本文選題：腦出血 + 預(yù)后　； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:腦白質(zhì)病變(white matter lesions,WMLs)又常被稱作腦白質(zhì)高信號(hào)(white matter hyperintensities,WMH)、腦白質(zhì)疏松(Leukoaraiosis,LA),常見(jiàn)于阿爾茲海默病、血管性癡呆、缺血性卒中、腦出血(intracerebral hemorrhage,ICH)等多種疾病。目前已有研究報(bào)道腦白質(zhì)病與缺血性卒中預(yù)后不良有關(guān),但關(guān)于腦白質(zhì)病變與腦出血預(yù)后方面的報(bào)道卻較少,故本研究探討腦白質(zhì)病變對(duì)腦出血遠(yuǎn)期預(yù)后不良的影響。方法:1、前瞻性登記2015年1月1日至2016年4月30日入住四川省人民醫(yī)院神經(jīng)內(nèi)科的腦出血患者,并詳細(xì)記錄他們的臨床資料,對(duì)于完善頭部MRI檢查的患者,基于MRI圖像使用Fazekas量表分別評(píng)估側(cè)腦室旁和深部腦白質(zhì)病變的嚴(yán)重程度。2、對(duì)比分析納入研究組和未納入研究組之間基線資料和預(yù)后的差異。根據(jù)6個(gè)月時(shí)m RS評(píng)分將納入患者分為兩組,定義m RS≥4分為預(yù)后不良組,m RS≤3分為預(yù)后良好組。利用單因素分析篩選出可能影響腦出血遠(yuǎn)期預(yù)后的危險(xiǎn)因素,再對(duì)這些因素進(jìn)行Logistic回歸分析,確定影響腦出血患者遠(yuǎn)期預(yù)后的獨(dú)立危險(xiǎn)因素。利用Goodman-Kruskal Gamma方法分析腦白質(zhì)病變的嚴(yán)重程度與腦出血遠(yuǎn)期預(yù)后不良的嚴(yán)重程度之間相互伴隨變化的趨勢(shì)和關(guān)聯(lián)強(qiáng)度。結(jié)果:1、登記腦出血患者共178例,有127例完善頭部MRI檢查,其中10例失訪;有51例未完善頭部MRI檢查,其中有2例數(shù)據(jù)不完整。納入研究組和未納入研究組基線對(duì)比顯示:兩組在高血壓病史、肺部感染、GCS評(píng)分、NIHSS評(píng)分、血腫量、出血部位、血腫破入腦室、血腫不規(guī)則、6個(gè)月時(shí)m RS評(píng)分方面存在顯著差異。2、腦白質(zhì)病變對(duì)自發(fā)性腦出血遠(yuǎn)期預(yù)后影響的研究中,除去10例失訪,最終納入117例腦出血患者。單因素分析顯示年齡、吸煙、肺部感染、血腫破入腦室、血腫不規(guī)則、血腫量、GCS評(píng)分、NIHSS評(píng)分、入院時(shí)收縮壓、腦白質(zhì)病變(white matter lesions,WMLs)的嚴(yán)重程度是自發(fā)性腦出血患者遠(yuǎn)期預(yù)后不良的危險(xiǎn)因素。3、將上述因素納入Logistic回歸分析,結(jié)果顯示自發(fā)性ICH患者遠(yuǎn)期預(yù)后不良的獨(dú)立危險(xiǎn)因素包括NIHSS評(píng)分(OR=3.467,95%CI:1.207~9.955,P0.05)、年齡(OR=1.065,95%CI:1.001~1.133,P0.05)、血腫破入腦室(OR=5.475,95%CI:1.428~20.994,P0.05)、出血量(OR=2.366,95%CI:1.206~4.641,P0.05)、腦白質(zhì)病變的嚴(yán)重程度(OR=5.706,95%CI:1.556~20.927,P0.05)。肺部感染有影響腦出血遠(yuǎn)期預(yù)后不良的趨勢(shì)(OR=3.316,95%CI:0.925~11.885,P=0.066)。4、側(cè)腦室旁腦白質(zhì)病變和深部腦白質(zhì)病變的嚴(yán)重程度均與腦出血遠(yuǎn)期預(yù)后不良的嚴(yán)重程度呈正相關(guān),相關(guān)系數(shù)分別為0.547和0.499。結(jié)論:1、腦白質(zhì)病變的嚴(yán)重程度是腦出血遠(yuǎn)期預(yù)后不良的獨(dú)立危險(xiǎn)因素;2側(cè)腦室旁腦白質(zhì)病變較深部腦白質(zhì)病變對(duì)腦出血遠(yuǎn)期預(yù)后不良有更好的預(yù)測(cè)意義3、在評(píng)估急性腦出血遠(yuǎn)期預(yù)后時(shí)可考慮將腦白質(zhì)病變的嚴(yán)重程度考慮在內(nèi),但它影響腦出血遠(yuǎn)期預(yù)后的病理生理機(jī)制仍需進(jìn)一步研究。
[Abstract]:At present, some studies have reported that leukoencephalopathy is associated with poor prognosis of ischemic stroke, but there are few reports on the prognosis of leukoencephalopathy and cerebral hemorrhage. Therefore, this study is to explore the effect of leukoencephalopathy on the long-term poor prognosis of cerebral hemorrhage.Methods: to prospectively register patients with intracerebral hemorrhage admitted to the Department of Neurology of Sichuan Provincial people's Hospital from January 1, 2015 to April 30, 2016, and record their clinical data in detail.The severity of paraventricular and deep white matter lesions was evaluated with Fazekas scale based on MRI images. The baseline data and prognosis were compared between the two groups.According to the score of Mrs at 6 months, the patients were divided into two groups, which were divided into two groups. The patients with poor prognosis were divided into two groups: the group with poor prognosis and the group with good prognosis.Single factor analysis was used to screen out the risk factors which might affect the long-term prognosis of cerebral hemorrhage. The Logistic regression analysis was carried out to determine the independent risk factors affecting the long-term prognosis of patients with intracerebral hemorrhage.Goodman-Kruskal Gamma method was used to analyze the correlation between the severity of leukoencephalopathy and the severity of long-term poor prognosis of intracerebral hemorrhage.Results among 178 patients with intracerebral hemorrhage (ICH), there were 127 cases with complete head MRI examination, including 10 cases with missing visit, 51 cases with incomplete head MRI examination and 2 cases with incomplete data.Baseline comparison between the study group and the study group showed that the two groups had a history of hypertension, a GCS score of pulmonary infection, a NIHSS score, a hematoma volume, a site of hemorrhage, and a hematoma broke into the ventricle.The hematoma was irregular, and there was significant difference in mRS score at 6 months. In the study of the long-term prognosis of spontaneous cerebral hemorrhage, 10 cases were lost, and 117 cases were included in the study.Univariate analysis showed age, smoking, pulmonary infection, hematoma breaking into the ventricle, irregular hematoma, hematoma volume, GCS score and NIHSS score, systolic blood pressure on admission.The severity of white matter lesions was the risk factor of poor long-term prognosis in patients with spontaneous intracerebral hemorrhage. The above factors were included in Logistic regression analysis.Pulmonary infection has a tendency to influence the long-term poor prognosis of intracerebral hemorrhage (CI: 0.925) 11.885Pu 0.066 .4.The severity of paraventricular white matter lesions and deep white matter lesions are positively correlated with the severity of long-term poor prognosis of intracerebral hemorrhage, and the correlation coefficients are 0.547 and 0.499respectively.Conclusion the severity of cerebral white matter lesions is an independent risk factor for long-term poor prognosis of intracerebral hemorrhage. 2 sides of paraventricular white matter lesions have better prognostic significance than deep white matter lesions in the long term prognosis of cerebral hemorrhage.In the long term prognosis of acute intracerebral hemorrhage, the severity of leukoencephalopathy may be taken into account.However, the pathophysiological mechanism of its influence on the long-term prognosis of intracerebral hemorrhage still needs to be further studied.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

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