發(fā)布時間：2018-05-13 20:45

  本文選題：青年 + 腦梗死　； 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：目的探討青年腦梗死的頭頸CTA特點及血管情況、CISS分型及可能的危險因素,對青年腦梗死高風險人群提供一級和二級預防依據(jù)。方法病例選自2013年1月1日至2017年1月1日就診于大連市中心醫(yī)院神經(jīng)內(nèi)科的青年腦梗死患者,共278例,對照組選自同期住院的老年腦梗死患者(年齡均≥60歲)。符合2010年中國中華醫(yī)學會所制定的急性缺血性腦卒中診治指南標準。均經(jīng)頭顱DWI檢查證實為腦梗死,且臨床癥狀與影像學顯示病灶相符合。對所有病例進行一般資料(包括性別、年齡、TIA或卒中史、高血壓史、糖尿病史、冠心病史、心腦血管病家族史、高血壓家族史、糖尿病家族史、吸煙及飲酒史)、實驗室檢查(包括血常規(guī)、凝血功能、血糖、血脂、同型半胱氨酸、尿酸等,部分患者行C反應蛋白及抗磷脂抗體檢測)和頭頸部CTA檢查,并進行CISS分型�；仡櫺允占鲜鱿嚓P(guān)數(shù)據(jù),探討青年腦梗死的頭頸CTA特點及危險因素分布。結(jié)果1.青年腦梗死占全部腦卒中的5.54%(278/5018),其中男性占87.41%,女性占15.82%,男女比例為5.52:1,發(fā)病年齡為18-45歲,平均38.27±5.36歲。2.青年組顱內(nèi)動脈狹窄有108例(40.45%),顱外動脈狹窄67例(25.09%),顱內(nèi)外血管同時受累44例(16.48%);老年組顱內(nèi)動脈狹窄有90例(30.00%),顱外動脈狹窄106例(35.33%),顱內(nèi)外血管同時受累68例(22.67%);對比兩組的血管狹窄分布,青年組以顱內(nèi)段為主,差異存在統(tǒng)計學意義(χ2=6.79,0.01P0.05)。青年組顯示顱內(nèi)動脈硬化152例患者,大腦前動脈病變17處,大腦中動脈病變78處,大腦后動脈病變19處,椎-基底動脈病變40處,其中大腦前動脈合并大腦后動脈病變1例,大腦中動脈合并大腦后動脈病變1例;頸總動脈硬化84處,頸內(nèi)動脈硬化23處。青年組共檢出血管狹窄或閉塞376處,其中有186處重度狹窄或閉塞,59處中度狹窄,131處輕度狹窄,前3個好發(fā)部位依次是大腦中動脈、頸動脈起始段及椎動脈開口處。3.青年腦梗死的CISS分型結(jié)果:大動脈粥樣硬化型有136例(48.92%),心源性卒中有43例(15.47%),穿支動脈型有54例(19.42%),其他病因有7例(2.52%),病因不明有38例(13.67%),以大動脈粥樣硬化型比例最高。4.在青年腦梗死患者中,既往史中有高血壓病史的患者147例(53.03%),有糖尿病病史的患者80例(28.79%),有TIA或腦卒中病史的患者42例(15.15%),有腦卒中家族史的患者78例(28.03%),有高血壓家族史的患者61例(21.91%),有糖尿病家族史的患者44例(19.51%),有吸煙史的患者191例(68.94%),有飲酒史的患者107例(38.64%),妊娠2例,應用毒品者1例;入院后實驗室檢查結(jié)果提示脂代謝異常200例(71.21%),高膽固醇血癥79例(28.42%),高甘油三酯血癥97例(34.89%),高低密度脂蛋白血癥137例(49.28%),高密度脂蛋白降低130例(46.76%),載脂蛋白A升高53例(19.06%),脂蛋白a升高36例(12.95%),高同型半胱氨酸血癥111例(40.15%),高尿酸血癥80例(28.79%)。結(jié)論1.青年腦梗死患者中男性患者所占比例明顯高于女性患者。2.青年腦梗死的血管病變主要分布在顱內(nèi)血管,大腦中動脈是最常見的部位。CISS分型中主要的病因分型是大動脈粥樣硬化型(LAA)。
[Abstract]:Objective to explore the characteristics of head and neck CTA and blood vessel, CISS classification and possible risk factors in young patients with cerebral infarction, and to provide primary and two level prevention basis for young people with high risk of cerebral infarction. Methods cases were selected from January 1, 2013 to January 1, 2017 in the neurology department of Dalian Central Hospital, 278 cases of cerebral infarction were compared. The elderly patients with cerebral infarction (aged more than 60 years old) were selected from the same period. They were in accordance with the guidelines for the diagnosis and treatment of acute ischemic stroke in China's Chinese Medical Association of China in 2010. All of them were confirmed by the head DWI examination as cerebral infarction, and the clinical symptoms were consistent with the imaging findings. General data (including sex, age, TI) were carried out. A or stroke history, history of hypertension, diabetes, coronary heart disease, family history of cardiovascular and cerebrovascular diseases, family history of hypertension, family history of diabetes, smoking and drinking history, laboratory examination (including blood routine, coagulation function, blood sugar, blood lipid, homocysteine, uric acid, C reactive protein and antiphospholipid antibody test) and head and neck CTA examination, CISS classification. A retrospective collection of the above data was made to explore the CTA characteristics and risk factors of the head and neck of young cerebral infarction. Results 1. young cerebral infarction accounted for 5.54% (278/5018) of all cerebral apoplexy, among which men accounted for 87.41%, women accounted for 15.82%, male and female ratio was 5.52:1, age of onset was 18-45, and the average of.2. youth group was 38.27 + 5.36 years old. There were 108 cases (40.45%) of arterial stenosis, 67 cases (25.09%) of cranial artery stenosis and 44 cases (16.48%) of intracranial and external vessels, 90 cases of intracranial artery stenosis (30%), 106 cases of extracranial artery stenosis (35.33%) and 68 cases (22.67%) involved in intracranial and external artery stenosis. Compared to the stenosis distribution in the two group, the young group was mainly intracranial segment, and the difference existed system in the young group. Study significance (chi 2=6.79,0.01P0.05). The young group showed 152 cases of intracranial arteriosclerosis, 17 lesions of the anterior cerebral artery, 78 lesions of the middle cerebral artery, 19 of the posterior cerebral artery and 40 of the vertebral basilar artery, 1 cases of the anterior cerebral artery and the posterior cerebral artery, 1 cases of the middle cerebral artery with the posterior cerebral artery, and the neck movement. There were 84 arteriosclerosis and 23 arteriosclerosis of internal carotid artery in the young group. There were 376 stenosis or occlusion in the young group, including 186 severe stenosis or occlusion, 59 moderate stenosis and 131 mild stenosis. The first 3 sites were the middle cerebral artery, the initial segment of the carotid artery and the CISS of the.3. young cerebral infarction in the vertebral artery opening: the large artery atherosclerosis was hard. There were 136 cases (48.92%), 43 cases (15.47%) of cardiogenic stroke, 54 of perforator artery type (19.42%), 7 (2.52%) in other causes, 38 (13.67%) of unknown etiology, with the highest proportion of.4. in young patients with cerebral infarction, 147 (53.03%) patients with history of hypertension in history, and 80 patients with diabetes history. (28.79%) 42 cases (15.15%) with TIA or stroke history, 78 patients with family history of stroke (28.03%), 61 patients with family history of hypertension (21.91%), 44 patients with family history of diabetes (19.51%), 191 cases (68.94%) with history of smoking history, 107 cases (38.64%) with history of drinking history, pregnancy 2, and drug users; The results of post hospital laboratory examination revealed 200 cases of lipid metabolism (71.21%), hypercholesterolemia in 79 cases (28.42%), high triglyceride in 97 cases (34.89%), high and low density lipoproteinemia in 137 cases (49.28%), high density lipoprotein in 130 cases (46.76%), apolipoprotein A increased in 53 (19.06%), lipoprotein a increased in 36 cases (12.95%), high homocysteine blood There were 111 cases (40.15%) and 80 cases of hyperuricemia (28.79%). Conclusion the proportion of male patients in 1. young cerebral infarction patients was significantly higher than that of female patients with.2.. The vascular lesions of cerebral infarction were mainly distributed in the intracranial vessels. The middle cerebral artery was the most common.CISS typing of the main cause classification is the large atherosclerotic type (LAA).

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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