本文選題：分支動脈粥樣硬化病 + CISS分型��； 參考：《武漢大學(xué)》2016年博士論文

【摘要】：目的：探討在中國缺血性卒中分型(China Ischemic Stroke Subclassification, CISS)分型基礎(chǔ)上分支動脈粥樣硬化病(Branch Atheromatous Disease, BAD)和非BAD的之間、BAD各種亞型之間臨床差異性。方法：回顧性收集2013年3月24日至2015年1月16日于武漢大學(xué)中南醫(yī)院神經(jīng)內(nèi)科住院治療并行顱內(nèi)動脈高分辨核磁共振(high-resolution magnetic resonance imaging, HR-MRI)檢查的腦缺血性卒中患者146例,經(jīng)過篩選最終納入80例,依據(jù)影像學(xué)表現(xiàn)診斷為BAD組45例,非BAD組35例。對這兩組之間的臨床特征及危險因素進(jìn)行對比,并行逐步回歸分析探討危險因素與分組的相關(guān)性。參照CISS分型,結(jié)合高分辨核磁共振斑塊成像將兩組患者進(jìn)一步分為大動脈粥樣硬化型(Large artery atherosclerosis, LAA)、穿支動脈疾病型(Penetrating artery disease, PAD),共納入BAD-LAA組32例、BAD-PAD組13例、非BAD-LAA組21例、非BAD-PAD組14例,對這四組之間的臨床特征及危險因素進(jìn)行對比,并行逐步回歸分析探討危險因素與分組的相關(guān)性。按照缺血病灶部位將BAD組進(jìn)一步分為豆紋動脈(lenticulostriate artery, LSA)組和腦橋旁正中動脈(paramedian pontine artery, PPA)組,參照CISS分型,結(jié)合高分辨核磁共振斑塊成像將全部患者分為BAD-LSA-LAA組16例、BAD-LSA-PAD組8例、BAD-PPA-LAA組16例. BAD-PPA-PAD組5例,對這四組之間的臨床特征及危險因素進(jìn)行對比。結(jié)果：在BAD組與非BAD組的對比中發(fā)現(xiàn),兩組患者在危險因素方面無明顯差異性,在臨床特征方面BAD組入院時NIHSS評分高于非BAD組(6.09±3.01 vs 4.31±3.68,P=0.002),逐步回歸分析發(fā)現(xiàn)吸煙患者比不吸煙患者發(fā)生BAD的風(fēng)險高4.928倍(P=0.021)。在BAD-LAA組、BAD-PAD組對比中發(fā)現(xiàn),BAD-LAA占所有BAD類型的71.11%,在病因危險因素及臨床特征方面兩組患者具有高度的一致性,行逐步回歸分析后發(fā)現(xiàn)BAD患者中吸煙患者比不吸煙患者更易發(fā)生LAA樣改變,風(fēng)險比為10.20倍(P=0.048),糖尿病患者比不合并糖尿病的患者發(fā)生PAD風(fēng)險高16.41 1倍(P=0.014)。在BAD-LAA組、非BAD-LAA組對比中發(fā)現(xiàn),危險因素方面BAD-LAA組糖尿癇患病率低于非BAD-LAA組(18.8% vs 47.6%,P=0.035),臨床特征方面兩組無明顯差異,行逐步回歸分析BAD患者中吸煙患者比不吸煙患者相對非BAD更易發(fā)生LAA樣改變,風(fēng)險比為15.97倍(P=0.014),糖尿病患者比不合并糖尿病的患者發(fā)生非BAD-LAA風(fēng)險高7.042倍(P=0.039)。在BAD-PAD組、非BAD-PAD組對比中發(fā)現(xiàn),危險因素方面非BAD-PAD組患者年齡高于BAD-PAD組(66.64±11.08vs 55.31±15.86,P=0.040),臨床特征方面BAD-PAD組入院時NIHSS評分高于非BAD-PAD組(5.38±2.99 vs 2.14±1.70,P0.001)。在BAD-LSA-LAA組、BAD-LSA-PAD組、BAD-PPA-LAA組、BAD-PPA-PAD組兩兩對比中,各臨床特征及危險因素表現(xiàn)出高度的一致性,僅BAD-LSA-PAD組低密度脂蛋白高于BAD-PPA-PAD組(3.79±0.77 vs 2.57±0.96,P=0.028)。結(jié)論：BAD是一種特殊類型的腦梗死,在CISS分型下其危險因素及臨床特征與大動脈粥樣硬化接近。穿支動脈原位動脈粥樣硬化病變約占所有BAD的三分之一。BAD各亞組之間具有高度的同質(zhì)性,相同部位、不同等級動脈上相似病理改變導(dǎo)致的BAD和相同等級動脈上相似病理改變、不同部位的BAD在臨床癥狀和進(jìn)展特征上具有高度的一致性。
[Abstract]:Objective: To explore the clinical differences between Branch Atheromatous Disease (Branch Atheromatous Disease, BAD) and non BAD on the basis of China Ischemic Stroke Subclassification (CISS) classification in China. Methods: retrospective collection from March 24, 2013 to January 16, 2015 at Wuhan University. 146 cases of cerebral ischemic stroke were hospitalized in the neurology department of central and South hospitals in parallel with high-resolution magnetic resonance imaging (HR-MRI). After screening, 80 cases were included, 45 cases in group BAD and 35 in non BAD group according to imaging findings. The clinical features and risk factors between these two groups were analyzed. Contrast, parallel stepwise regression analysis to explore the correlation between risk factors and groups. Referring to CISS typing and high resolution MRI imaging, two groups of patients were further divided into Large artery atherosclerosis (LAA), perforator artery disease type (Penetrating artery disease, PAD), and BAD-LAA were incorporated into BAD-LAA. Group 32, BAD-PAD group 13 cases, non BAD-LAA group 21 cases, non BAD-PAD group 14 cases, compare the clinical features and risk factors between these four groups, parallel stepwise regression analysis to explore the correlation between the risk factors and the group. According to the focal site of ischemia, the BAD group is further divided into the bean striate dynamic pulse (lenticulostriate artery, LSA) group and the parasponic median. Paramedian pontine artery (PPA) group, according to CISS typing, combined with high resolution MRI imaging, all the patients were divided into group BAD-LSA-LAA 16 cases, BAD-LSA-PAD Group 8 cases, BAD-PPA-LAA group 16 cases and BAD-PPA-PAD group 5 cases. The comparison between the four groups of clinical features and risk factors were compared. Results: the comparison between the BAD group and the non BAD group It was found that there was no significant difference in the risk factors between the two groups. The NIHSS score in the BAD group was higher than that in the non BAD group (6.09 + 3.01 vs 4.31 + 3.68, P=0.002), and the stepwise regression analysis found that the smoking patients were 4.928 times higher than the non smoking patients (P=0.021). In group BAD-LAA, the BAD-PAD group was found, BAD-LAA. In 71.11% of all BAD types, two groups of patients were highly consistent in the cause of risk factors and clinical features. Stepwise regression analysis found that smoking patients in BAD were more likely to have LAA like changes than non smokers. The risk ratio was 10.20 times (P=0.048), and the risk of PAD was 16 higher in diabetics than in non diabetic patients. .41 1 times (P=0.014). In group BAD-LAA and non BAD-LAA group, the risk factors of diabetic epilepsy in group BAD-LAA were lower than that of non BAD-LAA group (18.8% vs 47.6%, P=0.035), and there was no significant difference in clinical characteristics. The stepwise regression analysis showed that smoking patients in BAD patients were more likely to have LAA like changes than non smokers. The risk of non BAD-LAA in diabetic patients was 15.97 times higher than that of non diabetic patients (P=0.039). In group BAD-PAD, non BAD-PAD groups found that the risk factors of non BAD-PAD patients were higher than those in the BAD-PAD group (66.64 + 11.08vs 55.31 + 15.86, P=0.040). The clinical characteristics of the BAD-PAD group were NIHSS. The score was higher than that in the non BAD-PAD group (5.38 + 2.99 vs 2.14 + 1.70, P0.001). In group BAD-LSA-LAA, group BAD-LSA-PAD, BAD-PPA-LAA and BAD-PPA-PAD, each clinical feature and risk factor showed a high consistency. Only BAD-LSA-PAD group low density lipoprotein was higher than group BAD-PPA-PAD (3.79 + 0.77 vs 2.57 + 0.96, P=0.028). Conclusion: BAD is A special type of cerebral infarction, whose risk factors and clinical characteristics are close to the large atherosclerosis in the CISS classification. The in situ atherosclerotic lesion of the perforator artery accounts for a high degree of homogeneity between the 1/3.BAD subgroups of all BAD, the same site, and the same pathological changes in the arteries of different grades of BAD and the same Similar pathological changes in grade arteries showed that BAD in different parts had high consistency in clinical symptoms and progress characteristics.

【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R743

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