發(fā)布時(shí)間：2018-05-13 16:43

  本文選題：頸動(dòng)脈 + 粥樣硬化斑塊��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的研究頸動(dòng)脈粥樣硬化斑塊(Carotid atherosclerotic plaque)經(jīng)過經(jīng)皮超聲治療前后斑塊大小的變化,以及頸動(dòng)脈粥樣硬化斑塊形成的相關(guān)危險(xiǎn)因素與經(jīng)皮超聲治療前后頸動(dòng)脈粥樣硬化斑塊大小變化的關(guān)系。方法根據(jù)納入及排除標(biāo)準(zhǔn),收集2015年5月~2016年5月來自大連市中心醫(yī)院神經(jīng)內(nèi)科的住院的并且經(jīng)頸動(dòng)脈超聲檢查有頸動(dòng)脈粥樣硬化斑塊或頸動(dòng)脈輕中度狹窄的患者,共60例,男性29例,女性31例,年齡40-85歲,平均年齡65.07±8.74歲。共分為兩組,A組(n=30),即單側(cè)斑塊組,主要為單側(cè)頸動(dòng)脈粥樣硬化斑塊者,給予超聲治療;B組(n=30),即雙側(cè)斑塊組,主要為雙側(cè)頸動(dòng)脈粥樣硬化斑塊者或輕中度狹窄的患者,該組分為兩個(gè)亞組:B1組:一側(cè)給予單純藥物治療(阿托伐他汀鈣片20mg+阿司匹林腸溶片100mg);B2組:另一側(cè)在藥物治療基礎(chǔ)上聯(lián)合經(jīng)皮超聲治療(阿托伐他汀鈣片20mg+阿司匹林腸溶片100mg+超聲治療)。所有患者均記錄年齡、性別、體重、身高、吸煙史、高血壓病史、糖尿病史、腦梗死病史等一般資料,并且記錄治療前后總膽固醇(total cholesterol,TC)、纖維蛋白原(Fibrinogen,FIB)、甘油三酯(triacylgly-cerol,TG)、D-二聚體、高密度脂蛋白膽固醇(high-density lipoprotein-cholesterol,HDL-C)、同型半胱氨酸(homocysteine,Hcy)、低密度脂蛋白膽固醇(Low-density lipoprotein-cholesterol,LDL-C)、超敏C反應(yīng)蛋白(High Sensitivity C-reaction Protein,Hs-CRP)水平等血液指標(biāo)的檢測結(jié)果以及記錄治療前頸動(dòng)脈粥樣硬化斑塊的長度(Length before treatment,Lb)及厚度(Thickness before treatment,Tb)、治療后斑塊的長度(Length after treatment,La)及厚度(Thickness after treatment,Ta)、斑塊的長度變化(Lb-La,,△L)及厚度變化(Tb-Ta,△T)。運(yùn)用SPSS 20.0統(tǒng)計(jì)分析軟件對數(shù)據(jù)進(jìn)行處理,P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1、A組與B組的一般資料,即性別、年齡、糖尿病史、腦梗死病史、體重指數(shù)(BMI)、吸煙史、高血壓病史,以及治療前FIB、D-二聚體、Hs-CRP、Hcy、TC、TG、HDL-C、LDL-C相比無統(tǒng)計(jì)學(xué)差異。2、La與Lb相比及Ta與Tb相比,A組、B2組均減小,且有顯著統(tǒng)計(jì)學(xué)差異(P0.01)。B1組治療后斑塊大小較治療前無明顯減小,無統(tǒng)計(jì)學(xué)差異。3、A組治療后TG、LDL-C、Hcy、FIB、Hs-CRP與治療前相比有所減小,但無統(tǒng)計(jì)學(xué)差異。治療后TC較治療前有所減小,治療后HDL-C、D-二聚體較治療前有所增大,均具有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。B1、B2兩組治療后TC、Hcy、TG、FIB、LDL-C、D-二聚體、Hs-CRP與治療前相比無統(tǒng)計(jì)學(xué)差異。治療后HDL-C較治療前有所增大,具有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。4、A組與B2組治療前長度及厚度分別相比,均無統(tǒng)計(jì)學(xué)差異。A組與B2組的△L相比,有顯著統(tǒng)計(jì)學(xué)差異(P0.01),A組與B2組的△T相比,有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。5、A組與B2組的△L百分比相比,有顯著統(tǒng)計(jì)學(xué)差異(P0.05),A組與B2組的△T百分比相比,有顯著統(tǒng)計(jì)學(xué)差異(P0.01)。6、采用多因素線性回歸分析示Tb對△L及△T均有影響(P0.01)。性別、年齡、BMI、糖尿病史、高血壓病史、腦梗死病史、吸煙史、TC、FIB、TG、、Hcy、HDL-C、D-二聚體、LDL-C、Hs-CRP對治療前后斑塊的大小變化無顯著影響。結(jié)論1、經(jīng)皮超聲治療可以減小頸動(dòng)脈粥樣硬化斑塊的大小。2、經(jīng)皮超聲輔助藥物治療斑塊的效果更佳。3、治療前斑塊的厚度是經(jīng)皮超聲治療療效的影響因素。性別、年齡、體重指數(shù)、糖尿病史、高血壓史、腦梗死病史、吸煙史、總膽固醇、纖維蛋白原、甘油三酯、同型半胱氨酸、高密度脂蛋白膽固醇、D-二聚體、低密度脂蛋白膽固醇、超敏C反應(yīng)蛋白等水平對療效無顯著影響。
[Abstract]:Objective to study the changes in the size of plaque in the carotid atherosclerotic plaque (Carotid atherosclerotic plaque) before and after percutaneous ultrasound therapy, as well as the relationship between the risk factors for the formation of carotid atherosclerotic plaques and the changes in the size of carotid atherosclerotic plaque before and after percutaneous ultrasound therapy. Methods according to the inclusion and exclusion criteria, the methods were collected. A total of 60 patients, 29 men, 31 women, 40-85 years old and 65.07 + 8.74 years old, were divided into two groups, group A (n=30), that is, the A group (n=30), that is, the unilateral plaque group, from the inpatients of the neurology department of Dalian Central Hospital in May 2015. Patients with unilateral carotid atherosclerotic plaques were treated with ultrasound; B group (n=30), bilateral plaque group, mainly bilateral carotid atherosclerotic plaques or mild to moderate stenosis, was divided into two subgroups: group B1: one side was given a single drug treatment (Atorvastatin Calcium Tablets 20mg+ Aspirin Enteric-coated Tablets 100mg); the other side was in the other side of the drug. Combined percutaneous ultrasound therapy (Atorvastatin Calcium Tablets 20mg+ Aspirin Enteric-coated Tablets 100mg+ ultrasound). All patients recorded age, sex, weight, height, smoking history, hypertension history, diabetes history, cerebral infarction history and other general data, and recorded the total cholesterol (total cholesterol, TC), fibrous eggs before and after treatment. Bai Yuan (Fibrinogen, FIB), triglyceride (triacylgly-cerol, TG), D- two polymer, high density lipoprotein cholesterol (high-density lipoprotein-cholesterol, HDL-C), homocysteine (homocysteine, Hcy), low density lipoprotein cholesterol (Low-density lipoprotein-cholesterol), hypersensitive reactive protein Otein, Hs-CRP) level of blood indexes and the length of carotid atherosclerotic plaques before treatment (Length before treatment, Lb) and thickness (Thickness before treatment, Tb). The length of plaque after treatment (Length after) and thickness And the thickness change (Tb-Ta, Delta T). Using SPSS 20 statistical analysis software to deal with the data, P0.05 was statistically significant. Results 1, the general data of group A and B group, namely, sex, age, diabetes history, cerebral infarction history, body mass index (BMI), smoking history, hypertension history, and FIB, D- two polymer before treatment, Hs-CRP, Hcy, TC, TC Compared to -C and Lb, compared with Lb and Ta and Tb, A group and B2 group decreased, and there was significant statistical difference (P0.01), there was no significant reduction in plaque size after treatment in.B1 group (P0.01), no statistical difference was observed before treatment, and there was no statistical difference before treatment, but there was no statistical difference. Before treatment, the HDL-C, D- two polymer increased, and all had significant statistical difference (P0.05).B1, B2 two groups after treatment, TC, Hcy, TG, FIB, LDL-C, D- two polymer, Hs-CRP and before treatment, there was no statistical difference. There was no significant difference in the length and thickness of the.A group compared with the B2 group (P0.01). Compared with the B2 group, there were significant statistical differences (P0.05).5 compared with the B2 group (P0.05), and there were significant differences in the delta L percentage between the A group and the B2 group (P0.05), and there were significant differences in the percentage of delta L between the.A group and the B2 group. 1).6, using multiple factor linear regression analysis showed that Tb had effect on Delta L and delta T (P0.01). Sex, age, BMI, diabetes history, hypertension history, cerebral infarction history, smoking history, TC, FIB, TG, Hcy, HDL-C, D- two polymer, there was no significant effect on the change of plaque size before and after treatment. Conclusion 1, percutaneous ultrasound therapy can reduce carotid porridge The size of the atherosclerotic plaque is.2, the effect of the percutaneous ultrasound assisted drug therapy is better.3. The thickness of the plaque before treatment is the influencing factor of the percutaneous ultrasound therapy. Sex, age, body mass index, diabetes history, hypertension history, history of cerebral infarction, smoking history, total cholesterol, fibrinogen, triglyceride, homocysteine, high density Lipoprotein cholesterol, D- two dimer, low density lipoprotein cholesterol and high sensitivity C reactive protein had no significant effect on the curative effect.

【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】：2017
【分類號】：R743.3

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本文編號：1883994