本文選題：腦卒中 + 性別差異��； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的：腦卒中是危害人類生命與健康的常見病之一，其發(fā)病率和患病率常年居高不下，且有不斷上升的趨勢(shì)，針對(duì)腦卒中的不同病因和危險(xiǎn)因素，做好相應(yīng)的預(yù)防和治療顯得尤為重要。隨著對(duì)腦血管病研究的不斷深入，不同性別的卒中患者在發(fā)病率、患病率、危險(xiǎn)因素、卒中亞型、臨床表現(xiàn)、治療和預(yù)后等各方面均存在差異逐漸受到人們的重視。本研究旨在通過(guò)對(duì)1000余名急性腦卒中患者進(jìn)行回顧性分析，來(lái)觀察不同性別腦卒中患者發(fā)病年齡、常見危險(xiǎn)因素、卒中類型、缺血性卒中病因分型、病情嚴(yán)重程度等方面的不同，另外本研究對(duì)缺血性腦卒中病因分型與不同危險(xiǎn)因素的關(guān)系進(jìn)行探討，繼而實(shí)現(xiàn)針對(duì)性的診斷、治療及預(yù)防。 方法：回顧性收集自2011年11月至2013年11月于吉林大學(xué)第一醫(yī)院神經(jīng)內(nèi)科住院的出血性腦卒中患者202例和缺血性腦卒中患者1143例，記錄其年齡和危險(xiǎn)因素，并且對(duì)缺血性腦卒中患者的死亡率、是否應(yīng)用溶栓治療、出入院時(shí)NIHSS評(píng)分進(jìn)行記錄，分析其性別差異。另外參考急性卒中治療低分子肝素試驗(yàn)（TOAST）分型方法將缺血性腦卒中患者分組，分析其性別差異及相關(guān)危險(xiǎn)因素對(duì)其發(fā)病風(fēng)險(xiǎn)的影響。 結(jié)果：在腦卒中患者中，女性平均年齡大于男性，另外女性發(fā)病高峰年齡較男性大。在所有腦卒中患者中，缺血性腦血管病患者平均年齡大于出血性腦血管病，且差異有統(tǒng)計(jì)學(xué)意義。在常見的危險(xiǎn)因素中，高血壓和糖尿病的女性患者中所占比例高于男性，而吸煙史、飲酒史、高同型半胱氨酸、高尿酸病史在男性中所占比例則明顯高于女性。相對(duì)于腦出血，與腦梗死顯著相關(guān)的危險(xiǎn)因素依次為高同型半胱氨酸血癥、房顫、糖尿病、吸煙史、高脂血癥，而相對(duì)于腦梗死，高血壓和年齡對(duì)腦出血的影響更大。 在出血性腦血管病患者中，平均發(fā)病年齡、高峰年齡、死亡率不存在性別差異。在常見危險(xiǎn)因素中，吸煙史和飲酒史在男性中所占比例明顯高于女性，其他危險(xiǎn)因素對(duì)出血性腦血管病的影響不存在性別差異。 在缺血性腦血管患者中，女性平均發(fā)病年齡及高峰年齡大于男性。在常見危險(xiǎn)因素中，高血壓和糖尿病病史在女性中所占比例高于男性，而吸煙史、飲酒史、高同型半胱氨酸、高尿酸血癥在男性重的比例高于女性。在嚴(yán)重程度、病死率、和溶栓治療方面不存在性別差異。對(duì)缺血性腦卒中進(jìn)行TOAST分型后，LAA（大動(dòng)脈粥樣硬化卒中）組中男性比例高于女性，CE（心源性栓塞）和SAO（小動(dòng)脈粥樣硬化卒中）卒中，，女性比例高于男性，差異有統(tǒng)計(jì)學(xué)意義。而在SOE（其他原因所致卒中）和SUE（不明原因所致卒中）組中，男女比例無(wú)差異。房顫對(duì)CE的發(fā)生有顯著作用，吸煙史對(duì)LAA的發(fā)生作用顯著。 結(jié)論：（1）腦卒中在危險(xiǎn)因素和平均發(fā)病年齡方面存在性別差異。（2）無(wú)論缺血性腦卒中還是出血性腦卒中，不同危險(xiǎn)因素對(duì)其發(fā)生所起的作用存在差異。（3）不同缺血性腦卒中亞型的發(fā)生與不同危險(xiǎn)因素之間的相關(guān)性存在差異。因此，在腦卒中的危險(xiǎn)因素研究和防治工作中，應(yīng)該考慮不同性別患者的危險(xiǎn)因素的不同以及不同危險(xiǎn)因素對(duì)卒中亞型的影響，做到有的放矢，這樣對(duì)于降低腦卒中的發(fā)病率、病死率和致殘率才具有重要的參考價(jià)值和指導(dǎo)意義。
[Abstract]:Objective: stroke is one of the common diseases which are harmful to human life and health. The incidence and incidence of stroke are constantly high, and there is a rising trend. It is particularly important to prevent and treat the different causes and risk factors of stroke. The incidence, prevalence, risk factors, risk factors, Central Asian type, clinical manifestation, treatment and prognosis are gradually paid attention to. The purpose of this study is to observe the age, common risk factors, type of stroke, and the deficiency of more than 1000 acute stroke patients. The etiology of hemorrhagic stroke is different, and the severity of the disease is different. In addition, the relationship between the etiological classification of ischemic stroke and the different risk factors is discussed in this study, and then the targeted diagnosis, treatment and prevention are achieved.
Methods: 202 patients with hemorrhagic stroke and 1143 patients with ischemic stroke were collected from November 2011 to November 2013 in the Department of Neurology of No.1 Hospital of Jilin University. The age and risk factors were recorded, and the mortality of ischemic stroke patients was treated with thrombolytic therapy, and the NIHSS score was carried out at the time of admission. The gender differences were recorded. In addition, the effects of gender differences and related risk factors on the risk of ischemic stroke were analyzed with the acute stroke treatment of low molecular weight heparin test (TOAST).
Results: in stroke patients, the average age of women is greater than that of men, and the peak age of women is larger than that of men. In all stroke patients, the average age of ischemic cerebrovascular disease is greater than hemorrhagic cerebrovascular disease, and the difference is statistically significant. Among the common risk factors, women with hypertension and diabetes are among the common risk factors. The proportion of smoking history, drinking history, high homocysteine, high uric acid history was significantly higher in men than in women. Compared with cerebral hemorrhage, the risk factors associated with cerebral infarction were hyperhomocysteinemia, atrial fibrillation, diabetes, smoking history, hyperlipidemia, and relative to cerebral infarction, hypertension, and high blood pressure. Age has a greater impact on cerebral hemorrhage.
Among the patients with hemorrhagic cerebrovascular disease, the average age of onset, the peak age and the death rate did not exist in gender differences. Among the common risk factors, the history of smoking and the history of alcohol consumption were significantly higher in men than in women, and the influence of other risk factors on hemorrhagic cerebrovascular disease did not exist in gender differences.
Among the patients with ischemic cerebrovascular disease, the average age and peak age of women were greater than men. Among the common risk factors, the history of hypertension and diabetes was higher in women than in men, while smoking history, drinking history, high homocysteine, hyperuricemia were higher in males than in women. There was no gender difference in the treatment of thrombus. After the TOAST typing of ischemic stroke, the male proportion in the LAA (large atherosclerotic stroke) group was higher than that of the female, CE (cardiogenic embolism) and SAO (small atherosclerotic stroke) stroke, the female ratio was higher than that of the male, and the difference was statistically significant. In SOE (other causes of stroke) and SUE (no) There was no difference in the ratio of male to female in the stroke group. There was a significant effect of atrial fibrillation on the occurrence of CE. Smoking history had a significant effect on the occurrence of LAA.
Conclusions: (1) there is a gender difference between the risk factors and the average age of onset of cerebral apoplexy. (2) there are differences in the role of different risk factors in both ischemic stroke and hemorrhagic stroke. (3) there is a difference in the correlation between the occurrence of different ischemic stroke subtypes and the different risk factors. Therefore, in the brain In the study and prevention of the risk factors of stroke, we should consider the different risk factors of the different sex patients and the influence of different risk factors on the stroke Central Asian type, so as to make a definite target in order to reduce the incidence of stroke, the mortality rate and the rate of disability.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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