發(fā)布時間：2018-06-04 03:37

  本文選題：腦動脈粥樣硬化型狹窄 + 側(cè)支循環(huán)��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探討腦動脈粥樣硬化型狹窄(狹窄程度≥50%)患者腦血管病危險因素對側(cè)支循環(huán)開放的影響。[方法]本課題選擇2011年5月至2016年12月在昆明醫(yī)科大第五附屬醫(yī)院神經(jīng)內(nèi)科經(jīng)全腦血管造影檢查并診斷為單支顱內(nèi)動脈粥樣硬化性狹窄(狹窄程度≥50%)的急性腦梗死患者104例作為研究對象。根據(jù)腦動脈狹窄程度分為中度狹窄、重度狹窄和閉塞,探討腦動脈狹窄程度與側(cè)支循環(huán)開放的相關(guān)性。采用ASITN/SIR血流分級系統(tǒng)將患者分為側(cè)支循環(huán)開放不良組(血流0-2級)48例和側(cè)支循環(huán)開放良好組(血流3-4級)56例,收集兩組患者資料(年齡、性別、血管狹窄的程度、高血壓、糖尿病、血脂異常、高同型半胱氨酸、吸煙史及飲酒史等資料),探討腦血管病危險因素與側(cè)支循環(huán)開放(側(cè)支血流開放)的相關(guān)性。根據(jù)側(cè)支循環(huán)開放的等級對入組患者進(jìn)行分組,分為側(cè)支循環(huán)未開放組17例,一級側(cè)支循環(huán)開放組(一級組)38例,二級側(cè)支循環(huán)開放組(二級組)38例和三級側(cè)支循環(huán)開放組(三級組)11例,比較各組腦血管危險因素差異性,探討腦血管病危險因素與不同等級側(cè)支循環(huán)開放的相關(guān)性。[結(jié)果]1在不同狹窄程度分組中,側(cè)支循環(huán)開放良好組總秩次較不良組高,經(jīng)Spearman等級相關(guān)分析提示腦動脈粥樣硬化型狹窄程度與側(cè)支循環(huán)開放良好與否呈負(fù)相關(guān),狹窄程度越重,側(cè)支循環(huán)開放越好。2側(cè)支循環(huán)開放良好組與側(cè)支循環(huán)開放不良組比較,高血壓、吸煙史在兩組中存在差異,且差異具有統(tǒng)計學(xué)意義(P0.05)。年齡、性別、糖尿病、血脂異常、甘油三酯、高同型半胱氨酸血癥、總膽固醇、飲酒史、低密度脂蛋白、高密度脂蛋白在兩組中比較,差異無統(tǒng)計學(xué)意義(P0.05)。3以側(cè)支循環(huán)開放良好與否為應(yīng)變量,高血壓、吸煙史為自變量,運(yùn)用二分類Logistic回歸分析,提示吸煙史不是側(cè)支循環(huán)開放的影響因素,高血壓為側(cè)支循環(huán)開放的保護(hù)因素(OR值1),高血壓有利于側(cè)支循環(huán)開放。4腦動脈粥樣硬化型狹窄程度與側(cè)支循環(huán)開放的等級正相關(guān),狹窄程度越重,側(cè)支循環(huán)開放的等級越高。5比較側(cè)支循環(huán)未開放組、一級組、二級組、三級組患者一般資料情況,其中年齡、性別、高血壓、總膽固醇、飲酒史、甘油三酯、高同型半胱氨酸血癥、低密度脂蛋白、糖尿病、吸煙史、高密度脂蛋白在上述4組中比較差異不具有統(tǒng)計學(xué)意義(P0.05)。血脂異常在上述4組中比較時差異具有統(tǒng)計學(xué)意義(P0.05),提示血脂異常在上述4組中分布不完全相同。6血脂異常在上述4組中兩兩比較,側(cè)支循環(huán)開放一級組、二級組、三級組這3組間兩兩比較差異無統(tǒng)計學(xué)意義(P0.05),側(cè)支循環(huán)未開放組與一級組比較,差異亦無統(tǒng)計學(xué)意義(P0.05)。血脂異常的秩均值在側(cè)支循環(huán)未開放組高于二級組、未開放組高于三級組,差異有統(tǒng)計學(xué)意義(P0.05)。7血脂異常與二級側(cè)支循環(huán)開放呈負(fù)相關(guān),且具有統(tǒng)計學(xué)意義(P0.05),血脂異常不利于二級側(cè)支循環(huán)開放。本研究尚未顯示血脂異常對三級側(cè)支循環(huán)開放的影響(P0.05)。8總膽固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白這四種指標(biāo)分別對不同等級側(cè)支循環(huán)開放無明顯影響(P0.05),而側(cè)支循環(huán)開放受到血脂異常指標(biāo)的影響。[結(jié)論]1本研究提示腦動脈粥樣硬化型狹窄患者腦動脈狹窄程度越重,側(cè)支循環(huán)開放可能越好,側(cè)支循環(huán)開放的等級可能越高。2高血壓可能有利于腦動脈粥樣硬化型狹窄患者側(cè)支循環(huán)開放。3高密度脂蛋白、低密度脂蛋白、總膽固醇、甘油三酯這四種指標(biāo)發(fā)生異常,可能會協(xié)同加重血管損傷,不利于側(cè)支循環(huán)開放。4本研究采用ASITN/SIR血流分級系統(tǒng)和三級側(cè)支循環(huán)開放兩種分級分組方法評估側(cè)支循環(huán),但各種腦血管病危險因素對側(cè)支循環(huán)開放影響的結(jié)果不同。腦血管病危險因素對側(cè)支循環(huán)開放影響的研究結(jié)果可能會受側(cè)支循環(huán)開放不同分級分組方法的影響。5腦血管病危險因素對腦動脈粥樣硬化型狹窄患者側(cè)支循環(huán)的作用靶點(diǎn)可能不同。當(dāng)以側(cè)支循環(huán)開放的等級為分組對象時,血脂異常不利于二級側(cè)支循環(huán)的開放,而本研究未顯示血脂異常對側(cè)支循環(huán)未開放組、一級及三級側(cè)支循環(huán)開放的影響,可能是各級側(cè)支循環(huán)開放的病理生理機(jī)制不同,導(dǎo)致腦血管病危險因素對不同等級側(cè)支循環(huán)開放的影響存在差異。
[Abstract]:[Objective] to investigate the effect of cerebrovascular disease risk factors on collateral circulation opening in patients with cerebral atherosclerotic stenosis (or more than 50%). [Methods] the subjects were selected from May 2011 to December 2016 in the neurology department of the Fifth Affiliated Hospital of Kunming Medical University by whole brain angiography and diagnosis of single intracranial atherosclerotic narrowness. 104 cases of acute cerebral infarction with narrow (degree of stenosis or more than 50%) were divided into moderate stenosis, severe stenosis and occlusion, and the correlation between the degree of cerebral artery stenosis and collateral circulation opening was discussed. The patients were divided into 48 cases of collateral circulation and opening group (0-2 levels of blood flow) by ASITN/SIR flow classification system. 56 cases of collateral circulation (blood flow 3-4) were used to collect data of two groups of patients (age, sex, degree of vascular stenosis, hypertension, diabetes, dyslipidemia, high homocysteine, smoking history and drinking history), and the correlation between the risk factors of cerebrovascular disease and the opening of collateral circulation (the opening of collateral flow). The open class was divided into groups, divided into 17 cases of collateral circulation unopen group, 38 cases of first grade collateral circulation open group (first class group), 38 cases of grade two collateral circulation open group (two grade group) and 11 cases of grade three collateral circulation open group (three group), compared the difference of risk factors of cerebrovascular disease in each group, to explore the risk factors and different of cerebrovascular disease and so on. The correlation between the circulation and opening of the lateral branch of the lateral branch was higher than that in the group with different degree of stenosis. The total rank of the lateral branch and open good group was higher than that of the bad group. The degree of cerebral atherosclerotic stenosis was negatively correlated with the good or not of the collateral circulation. The greater the degree of stenosis was, the better the degree of stenosis was, the better the collateral circulation was open, the better the lateral branch circulation was better.2 collateral circulation]1. There was a significant difference in hypertension and smoking history between the two groups, and the difference was statistically significant (P0.05). Age, sex, diabetes, dyslipidemia, triglycerides, hyperhomocysteinemia, total cholesterol, drinking wine history, low density lipoprotein, and high-density lipoprotein were compared in the two groups. There was no statistical significance (P0.05).3 as a variable, hypertension and smoking history as the independent variable, hypertension and smoking history, using two classified Logistic regression analysis, suggesting that smoking history is not the influence factor of collateral circulation open, hypertension is the protective factor of collateral circulation open (OR value 1), hypertension is beneficial to the collateral circulation and open.4 brain movement The degree of arteriosclerosis stenosis was positively correlated with the level of collateral circulation opening, the more severe the degree of stenosis was, the higher the level of the collateral circulation was, the higher the level of collateral circulation was.5 compared with the unopen group of collateral circulation, the first class, the two class and the three group, of which age, sex, hypertension, total cholesterol, drinking history, triglycerides, high homocysteine blood Disease, low density lipoprotein, diabetes, smoking history, high density lipoprotein in the above 4 groups, the difference was not statistically significant (P0.05). The difference of dyslipidemia in the above 4 groups was statistically significant (P0.05), suggesting that the distribution of blood lipid abnormality in the above 4 groups was not exactly the same.6 dyslipidemia in the above 4 groups, and the lateral branch was 22. There was no statistical difference between the 3 groups of the 3 groups (P0.05). The difference was not statistically significant (P0.05). The rank mean of blood lipid abnormality was higher than the group two in the unopen group of collateral circulation, and the unopen group was higher than the three group, and the difference was statistically significant (P0.05). .7 dyslipidemia was negatively correlated with the opening of grade two collateral circulation, and had statistical significance (P0.05). Dyslipidemia was not conducive to the opening of the two level collateral circulation. The effect of dyslipidemia on the opening of grade three collateral circulation (P0.05).8 total cholesterol, triglycerides, low density lipoprotein and high-density lipoprotein, respectively There is no obvious effect on the opening of collateral circulation in different grades (P0.05), and the lateral circulation opening is influenced by abnormal blood lipid. [conclusion]1 this study suggests that the more severe cerebral artery stenosis in patients with cerebral atherosclerotic stenosis, the better the lateral circulation opening may be better, the higher the level of the collateral circulation may be, the higher the.2 hypertension may be beneficial to the brain movement. The four indexes of.3 high density lipoprotein, low density lipoprotein, total cholesterol and triglyceride are abnormal in the collateral circulation of patients with atherosclerotic stenosis, which may synergistically aggravate vascular injury and be not conducive to collateral circulation open.4 study by using the ASITN/SIR flow classification system and the three stage lateral branch circulation to open two classification grouping methods Evaluation of collateral circulation, but the impact of risk factors for cerebrovascular disease on collateral circulation is different. The results of risk factors for cerebrovascular disease may be affected by lateral branch circulation opening different classification grouping methods in.5 cerebrovascular disease risk factors on collateral circulation in patients with cerebral atherosclerotic stenosis The target of the ring may be different. When the level of the collateral circulation and opening is classified as the group object, the dyslipidemia is not conducive to the opening of the two level collateral circulation, but this study does not show that the effect of dyslipidemia on the lateral circulation unopened group and the opening of the first and three level collateral circulation may be the pathophysiological mechanism of the collateral circulation open at all levels. The risk factors of cerebrovascular disease have different effects on different levels of collateral circulation.
【學(xué)位授予單位】：昆明醫(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：1975711