發(fā)布時間：2018-06-02 09:16

  本文選題：缺血性腦血管病 + 腦微出血�。� 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究背景:隨著SWI的廣泛應(yīng)用,臨床發(fā)現(xiàn)了越來越多的腦微出血(cerebral microbleeds,CMBs)。典型的CMBs是指在SWI上顯示的直徑在2-5mm,最大不超過10mm的圓形或類圓形低信號病灶,病灶邊緣清楚,周圍無水腫。目前發(fā)現(xiàn)CMBs與腦出血密切相關(guān),可以預(yù)測腦卒中的復(fù)發(fā),還可引起認(rèn)知功能障礙、步態(tài)障礙、抑郁情緒等中樞神經(jīng)功能障礙。CMBs的發(fā)生與很多因素相關(guān),其中最重要的可逆性危險因素是高血壓。血壓水平越高,CMBs發(fā)生率越高。血壓變異性(bloodpressure variability,BPV)是近年來研究較多的血管危險因素,與高血壓靶器官損害密切相關(guān)。目前BPV與腦卒中研究較多,而與CMBs的相關(guān)性研究較少。研究目的:探討合并CMBs的缺血性腦血管病患者的動態(tài)血壓特征。研究方法:收集2015年7月至2016年11月至齊魯醫(yī)院神經(jīng)內(nèi)科的住院的缺血性腦血管患者122人,其中微出血組72例,非微出血組50例。本研究亞組分析中按CMBs部位分為深部、幕下及腦葉三個區(qū)域,按照CMBs數(shù)量分為無、輕度、中度、重度四組。詳細(xì)記錄患者入院時的年齡、性別、吸煙、飲酒、高血壓史、糖尿病史、既往腦血管病史、冠心病病史;入院后24h內(nèi)測定相關(guān)生化指標(biāo)(總膽固醇、甘油三酯、低密度脂蛋白、載脂蛋白B、同型半胱氨酸、肌酐和尿素氮),完善患者的頭顱磁共振成像(MRI)及磁敏感加權(quán)成像(SWI)、心電圖、超聲心動圖、頸部血管彩超檢查等檢查。患者完成24h動態(tài)血壓監(jiān)測,包括24h平均收縮壓(24hSBP)、24h平均舒張壓(24hDBP)、日間平均收縮壓(DSBP)、夜間平均收縮壓(NSBP)、日間平均舒張壓(DDBP)、夜間平均舒張壓(NDBP);血壓變異性(BPV)包括日間收縮壓標(biāo)準(zhǔn)差(DSBP-SD)和日間舒張壓標(biāo)準(zhǔn)差(DDBP-SD)、夜間收縮壓標(biāo)準(zhǔn)差(NSBP-SD)、夜間舒張壓標(biāo)準(zhǔn)差(NDBP-SD)、日間收縮壓變異系數(shù)(DSBP-CV)、日間舒張壓變異系數(shù)(DDBP-CV)、夜間收縮壓變異系數(shù)(NSBP-CV)、夜間舒張壓變異系數(shù)(NDBP-CV)、夜間收縮壓下降率。應(yīng)用統(tǒng)計分析方法CMBs組患者與無CMBs組患者的相關(guān)危險因素分析及動態(tài)血壓特征。結(jié)果:1.一般資料比較CMBs組與無CMBs組進(jìn)行比較,糖尿病病史、飲酒史、總膽固醇、低密度脂蛋白無顯著差異。CMBs組的同型半胱氨酸、高血壓病史、吸煙史顯著高于無CMBs 組(P0.05)。2.動態(tài)血壓參數(shù)比較CMBs 組 24hSBP、24hDBP、DSBP、DDBP、NSBP、NDBP 高于非 CMBs組,差異有統(tǒng)計學(xué)意義(P0.05)。在單因素分析中,24hABPM所得到的短時BPV相關(guān)指標(biāo)中,CMBs組的24hDBP-CV、DDBP-CV 比非 CMBs 組高,ΔSBP、ΔDBP 比非 CMBs 組低,差異有統(tǒng)計學(xué)意義。經(jīng)多因素Logistic回歸分析調(diào)整,僅有ΔDBP與CMBs相關(guān)性有統(tǒng)計學(xué)意義(P0.05)。3.不同數(shù)量的腦微出血與動態(tài)血壓的比較根據(jù)CMBs的數(shù)量分為4組,分別為非CMBs組、輕度CMBs組、中度CMBs組、重度 CMBs 組。結(jié)果顯示 24hSBP、24hDBP、DSBP、DDBP、NSBP、NDBP隨CMBs的增加而增大,差異有統(tǒng)計學(xué)意義。中度CMBs組、重度CMBs組的ΔSBP值比非CMBs組低,差異有統(tǒng)計學(xué)意義;輕度CMBs組、中度CMBs組、重度CMBs組的ΔDBP比非CMBs組低,差異有統(tǒng)計學(xué)意義。4.不同部位的腦微出血與血壓變異性的比較按照CMBs在顱內(nèi)的分布區(qū)域不同,將CMBs分為腦葉、深部、幕下、混合四亞組。統(tǒng)計學(xué)結(jié)果顯示24h DBP-CV、DDBP-CV、ΔDBP與腦葉CMBs、深部CMBs、幕下CMBs及混合CMBs均相關(guān),而24h SBP-CV、DSBP-CV、ΔSBP僅和深部CMBs相關(guān),差異有統(tǒng)計學(xué)意義。將BPV相關(guān)單因素分析有意義的指標(biāo)與CMBs亞組引入Logistic回歸分析模型統(tǒng)計,數(shù)據(jù)表明DDBP-CV、ΔDBP是深部CMBs的獨(dú)立危險因素,差異有統(tǒng)計學(xué)意義;ΔDBP是幕下及混合CMBs的獨(dú)立危險因素,差異有統(tǒng)計學(xué)意義;腦葉CMBs的發(fā)生與24h DBP-CV、DDBP-CV、ΔDBP進(jìn)行比較,差異無統(tǒng)計學(xué)意義。結(jié)論:當(dāng)患者有長期高血壓病史并控制不佳、長期吸煙史及高同型半胱氨酸血癥時,需高度警惕腦微出血可能,及時行顱腦磁敏感加權(quán)序列掃描確診。血壓變異性是CMBs的重要影響因素,其中24hDBP-CV、DDBP-CV、ΔDBP是腦深部CMBs的獨(dú)立危險因素,DDBP-CV、ΔDBP是幕下CMBs的獨(dú)立危險因素。對CMBs患者不僅需要關(guān)注血壓水平,還需行ABPM檢查評價血壓晝夜波動情況。
[Abstract]:Background: with the extensive use of SWI, more and more cerebral microbleeds (cerebral microbleeds, CMBs) are found. The typical CMBs refers to the circular or circular low signal lesion of 2-5mm, the largest not more than 10mm on SWI, with a clear edge of the lesion and no edema in the circumference. Predicting the recurrence of cerebral apoplexy can also cause cognitive dysfunction, gait disorder, depression and other central nervous dysfunction.CMBs related to many factors. The most important reversible risk factor is hypertension. The higher the level of blood pressure, the higher the incidence of CMBs. Bloodpressure variability (BPV) is the study of recent years. More vascular risk factors are closely related to the damage to target organs of hypertension. At present, there are many studies on BPV and cerebral apoplexy, but there are few studies on the correlation with CMBs. Objective: To investigate the dynamic blood pressure characteristics of patients with ischemic cerebrovascular disease with CMBs. Methods: to collect the hospitalization from July 2015 to November 2016 to the Department of Neurology in Qilu Hospital There were 122 patients with ischemic cerebrovascular disease, including 72 cases of micro bleeding group and 50 cases of non micro bleeding group. In this study, the subgroup analysis was divided into deep, subtentorium and three regions of the brain, divided into no, mild, moderate, and severe four groups according to the number of CMBs, and recorded the age, sex, smoking, drinking, hypertension, and diabetes history of the patients at admission. History of cerebrovascular disease, history of coronary heart disease; Determination of related biochemical indexes in 24h after admission (total cholesterol, triglycerides, low density lipoprotein, apolipoprotein B, homocysteine, creatinine and urea nitrogen), and improving the patient's cranial magnetic resonance imaging (MRI) and magnetic susceptibility weighted imaging (SWI), electrocardiogram, echocardiography, cervical vascular color Doppler examination, etc. Examination. Patients completed 24h ambulatory blood pressure monitoring, including 24h mean systolic pressure (24hSBP), mean 24h diastolic pressure (24hDBP), mean daytime systolic pressure (DSBP), mean night systolic pressure (NSBP), mean daytime diastolic pressure (DDBP), mean night diastolic pressure (NDBP), and blood pressure variability (BPV) including standard difference of daytime systolic pressure (DSBP-SD) and diastolic diastolic pressure (DBP) standard difference (DDBP-SD), night systolic pressure standard deviation (NSBP-SD), nighttime diastolic pressure standard deviation (NDBP-SD), daytime systolic pressure variation coefficient (DSBP-CV), diastolic pressure variation coefficient (DDBP-CV), night systolic pressure variation coefficient (NSBP-CV), night diastolic pressure variation coefficient (NDBP-CV), and night systolic pressure drop rate. Statistical analysis method for CMBs group patients and no CMBs Analysis of related risk factors and dynamic blood pressure characteristics of group patients. Results 1. general data compared with group CMBs and no CMBs group, the history of diabetes, drinking history, total cholesterol, low density lipoprotein had no significant difference in.CMBs group of homocysteine, hypertension history, smoking history was significantly higher than that of non CMBs group (P0.05).2. dynamic blood pressure parameter ratio Compared with group CMBs, 24hSBP, 24hDBP, DSBP, DDBP, NSBP, NDBP were higher than non CMBs groups, and the difference was statistically significant (P0.05). In the single factor analysis, the CMBs group was higher than that of non CMBs group, and the difference was statistically significant. The correlation between only Delta DBP and CMBs was statistically significant (P0.05). The comparison of the number of cerebral microbleeds and dynamic blood pressure in different numbers of.3. was divided into 4 groups according to the number of CMBs, which were non CMBs, mild CMBs, moderate CMBs, and severe CMBs. The results showed 24hSBP, 24hDBP, DSBP, and the difference was statistically significant. The value of delta SBP in the moderate CMBs group and the severe CMBs group was lower than that in the non CMBs group, and the difference was statistically significant. The delta DBP in the mild CMBs group, the moderate CMBs group and the severe CMBs group was lower than the non CMBs group. The difference was statistically significant in the difference between the brain microbleeding and the blood pressure variability in the.4. different parts of the.4., and the CMBs was divided into the lobes, and the CMBs was divided into the lobes, and the depth was divided into the lobes of the brain. The statistical results showed that 24h DBP-CV, DDBP-CV, and delta DBP were related to CMBs, CMBs, CMBs and mixed CMBs in the deep part of the brain, and 24h SBP-CV, DSBP-CV, and delta SBP only correlated with the depth. The data showed that DDBP-CV, Delta DBP was an independent risk factor of deep CMBs, and the difference was statistically significant; Delta DBP was an independent risk factor for the sub episodes and mixed CMBs, and the difference was statistically significant. The difference between CMBs and 24h DBP-CV, DDBP-CV, and delta DBP was not statistically significant. In the history of long-term smoking and hyperhomocysteinemia, it is necessary to be highly alert for the possibility of cerebral microhemorrhage and be diagnosed with brain magnetic sensitivity weighted sequence scan in time. Blood pressure variability is an important factor in CMBs, of which 24hDBP-CV, DDBP-CV, and delta DBP are independent risk factors of CMBs in the deep brain, DDBP-CV, and delta DBP is an independent risk factor for sub episodes CMBs. MBs patients not only need to pay attention to blood pressure level, but also need ABPM examination to evaluate the circadian fluctuation of blood pressure.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

【相似文獻(xiàn)】

中國期刊全文數(shù)據(jù)庫 前10條

1 林家弟,王連春,劉斌,張_";成都地區(qū)正常成人24小時動態(tài)血壓特征[J];四川醫(yī)學(xué);2000年08期

2 方健強(qiáng) ,劉波 ,黃寧生;老年高血壓合并腦卒中的動態(tài)血壓觀察[J];廣西醫(yī)學(xué);2003年12期

3 胡立;老年收縮期高血壓患者的動態(tài)血壓與隨訪門診血壓的關(guān)系[J];天津醫(yī)藥;2004年05期

4 齊連芬;方業(yè)明;劉曉潔;李川潔;;70歲以上老年人24小時動態(tài)血壓分析[J];實(shí)用心電學(xué)雜志;2006年05期

5 楊曉春;吳成平;;超重引起青少年動態(tài)血壓升高的研究[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2008年36期

6 易祥武;幸志強(qiáng);丁春平;劉芳;王芳;許鵬;;大夜班對護(hù)士24h動態(tài)血壓的影響[J];江西醫(yī)藥;2008年01期

7 姜馨;田文華;;動態(tài)血壓臨床應(yīng)用的研究現(xiàn)狀[J];中國循證心血管醫(yī)學(xué)雜志;2009年02期

8 趙子錦;高玉玲;;動態(tài)血壓記錄的研究進(jìn)展[J];內(nèi)蒙古醫(yī)學(xué)雜志;1993年02期

9 楊開泰;動態(tài)血壓分析系統(tǒng)的組裝配置應(yīng)用研究[J];云南大學(xué)學(xué)報(自然科學(xué)版);1997年S3期

10 余紀(jì)倫,王勇堅;偶側(cè)血壓增高52例動態(tài)血壓分析[J];浙江中西醫(yī)結(jié)合雜志;1997年04期

中國重要會議論文全文數(shù)據(jù)庫 前10條

1 王潤生;陳青山;王新平;姚樹玉;王建洲;呂沛霖;;前部缺血性視神經(jīng)病變患者動態(tài)血壓、心率分析[A];加入WTO和中國科技與可持續(xù)發(fā)展——挑戰(zhàn)與機(jī)遇、責(zé)任和對策（下冊）[C];2002年

2 閆志暉;付越榕;趙子彥;;5～20歲兒童及青少年的動態(tài)血壓變化趨勢觀察[A];2011年全國時間生物醫(yī)學(xué)學(xué)術(shù)會議論文集[C];2011年

3 周燕斌;謝燦茂;嚴(yán)英碩;高修仁;;阻塞性睡眠呼吸暫停綜合征患者動態(tài)血壓變化的研究[A];中國睡眠研究會第二屆學(xué)術(shù)年會論著匯編[C];2001年

4 朱曉軍;包麗芳;;老年人動態(tài)血壓晝夜模式及健康指導(dǎo)[A];全國內(nèi)科護(hù)理學(xué)術(shù)交流暨專題講座會議論文匯編[C];2003年

5 魏芳;路方紅;趙子彥;李玉陽;;動態(tài)血壓余弦法生物節(jié)律分析的臨床應(yīng)用研究[A];全國時間生物醫(yī)學(xué)學(xué)術(shù)座談會論文匯編[C];2001年

6 伊?xí)詵|;浦小平;;超聲心動圖與動態(tài)血壓對高血壓不同左室構(gòu)型的對比研究[A];第九屆全國超聲醫(yī)學(xué)學(xué)術(shù)會議論文匯編[C];2006年

7 閆志暉;趙子彥;趙生法;;活動監(jiān)測記錄輔助分析動態(tài)血壓的初步探索[A];2006全國時間生物醫(yī)學(xué)學(xué)術(shù)會議論文集[C];2006年

8 侯軍華;蘭蘭;趙素平;;阻塞性睡眠呼吸暫停綜合征的動態(tài)血壓波動特征及護(hù)理[A];全國五官科護(hù)理學(xué)術(shù)交流暨專題講座會議論文匯編[C];2002年

9 崔春蘭;顧春東;;不同年齡高血壓患者動態(tài)血壓日夜差值的分析(附200例)[A];2006年浙江省內(nèi)科學(xué)學(xué)術(shù)年會、2006年浙江省老年醫(yī)學(xué)學(xué)術(shù)年會論文匯編[C];2006年

10 賀斌;汪國貴;鄧先林;李曉萍;車立蓉;楊蘭;常小蘇;朱海燕;蘭小瓊;呂惠;劉蕾;;高原紅細(xì)胞增多癥合并高血壓患者在平原地區(qū)24小時動態(tài)血壓分析[A];中華醫(yī)學(xué)會心血管病學(xué)分會第八次全國心血管病學(xué)術(shù)會議匯編[C];2006年

中國重要報紙全文數(shù)據(jù)庫 前3條

1 朱冰船;什么是24小時動態(tài)血壓[N];農(nóng)村醫(yī)藥報（漢）;2007年

2 閻軼潔;市第二人民醫(yī)院一科研成果達(dá)國際先進(jìn)水平[N];太原日報;2008年

3 記者劉云濤;傳統(tǒng)血壓測量概念受到挑戰(zhàn)[N];中國醫(yī)藥報;2005年

中國博士學(xué)位論文全文數(shù)據(jù)庫 前3條

1 趙曼麗;高血壓患者缺血性腦白質(zhì)病變與動態(tài)血壓及DTI的相關(guān)性研究[D];山東大學(xué);2015年

2 簡明;無創(chuàng)性24小時動態(tài)血壓[D];中國協(xié)和醫(yī)科大學(xué);1993年

3 臧小英;社區(qū)老年原發(fā)性高血壓患者動態(tài)血壓現(xiàn)況分析及連續(xù)護(hù)理干預(yù)研究[D];天津醫(yī)科大學(xué);2011年

中國碩士學(xué)位論文全文數(shù)據(jù)庫 前10條

1 王珊珊;2型糖尿病患者24小時動態(tài)血壓、骨保護(hù)素與頸動脈內(nèi)中膜厚度的相關(guān)性分析[D];河北醫(yī)科大學(xué);2015年

2 羅容容;高血壓患者動態(tài)血壓參數(shù)與BNP及左心室肥厚的相關(guān)性研究[D];昆明醫(yī)科大學(xué);2015年

3 尼羅帕;原發(fā)性高血壓患者左心室舒張功能與24h動態(tài)血壓參數(shù)的相關(guān)性[D];新疆醫(yī)科大學(xué);2015年

4 王劍蘭;原發(fā)性高血壓中醫(yī)辨證分型與24h動態(tài)血壓相關(guān)性的研究[D];遼寧中醫(yī)藥大學(xué);2015年

5 陳鈺;80歲以上老年高血壓合并良性前列腺增生患者動態(tài)血壓的特征[D];蘇州大學(xué);2016年

6 趙露;2型糖尿病合并高血壓住院患者動態(tài)血壓特點(diǎn)與靶器官損害的關(guān)系[D];重慶醫(yī)科大學(xué);2016年

7 梁家瑞;CKD患者動態(tài)血壓相關(guān)指標(biāo)變化特征分析[D];昆明醫(yī)科大學(xué);2016年

8 辛陽;一種指環(huán)型動態(tài)血壓測量方法研究及系統(tǒng)實(shí)現(xiàn)[D];西安電子科技大學(xué);2015年

9 郄新穩(wěn);腔隙性腦梗死合并腦微出血患者的24h動態(tài)血壓特征[D];河北醫(yī)科大學(xué);2016年

10 簡鹿豹;缺血性腦血管病患者腦微出血與動態(tài)血壓的相關(guān)性分析[D];山東大學(xué);2017年

，

本文編號：1968236