本文選題：非心源性缺血性腦卒中　切入點：ABI　出處：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：了解踝臂指數(shù)（ankle-brachial index，ABI）與非心源性缺血性腦卒中患者動脈粥樣硬化多血管床損害及其危險因素的關(guān)系 方法：選擇進(jìn)行ABI評價的非心源性缺血性腦卒中患者為研究對象，根據(jù)ABI評價結(jié)果，將觀察對象分為ABI正常組和ABI減低組用頸動脈椎及鎖骨下動脈彩超心臟彩色多普勒超聲及心電圖或動態(tài)心電圖血清胱抑素（Cys）測定，并結(jié)合既往病史評價兩組患者動脈粥樣硬化多血管床損害情況 結(jié)果：共納入非心源性缺血性腦卒中患者122例，其中ABI正常者89（72.95%）例，ABI減低者33（27.05%）例，其中僅有8例（24.24%）患者有間歇性跛行癥狀 ABI減低組的ABI值低于正常組(0.740.15vs1.100.58，P0.01)兩組患者性別吸煙飲酒比例比較，差異無統(tǒng)計學(xué)意義（P0.05）；但ABI減低組中高血壓（78.79%vs51.69%）糖尿病（45.45%vs21.34%）血脂異常（75.75%vs60.67%）的患病率均比正常組高（P0.05） 兩組患者冠心�。�48.48%vs26.69%）腎功能異常（75.76%vs48.31%）的比率相比較， AB I減低組均高于正常組（P0.05）且CysC的中位數(shù)ABI減低組高于正常組（1.46vs1.12，P0.01）將兩組患者的ABI值與CysC進(jìn)行線性相關(guān)分析顯示，結(jié)果顯示兩者之間無線性相關(guān)關(guān)系（P0.05） 兩組患者頸動脈椎動脈及鎖骨下動脈粥樣硬化的情況比較， ABI減低組的頸動脈粥樣硬化比率（100%vs82.02%）及頸動脈合并椎動脈或鎖骨下動脈粥樣硬化的比率（66.67%vs41.57%）均高于正常組，且差異均有統(tǒng)計學(xué)意義（P0.05） 兩組患者頸動脈IMT增厚情況的比較，其中IMT一處增厚和兩處增厚的比率無統(tǒng)計學(xué)意義（P0.05）；ABI減低組三處及以上增厚的比率明顯高于ABI正常組（81.81%vs53.93%，P0.01） 兩組患者伴發(fā)冠心病腎功能異常頸或椎動脈及鎖骨下動脈粥樣硬化的情況比較，兩組患者中伴發(fā)兩種疾病的比率無明顯差異；伴發(fā)三種疾病的比率高于ABI正常組（27.27%vs8.99%,P0.05） 以ABI減低為因變量，將年齡高血壓病糖尿病血脂異常冠心病腎功能異常頸動脈粥樣硬化作為自變量，進(jìn)行多因素Logistic回歸分析，結(jié)果除高血壓及頸動脈硬化外，，年齡（OR=0.923，95%的CI：0.857～0.994；P0.05）糖尿�。�0R=0.183,95%的CI：0.055～0.606；P0.01）血脂異常（OR=0.243,95%的CI：0.067～0.882； P0.05）冠心�。∣R=0.327,95%的CI：0.134～0.795；P0.05）及腎功能異常(OR=0.264，95%的CI=0.101～0.685， P0.01)均為ABI減低的獨立危險因素 結(jié)論：非心源性缺血性腦卒中患者ABI異常的發(fā)生率較高27.05%，其中僅有24.24%左右患者有間歇性跛行癥狀年齡糖尿病血脂異常冠心病腎功能異常是ABI減低的獨立危險因素ABI減低的患者合并冠心病及腎功能異常的比率較高，提示非心源性缺血性腦卒中患者可能存在著動脈粥樣硬化多血管床的損害測量ABI是評價動脈粥樣硬化多血管床損害的一種簡便無創(chuàng)的篩查方法
[Abstract]:Objective: to investigate the relationship between ankle-brachial index ABI (ankle brachial index) and atherosclerotic multivascular bed damage and its risk factors in patients with non-cardiogenic ischemic stroke. Methods: Non-cardiogenic ischemic stroke patients who were evaluated by ABI were selected as the study subjects. According to the results of ABI evaluation, The subjects were divided into two groups: normal ABI group and low ABI group. The subjects were measured by color Doppler echocardiography and electrocardiogram (ECG) or dynamic electrocardiogram (DECG) in carotid vertebrae and subclavian artery. Multivessel bed damage of atherosclerosis in both groups was evaluated in combination with previous medical history. Results: a total of 122 patients with non-cardiogenic ischemic stroke were included, of whom 8972.95 had normal ABI and 332.05 had decreased ABI, only 8 of them had intermittent claudication symptoms. The ABI value in the ABI reduction group was lower than that in the normal group (0.740.15 vs 1.100.58 / P0.01). There was no significant difference in smoking and drinking ratio between the two groups, but the prevalence rate of 78.79 vs 51.69 in the ABI reduction group was higher than that in the normal group (75.75 vs 60.67). The ratio of abnormal renal function (75.76 vs 48.31) in the two groups was higher than that in the normal group (P 0.05), and the median ABI of the CysC decreased group was higher than that of the normal group (1.46 vs 1.12 P 0.01). The linear correlation analysis showed that the ABI value of the two groups was correlated with CysC. The results show that there is a wireless correlation between them (P0.05). Comparison of carotid vertebral artery and subclavian artery atherosclerosis in two groups, the ratio of carotid artery atherosclerosis and carotid artery combined with vertebral artery or subclavian artery atherosclerosis in ABI reduction group was 100 vs 82.022.02) and the ratio of carotid artery with vertebral artery or subclavian artery atherosclerosis was 66.67 vs 41.57). The difference was statistically significant (P0.05). Comparison of carotid IMT thickening between the two groups, there was no significant difference in the ratio of IMT thickening in one place and two thickening. The ratio of thickening in three or more places in the IMT group was significantly higher than that in the normal ABI group (81.81 vs 53.93). There was no significant difference between the two groups in the incidence of coronary heart disease associated with abnormal renal function, cervical or vertebral artery and subclavian artery atherosclerosis, and the ratio of the three diseases was higher than that in the normal ABI group (27.27vs8.99g, P 0.05). With the decrease of ABI as dependent variable, coronary artery disease with abnormal renal function and carotid atherosclerosis were used as independent variables in patients with age hypertension, diabetes mellitus, dyslipidemia, coronary artery disease, and carotid atherosclerosis. The results were obtained by multivariate Logistic regression analysis, except hypertension and carotid atherosclerosis. Age: 0.8570.994P0.05) Diabetes mellitus 0.18395% CI: 0.055 0.606P0.01) dyslipidemia 0.24395% CI: 0.0670.882; P0.05) Coronary heart disease OR0.32795% CI0.1340.795P0.05) and abnormal renal function OR0.26495% CI 0.1010.685, P0.01) are independent risk factors for decreasing ABI. Conclusion: the incidence of abnormal ABI in patients with non-cardiogenic ischemic stroke is 27.05. Only 24.24% of the patients with intermittent claudication symptoms, age diabetes, dyslipidemia, coronary heart disease, abnormal renal function are independent risk factors of ABI reduction. The incidence of coronary heart disease and abnormal renal function was higher in patients with reduced ABI. The results suggest that ABI is a simple and noninvasive screening method for evaluating the multivascular bed damage of atherosclerosis in patients with non-cardiogenic ischemic stroke.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3;R543.5

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