本文選題：缺血性腦白質(zhì)疏松 + 部位　； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的：了解缺血性腦白質(zhì)疏松（Ischemic leukoaraiosis,ILA）病變部位（腦室周圍白質(zhì)疏松（Periventricular lesions PVL）和皮質(zhì)下白質(zhì)疏松（Deep white matterlesions DWML））及嚴重程度的相關(guān)因素，探討ILA可能的病理生理機制。 方法：選擇健康體檢者為對照組，ILA患者均符合納入及排除標準。對照組(組1）60例，男性32例，女性28例，年齡27-77歲，平均(51.68±11.13)歲。ILA組又分為單純側(cè)腦室體旁白質(zhì)疏松（Simple periventricular lesions SPVL）組（組2）和側(cè)腦室體旁及皮質(zhì)下白質(zhì)共存組（periventricular lesions and deep white matterlesions PVLDWML）（組3）；組2患者78例，男性43例，女性35例，年齡40-82歲,平均(61.50±9.68)歲；組3患者49例，男性27例，女性22例，年齡46-88歲，平均(66.39±10.15)歲。記錄研究對象的一般資料，測定空腹血糖（FastingBlood Glucose，F(xiàn)BG）、血清總膽固醇（Total cholesterol，TC）、甘油三酯（Triglyceride，TG）、高密度脂蛋白膽固醇（High density lipoprotein-cholesterol，HDL-ch）、低密度脂蛋白膽固醇（Low density lipoprotein-cholesterol，LDL-ch）、脂蛋白(a（)Lipoprotein(a)，LP(a)）、同型半胱氨酸（Homocysteine，Hcy）、尿素氮（Bloodurea nitrogen，BUN）、肌酐（Creatinine，Cre）、尿酸（Uric acid，UA）、胱抑素C(CystatinC，CysC)、C-反應蛋白(C-reactive protein，CRP)、血漿纖維蛋白原（Fibrinogen，F(xiàn)ib）、部分凝血活酶時間（Partial thromboplastin time，APTT）、凝血酶原時間（Prothrombin time，PT）、凝血酶時間（Thrombin time，TT）。行頭顱MRI檢查。應用Fazekas分級方法對ILA的嚴重程度進行評級。記錄頭顱MRI檢查所示梗死灶的數(shù)量、部位及大小。所有數(shù)據(jù)使用SPSS20.0統(tǒng)計學軟件進行分析。檢驗的顯著性水準為雙側(cè)檢驗P＜0.05。 結(jié)果： 1.組2、組3的年齡明顯高于組1(P＜0.01，P＜0.01)，組3的年齡明顯高于組2(P＜0.05)；組3的高血壓陽性例數(shù)明顯高于組1及組2(P＜0.01，P＜0.05)；組3的血清Hcy水平明顯高于組1(P＜0.05）；組3的血清CysC水平明顯高于組1、組2(P＜0.05，P＜0.05)；組3的血漿Fib水平明顯高于組1(P＜0.01）；組2的PT明顯高于組1(P＜0.05)；組2的INR明顯高于組1(P＜0.05)；組2、組3的PVL評級明顯高于組1(P＜0.01，P＜0.01)，組3的PVL評級明顯高于組2(P＜0.01)；組3的DWML評級明顯高于組1、組2(P＜0.01，P＜0.01)。所有梗死灶直徑＜1.5cm，組2、組3的基底節(jié)區(qū)梗死灶數(shù)量明顯高于組1(P＜0.01，P＜0.01)，組3的基底節(jié)區(qū)梗死灶數(shù)量明顯高于組2(P＜0.01)；組3的幕下梗死灶數(shù)量明顯高于組1、組2(P＜0.01，P＜0.01)。三組的性別、高脂血癥、糖尿病、冠心病例數(shù)、吸煙史及飲酒史構(gòu)成比無顯著差異，血清FBG、TC、TG、HDL-ch、LDL-ch、LP(a)、BUN、Cre、UA、CRP水平及血TT、APTT無顯著差異。三組的皮質(zhì)下梗死灶數(shù)量無顯著差異。 2.組2病變部位危險因素分析，單因素Logistic回歸分析：年齡(OR=1.103)、PT（OR=1.923）、INR（OR=566.985）3個指標進入回歸方程，均有統(tǒng)計學意義(P＜0.01；P＜0.01；P＜0.05)。多因素Logistic回歸分析：年齡（OR=1.103）有統(tǒng)計學意義(P＜0.05)。 3.組3病變部位危險因素分析，單因素Logistic回歸分析：年齡(OR=1.157)、高血壓(OR=0.176)、CysC (OR=105.793)、Hcy(OR=1.087)、Fib(OR=2.380)、PT（OR=1.727）6個指標進入回歸方程，均有統(tǒng)計學意義(P＜0.01；P＜0.01；P＜0.01；P＜0.05；P＜0.01；P＜0.05)。多因素Logistic回歸分析：年齡（OR=1.154）、高血壓(OR=0.147)、PT(OR=2.418)有統(tǒng)計學意義(P＜0.01；P＜0.01；P＜0.05)。 4.總側(cè)腦室旁白質(zhì)疏松(Total periventricular lesions，TPVL）危險因素分析，單因素Logistic回歸分析：年齡(OR=0.000)、高血壓(OR=0.369)、CysC(OR=18.196)、Hcy(OR=1.059)、Fib(OR=1.908)、PT（OR=1.842）、INR（OR=331.257）7個指標進入回歸方程，均有統(tǒng)計學意義(P＜0.01；P＜0.01；P＜0.05；P＜0.05；P＜0.05；P＜0.01；P＜0.05)。多因素Logistic回歸分析：年齡（OR=1.118）有統(tǒng)計學意義(P＜0.01；P＜0.05)。 5.年齡與SPVL評級呈顯著正相關(guān)（r=0.226，P＜0.05)。 6.CysC、Hcy、Fib水平與DWML評級無顯著相關(guān)。 7.年齡與TPVL評級呈顯著正相關(guān)（r=0.326，P＜0.01)。 8.年齡、CysC、Hcy水平與ILA總評級（F評級）呈顯著的正相關(guān)(r=0.315，P＜0.01；r=0.249，P＜0.05；r=0.187，P＜0.05)。與F評級有關(guān)指標進行多元線性回歸分析:F評級=-0.868+3.016CysC+0.764高血壓。 結(jié)論： 1.年齡、PT、INR是SPVL的危險因素；其中年齡是SPVL的獨立危險因素，且與SPVL評級呈正相關(guān)，，可以反映SPVL的嚴重程度。 2.高血壓、血CysC、Hcy、Fib水平是DWML的危險因素；其中高血壓是DWML的獨立危險因素。上述指標不能反映DWML的嚴重程度。 3.年齡、高血壓、血Hcy、CysC、Fib水平、PT、INR是TPVL的危險因素；其中年齡是TPVL的獨立危險因素，且年齡與TPVL評級呈正相關(guān)，可以反映TPVL的嚴重程度。年齡、血清Hcy、CysC水平與ILA總評級呈正相關(guān)，可以反映ILA的總體嚴重程度。CysC、高血壓對ILA形成的影響最大。
[Abstract]:Objective : To investigate the possible pathological and physiological mechanisms of acute ischemic leukoaraiosis ( ila ) at the lesion site ( Periventricular lesions PVL ) and deep white matterlesions DWML .

Methods : The healthy subjects were selected as the control group and the patients with ila were accorded with the inclusion and exclusion criteria . The control group ( group 1 ) 60 cases , the male 32 cases , the female 28 cases , the age 27 - 77 years , the average ( 51.68 鹵 11.13 ) years old . The ila group was divided into simple periventricular lesions SPVL group ( group 2 ) and lateral ventricle and subcortical white matter coexistence group ( periventricular lesions and deep white matterlesions PVLDWML ) ( group 3 ) ;
There were 78 males , 43 females , 35 females , age 40 - 82 years , average ( 61.50 鹵 9.68 ) years .
In group 3 , 49 cases , 27 male , 22 female , 46 - 88 years old , mean ( 66.39 鹵 10.15 ) years old . General data of study subjects were recorded , fasting blood glucose ( FBG ) , total cholesterol ( TC ) , triglyceride ( TG ) , high density lipoprotein cholesterol ( HDL - ch ) , low density lipoprotein cholesterol ( LDL - ch ) , uric acid ( UA ) , cystatin C ( CysC ) , uric acid ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) , plasma fibrinogen ( C - reactive protein , CRP ) TT). The severity of the infarction was graded using the Fazekas classification method . The number , location and size of the infarct focus indicated by the cranial MRI examination were recorded . All data were analyzed by SPSS 20.0 statistical software . The significance level of the test was 2 - sided test ( P & lt ; 0.05 ) .

Results :

1 . The age of group 2 and group 3 was significantly higher than that in group 1 ( P & lt ; 0.01 , P & lt ; 0.01 ) , and the age of group 3 was significantly higher than that of group 2 ( P & lt ; 0.05 ) ;
The positive number of hypertension in group 3 was significantly higher than that in group 1 and group 2 ( P < 0.01 , P < 0.05 ) .
The serum homocysteine level in group 3 was significantly higher than that in group 1 ( P < 0.05 ) .
The level of serum CysC in group 3 was significantly higher than that in group 1 and group 2 ( P < 0.05 , P < 0.05 ) .
The plasma Fib level in group 3 was significantly higher than that in group 1 ( P < 0.01 ) .
The PT of group 2 was significantly higher than that in group 1 ( P < 0.05 ) .
The INR of group 2 was significantly higher than that in group 1 ( P < 0.05 ) .
The scores of PVL in group 2 and group 3 were significantly higher than those in group 1 ( P < 0.01 , P < 0.01 ) , and the scores of PVL in group 3 were significantly higher than those in group 2 ( P < 0.01 ) .
The DWML rating of group 3 was significantly higher than that of group 1 and group 2 ( P & lt ; 0.01 , P & lt ; 0.01 ) . The number of infarction foci in basal ganglia of group 2 and group 3 was significantly higher than that in group 1 ( P & lt ; 0.01 , P & lt ; 0.01 ) , and the number of infarction foci in basal ganglia region of group 3 was significantly higher than that in group 2 ( P & lt ; 0.01 ) .
The number of infarction foci was significantly higher in group 3 than in group 1 and group 2 ( P < 0.01 , P < 0.01 ) . There was no significant difference in serum FBG , TC , TG , HDL - ch , LDL - ch , LP ( a ) , BUN , cre , UA , CRP level and blood TT and PT . There was no significant difference in the number of subcortical infarcts in three groups .

2 . Analysis of risk factors of 2 lesions in group 2 , single - factor logistic regression analysis : age ( OR = 1.103 ) , PT ( OR = 1.923 ) , INR ( OR = 565.985 ) , were statistically significant ( P < 0.01 ) .
P錛

本文編號：1801613