本文選題：腦梗死　切入點：頸動脈超聲造影　出處：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討急性前循環(huán)腦梗死患者頸動脈超聲造影對不穩(wěn)定斑塊的診斷價值及其與腦梗死發(fā)病機制和復(fù)發(fā)的相關(guān)性,為二級預(yù)防策略的制定提供參考。方法:本研究納入2015年10月至2016年12月期間,于首都醫(yī)科大學(xué)附屬北京天壇醫(yī)院住院治療的急性前循環(huán)腦梗死患者,病因均為顱內(nèi)/外大動脈粥樣硬化。入組患者發(fā)病14天內(nèi)行頭顱MR、梗死灶同側(cè)頸動脈普通超聲及超聲造影檢查,并于90±7天隨訪缺血性腦卒中復(fù)發(fā)情況。采用Logistic回歸分析超聲檢查下斑塊穩(wěn)定性與頭MR DWI序列所示責(zé)任梗死灶形態(tài)的相關(guān)性,利用受試者工作特征(ROC)曲線計算不穩(wěn)定斑塊對顱內(nèi)栓塞形態(tài)梗死灶的診斷價值,并使用生存分析探討其對缺血性卒中復(fù)發(fā)的預(yù)測作用。結(jié)果:93例腦梗死患者行梗死灶同側(cè)頸動脈超聲造影檢查,35例(37.6%)合并不穩(wěn)定斑塊。頸動脈超聲造影下不穩(wěn)定斑塊是栓塞形態(tài)梗死灶的獨立危險因素(OR=3.63,95%CI 1.19-11.12,P=0.02),且在不合并顱內(nèi)大血管病變的患者中相關(guān)性更強(OR=5.67,95%CI 1.36-23.67,P=0.02)。相較于普通超聲,超聲造影下不穩(wěn)定斑塊對顱內(nèi)栓塞形態(tài)梗死灶有中等診斷價值(ROC曲線下面積0.73,P=0.01),可以為腦梗死患者動脈到動脈栓塞機制的診斷提供更多依據(jù)。單因素分析時,超聲造影下不穩(wěn)定斑塊是腦梗死患者3月內(nèi)復(fù)發(fā)的預(yù)測因素(P=0.04)。結(jié)論:在急性動脈粥樣硬化性腦梗死患者中,和普通頸動脈超聲相比,超聲造影對不穩(wěn)定斑塊的判斷更準(zhǔn)確,超聲造影下斑塊穩(wěn)定性與發(fā)病機制和預(yù)后相關(guān),對二級預(yù)防方案的制定具有參考意義。
[Abstract]:Objective: to investigate the diagnostic value of carotid ultrasonography in patients with acute anterior circulation cerebral infarction (ACI) and its correlation with the pathogenesis and recurrence of cerebral infarction in order to provide reference for the formulation of secondary prevention strategy.Methods: from October 2015 to December 2016, patients with acute anterior circulatory cerebral infarction (ACI) hospitalized in Temple of Heaven Hospital, Beijing affiliated to Capital Medical University, were treated with intracranial / external arteriosclerosis.The patients in the group were examined with head MRR, ipsilateral carotid ultrasound and contrast-enhanced ultrasonography within 14 days of onset, and the recurrence of ischemic stroke was followed up for 90 鹵7 days.Using Logistic regression analysis, the correlation between plaque stability and the responsible infarct shape in head Mr DWI sequence was studied. The diagnostic value of unstable plaque in intracranial embolism was calculated by using the operating characteristics of the subjects.Survival analysis was used to investigate its predictive effect on ischemic stroke recurrence.Results 35 cases (37.6%) with unstable plaque were examined by ipsilateral carotid ultrasonography in 93 patients with cerebral infarction.Compared with conventional ultrasound, unstable plaques under contrast-enhanced ultrasound have moderate diagnostic value for cerebral embolism. The area under the ROC curve is 0.73 ~ 0.01, which can provide more evidences for the diagnosis of arterial to artery embolization mechanism in cerebral infarction patients.In univariate analysis, unstable plaques under contrast-enhanced ultrasonography were the predictors of recurrence in patients with cerebral infarction within 3 months.Conclusion: in patients with acute atherosclerotic cerebral infarction, contrast-enhanced ultrasonography is more accurate in judging unstable plaque than common carotid ultrasound, and plaque stability is related to pathogenesis and prognosis.It has reference significance for the formulation of two-level prevention plan.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

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相關(guān)期刊論文 前2條

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本文編號：1719336