本文選題：短暫性腦缺血發(fā)作 + 高分辨磁共振��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過高分辨磁共振(High resolution magnetic resonance imaging HRMRI)檢查分析頸動脈系統(tǒng)短暫性腦缺血發(fā)作(Transient ischemic attack TIA)患者的頸部血管不穩(wěn)定斑塊的特性,并研究這些斑塊特性與頸動脈系統(tǒng)的TIA患者入院后短暫性神經(jīng)功能缺失的發(fā)作次數(shù)、每次發(fā)作持續(xù)時間的相關(guān)性,對TIA患者臨床治療起指導(dǎo)作用。方法:1收集2015年1月份-2016年12月份,所有入住唐山工人醫(yī)院神經(jīng)內(nèi)科并確診為頸動脈系統(tǒng)的TIA患者,入院后常規(guī)對這些患者行頭頸MRA,頸動脈超聲,經(jīng)顱多普勒超聲(Transcranial doppler,TCD)等相關(guān)檢查,同時收集患者的一般臨床資料,篩選出有不穩(wěn)定斑塊或頸動脈狹窄的頸動脈系統(tǒng)的TIA患者,且TIA癥狀與頸動脈狹窄位置相關(guān),然后對患者行HRMRI檢查,并且篩選出因不穩(wěn)定斑塊引起的動脈狹窄患者,最終134例患者入組。2對入組患者均給予硫酸氫氯吡格雷片75mg口服1/早聯(lián)合拜阿司匹林腸溶片100mg口服1/晚,阿托伐他汀鈣片20mg口服1/晚等藥物治療。通過影像學(xué)結(jié)果研究不穩(wěn)定斑塊的特性-薄或破裂纖維冒(纖維冒厚度0.7mm)、大脂質(zhì)核心(斑塊體積的40%)、鈣化、斑塊內(nèi)出血(intraplaque hemorrhage,IPH)等,同時分析斑塊特性和頸動脈系統(tǒng)的TIA患者住院7天內(nèi)的神經(jīng)功能缺失的發(fā)作次數(shù)、每次發(fā)作持續(xù)時間的關(guān)系等的臨床特征的相關(guān)性。3采用SPSS17.0統(tǒng)計軟件進(jìn)行臨床實驗數(shù)據(jù)的錄入并進(jìn)行統(tǒng)計學(xué)分析。根據(jù)TIA發(fā)作次數(shù),每次發(fā)作的持續(xù)時間分組,不穩(wěn)定斑塊的每一特性分別在發(fā)作次數(shù)組內(nèi)以及發(fā)作持續(xù)時間組內(nèi)進(jìn)行單因素分析的χ2檢驗,當(dāng)P0.05時,有統(tǒng)計學(xué)意義,對有統(tǒng)計學(xué)意義的不穩(wěn)定斑塊的特性納入有序Logistic回歸方程,分析不穩(wěn)定斑塊的特征與頸動脈系統(tǒng)的TIA患者臨床特征的相關(guān)性,進(jìn)行統(tǒng)計學(xué)分析,當(dāng)P0.05時說明有統(tǒng)計學(xué)意義,OR1時,說明是TIA患者神經(jīng)功能缺失嚴(yán)重程度的保護(hù)因素,當(dāng)OR1時,則是危險因素。結(jié)果:1研究期間對收集到符合條件的134例的頸動脈系統(tǒng)的TIA患者的資料進(jìn)行統(tǒng)計分析。按照臨床神經(jīng)功能缺失次數(shù),每次發(fā)作持續(xù)時間進(jìn)行分組。研究期間臨床神經(jīng)功能缺失發(fā)作次數(shù)≤1次、2-3次、3次的病人數(shù)分別是55例、42例、37例,按照每次發(fā)作持續(xù)時間進(jìn)行分組,依次是發(fā)作持續(xù)時間≤10min組、10-30min組、30min組,每組人數(shù)分別是45、52、37。2對患者的一般基線資料在每組間進(jìn)行單因素分析的χ2檢驗,P值均大于0.05,無統(tǒng)計學(xué)意義,則患者的一般基線資料對TIA患者的神經(jīng)功能發(fā)作次數(shù)以及每次發(fā)作的持續(xù)時間無影響。3記錄住院7天內(nèi)發(fā)作次數(shù)≤1次組中,薄或破裂纖維冒、大脂質(zhì)核心、鈣化、斑塊內(nèi)出血分別是10、13、30、9例,發(fā)作次數(shù)為2-3次組中分別有9、22、23、11例,發(fā)作次數(shù)3次組中有20、17、19、15例,以每次發(fā)作的持續(xù)時間進(jìn)行分組,分別是發(fā)作持續(xù)時間≤10min組(45例),發(fā)作持續(xù)時間10-30min組(52例)以及有37例發(fā)作時間持續(xù)時長30min的患者為第三組。斑塊在HRMRI檢查結(jié)果顯示有薄或破裂纖維冒、脂質(zhì)核心、鈣化、斑塊內(nèi)出血的患者中,每次發(fā)作癥狀持續(xù)時間≤10min有17、11、21、15例,發(fā)作癥狀持續(xù)時間10-30min組中,患者依次有20、24、27、10例,發(fā)作癥狀持續(xù)時間30min組中分別有23、27、20、17例。4分別對患者的計數(shù)及計量臨床基線資料進(jìn)行秩和檢驗或單因素的χ2檢驗,P值均大于0.05,無統(tǒng)計學(xué)意義,則患者的一般臨床資料對TIA患者的神經(jīng)功能發(fā)作次數(shù)以及每次發(fā)作的持續(xù)時間無影響。5 TIA患者臨床特性影響因素分析:將單因素分析有意義的是否有薄或破裂纖維冒(無=0,有=1),是否有大脂質(zhì)斑塊(無=0,有=1),是否合并內(nèi)出血(無=0,有=1)作為自變量,分別將發(fā)作的持續(xù)時間(≤10min=1,10-30min=2,30min=3)、發(fā)作次數(shù)(≤1次=1,2-3次=2,3次=3)為因變量進(jìn)行有序Logistic回歸分析。6結(jié)果患者的脂質(zhì)核心、斑塊內(nèi)出血、薄或破裂纖維冒進(jìn)入回歸方程,說明不穩(wěn)定斑塊的這三個因素是影響TIA患者發(fā)作次數(shù)、每次發(fā)作的持續(xù)時間的因素,且OR1,說明脂質(zhì)核心、斑塊內(nèi)出血、薄或破裂纖維冒是TIA患者臨床特征的危險因素,使臨床發(fā)作次數(shù)增加,每次發(fā)作的持續(xù)時間延長,斑塊鈣化對臨床發(fā)作次數(shù)及每次發(fā)作的持續(xù)時間無明顯相關(guān)性。結(jié)論:1通過HRMRI檢查提示,不穩(wěn)定斑塊的薄或破裂纖維冒,大脂質(zhì)核心,斑塊內(nèi)出血影響TIA患者的每次發(fā)作的持續(xù)時間長短及發(fā)作次數(shù)的多少,使患者每次發(fā)作的持續(xù)時間、發(fā)作次數(shù)比無相關(guān)因素的發(fā)作次數(shù)增多、每次發(fā)作的持續(xù)時間長。2斑塊鈣化對TIA患者的神經(jīng)功能缺失發(fā)作的次數(shù),每次發(fā)作的持續(xù)時間無明顯相關(guān)性,沒有使短暫性腦缺血發(fā)作患者每次發(fā)作的時間延長及次數(shù)增多。3斑塊的不穩(wěn)定性因素有很多,通過本次研究得出,并不是所有的不穩(wěn)定因素與短暫性腦缺血發(fā)作臨床特征有一定的相關(guān)性,所以在臨床工作中通過了解斑塊特性,并做出針對性治療,對疾病的治療及預(yù)防有著深遠(yuǎn)的意義。
[Abstract]:Objective: to examine the characteristics of cervical vascular instability in patients with transient ischemic attack (Transient ischemic attack TIA) of the carotid system (Transient ischemic attack TIA) by High resolution magnetic resonance imaging HRMRI and to study the characteristics of these plaque and the transient neurological deficit after admission to the carotid system. The frequency of loss of attack and the correlation of duration of each episode will guide the clinical treatment of TIA patients. Methods: 1 to collect all TIA patients who had been admitted to the Department of Neurology of Tangshan workers' hospital and diagnosed as carotid artery system in December January -2016 2015. After admission, the patients were routinely treated with the head neck MRA, carotid ultrasound, and transcranial Doppler. Transcranial Doppler (TCD) and other related examinations, and the general clinical data of the patients were collected, and TIA patients with unstable plaque or carotid artery stenosis were screened, and the TIA symptoms were associated with the position of carotid stenosis, then the patients were examined by HRMRI, and the patients with arterial stenosis caused by unstable plaques were screened. In the final 134 patients, 134 patients were treated with Clopidogrel Bisulfate Tablets 75mg oral 1/ early combined with Aspirin Enteric-coated Tablets 100mg oral 1/ evening, Atorvastatin Calcium Tablets 20mg oral 1/ late and other drugs. The characteristics of unstable plaques were studied by imaging results - thin or ruptured fiber (fiber riser thickness 0.7mm), large lipid core (40% of plaque volume), calcification, intraplaque hemorrhage (IPH) and so on. At the same time, the clinical characteristics of the clinical characteristics of the plaque characteristics and the clinical characteristics of TIA patients in the carotid system in the 7 days of hospitalization, the relationship of the duration of each seizure, and other clinical features, were performed by the SPSS17.0 statistical software for clinical data. According to the number of TIA episodes and the duration of the episodes, each characteristic of the unstable plaque was tested by the chi 2 test within the episodes and the duration of the attack, respectively. When P0.05, the statistical significance was statistically significant, and the characteristics of the statistically significant unstable plaques were brought into order. The Logistic regression equation analyzed the correlation between the characteristics of unstable plaques and the clinical features of TIA patients in the carotid artery system. Statistical analysis was made. When P0.05 was statistically significant, OR1 was a protective factor for the severity of neurological dysfunction in TIA patients. When OR1, it was a risk factor. Results: During the 1 study, the data were collected. The data of the TIA patients in the carotid artery system of the 134 cases were analyzed. The number of neurological deficits and duration of each episode were grouped. The number of clinical neural dysfunction episodes was less than 1 times, 2-3 times, and 3 times in 55 cases, 42 cases, 37 cases, respectively, according to the duration of each attack. The sequence was the duration of the onset duration less than 10min, group 10-30min, and group 30min. The number of people in each group was the chi 2 test of the general baseline data of the 45,52,37.2 for the patients in each group. The P values were all greater than 0.05, and there was no statistical significance. The general baseline data of the patients had the frequency of neural function seizures in the patients with TIA and the holding of each attack. In the 7 days of hospitalization, the duration of the.3 record was less than 1 times in the group, with thin or ruptured fibers, large lipid core, calcification, and hemorrhage in the plaque were 10,13,30,9 cases, and the number of episodes was 2-3 times in the group of 9,22,23,11, and the number of episodes in the 3 times group had 20,17,19,15 cases, which were divided into groups with each attack duration, respectively. Duration less than 10min (45 cases), paroxysmal duration 10-30min (52 cases) and 37 patients with long 30min duration in third. Plaque on HRMRI examination showed thin or ruptured fibrous, lipid core, calcification, and plaque bleeding in patients with each episode of symptomatic duration less than 10min there were 17,11,21,15 cases, paroxysmal symptoms In group 10-30min, there were 20,24,27,10 cases in sequence, and the duration of episodes of symptom duration in group 30min had 23,27,20,17 cases.4 respectively on the number of patients and the clinical baseline data of the patients and the single factor chi 2 test, the P values were all greater than 0.05, and the general clinical data of the patients were to the God of TIA patients. The frequency of functional seizures and duration of each attack did not affect the factors affecting the clinical characteristics of.5 TIA patients: whether a single factor analysis was meaningful for a thin or ruptured fiber (without =0, =1), whether there was a large lipid plaque (no =0, =1), or whether the internal bleeding (no =0, =1) was used as an independent variable, and the duration of the attack was respectively. Less than 10min=1,10-30min=2,30min=3), the number of episodes (less than 1 times =1,2-3 =2,3 =3) was the lipid core of the patients with.6 results based on the ordered Logistic regression analysis. The bleeding, thin or ruptured fibers entered the regression equation, indicating that the three factors of the unstable plaque were the duration of the attack of the TIA patients and the duration of each attack. The factors, and OR1, indicate that the lipid core, bleeding in the plaque, thin or ruptured fiber are risk factors for the clinical characteristics of TIA patients, which makes the number of clinical episodes increase, the duration of each episode prolonged, plaque calcification has no significant correlation to the frequency of clinical seizures and the duration of each attack. Conclusion: 1 by HRMRI examination, the instability is unstable. The thin or ruptured fibrous plaque of the plaque, the large lipid core, the bleeding in the plaque affects the duration of each episode of TIA and the number of episodes, which makes the duration of each attack, the number of episodes more than the number of episodes without related factors, and the nerve function of the TIA patients with.2 patch calcification at the duration of each seizure. There was no significant correlation between the number of missing attacks and the duration of each attack. There were many factors that did not prolong and increase the number of.3 plaques in patients with transient ischemic attacks. This study showed that not all the unstable factors have certain clinical features with transient ischemic attacks. Therefore, in clinical work, it is of great significance to understand the characteristics of plaques and make targeted treatment for the treatment and prevention of diseases.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.31

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