán)的完整性、頸內(nèi)動脈粥樣硬化斑塊,以及糖尿病和高血壓病史情況趨同,組間差異無顯著性(P0.05)。兩組患者梗死灶的責任動脈存在顯著差異(p=0.013),85.7%(6/7例)的大腦中動脈供血區(qū)梗死患者復發(fā),7.7%(1/13)的后循環(huán)梗死患者復發(fā)。復發(fā)組與對照組顱內(nèi)大動脈狹窄(狹窄率50%)發(fā)生率分別為73.7%(14/19)和23.7%(9/38),組間差異有顯著性(p=0.000)。兩組患者腦白質(zhì)稀疏的分級具有顯著性差異(p=0.000)。復發(fā)組和對照組分別有0%(0/19)和50%(19/38)的患者顯示0級腦白質(zhì)稀疏；1-3級腦白質(zhì)稀疏的患者,復發(fā)組分別有10.5%(2/19),47.4%(9/19),42.1%(8/19),對照組分別有21.1%(8/38,),21.1%(8/38)和7.9%(3/38)。多因素分析顯示,梗死灶的責任血管(OR,2.057；95%CI,1.079-3.922；P=0.029)和腦白質(zhì)稀疏的嚴重程度(OR,0.143；95%CI,0.042-0.480；P=0.002)是梗死復發(fā)的獨立危險因素。 結(jié)論腦卒中復發(fā)的危險因素包括初次發(fā)病時患者的年齡(65歲)、梗死灶的責任血管、顱內(nèi)大動脈狹窄50%和重度腦白質(zhì)稀疏(2-3級),其中梗死灶的責任血管和嚴重的腦白質(zhì)稀疏是腦梗死復發(fā)的獨立危險因素。高齡、大腦中動脈供血區(qū)急性腦梗死、伴有顱內(nèi)大動脈狹窄50%和3級WML的患者具有較高的梗死復發(fā)風險。
[Abstract]:Objective to evaluate the value of Mr imaging in predicting stroke recurrence and to evaluate and identify the high risk population for stroke recurrence. Materials and methods MRI was performed in 57 patients with primary stroke from March 2012 to August 2013, 19 of whom were included in recurrent cerebral infarction group. New acute infarction occurred at least one month after the first onset, and was confirmed by DWI. If the patient's clinical symptoms deteriorated or DWI showed a new acute infarction near the original infarct, but not more than 1 month after the first onset, The remaining 38 patients were included in the control group, all of whom were followed up by telephone for at least one year. No new symptoms of nerve damage were found, and the patients denied reinfarction. The first diagnosis data of the two groups were collected and analyzed. The MRA data were not obtained in 5 cases of control group and 3 cases of recurrent group. The size, number and location of the lesions were compared between the two groups, including head MRI plain scan MRA and cervical vascular Doppler sonography in 8 cases of control group and 2 cases of recurrent group, and 5 cases of control group and 3 cases of recurrent group did not obtain MRA data. There were significant differences between the two groups in the integrity of Willis circle, the stenosis of intracranial arteries, the degree of white matter sparsity, the atherosclerotic plaque of internal carotid artery, the history of diabetes and hypertension. There were significant differences between the two groups by using SPSS17.0 software package to analyze the data of PO.05. Results the average age of the patients in the relapsed group was 9 years higher than that in the control group. The t test of independent sample showed that the difference between the two groups was statistically significant. There was still a significant difference between the two groups. 66.7% of the patients aged over 65 had recurrent stroke. The number of primary lesions, the integrity of Willis circle, the internal carotid atherosclerotic plaque, and the history of diabetes and hypertension were similar in the two groups. There was no significant difference between the two groups (P 0.05). There was a significant difference in the responsible arteries between the two groups. The incidence of narrowing (50%) was 73.714 / 19) and 23.710 / 38 (P = 0.000), respectively. There was a significant difference in white matter sparsity between the two groups (P = 0.0000.000). The patients with recurrent and control groups had 0% white matter sparsity 1-3% and 5019% 38, respectively. Grade A patients with sparse white matter, In the recurrent group, there were 10. 5 / 19 / 47.4% and 42. 1 / 819, respectively. In the control group, there were 21. 1 / 8 / 8 and 21. 1 / 838, respectively. Multivariate analysis showed that the responsible blood vessel of the infarct, OR2.05795CI1.079-3.922P0. 029) and the severity of the white matter 0.14395CI0.042-0.480P0.002) were independent risk factors for the recurrence of infarction. Conclusion the risk factors of stroke recurrence include the age of the patients at the first onset and the responsible vessels of the infarct. Intracranial artery stenosis 50% and severe white matter sparsity grade 2-3 are independent risk factors for recurrence of cerebral infarction, including responsible vessels and severe white matter sparsity in the infarct area, aged, acute cerebral infarction in the middle cerebral artery supply area, and acute cerebral infarction in the middle cerebral artery (MCAA). Patients with intracranial artery stenosis (50% and 3 WML) had a higher risk of infarct recurrence.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3;R445.2

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