本文選題：動(dòng)脈粥樣硬化 + 動(dòng)脈彈性　； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年博士論文

【摘要】：第一部分大動(dòng)脈病變危險(xiǎn)因素研究研究背景和目的:目前對(duì)大動(dòng)脈病變的研究多關(guān)注動(dòng)脈粥樣硬化,而對(duì)其他類型血管壁病理改變(如動(dòng)脈彈性減低、動(dòng)脈迂曲擴(kuò)張)的研究相對(duì)較少。本研究在社區(qū)人群中研究多部位動(dòng)脈(包括主動(dòng)脈、頸動(dòng)脈、顱內(nèi)動(dòng)脈)、多種動(dòng)脈結(jié)構(gòu)和功能指標(biāo)(包括動(dòng)脈粥樣硬化、動(dòng)脈彈性、迂曲擴(kuò)張)與傳統(tǒng)血管病危險(xiǎn)因素的相關(guān)性。研究方法:本研究基于順義地區(qū)社區(qū)人群研究。對(duì)動(dòng)脈結(jié)構(gòu)和功能評(píng)估包括:動(dòng)脈粥樣硬化病變用頸動(dòng)脈內(nèi)-中膜厚度(IMT)、頸動(dòng)脈斑塊和顱內(nèi)動(dòng)脈狹窄評(píng)估;動(dòng)脈彈性用肱-踝脈搏波速度(baPWV)和頸動(dòng)脈脈搏波速度評(píng)估;動(dòng)脈迂曲擴(kuò)張用頸總動(dòng)脈外徑(CCA-IAD)、基底動(dòng)脈(BA)管腔直徑、頸內(nèi)動(dòng)脈(ICA)顱內(nèi)段直徑、基底動(dòng)脈分叉高度及側(cè)方偏移評(píng)估。納入研究的血管病危險(xiǎn)因素包括年齡、性別、體重指數(shù)、收縮壓、降壓藥治療、糖尿病、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、甘油三酯(TG)、降脂藥物治療、同型半胱氨酸濃度。采用多因素線性模型及多因素logistic回歸模型評(píng)估這些動(dòng)脈病變指標(biāo)與年齡、性別及傳統(tǒng)血管病危險(xiǎn)因素的相關(guān)性。研究結(jié)果:本研究共1787人入組,平均年齡56.4歲(標(biāo)準(zhǔn)差10.6歲)。1.對(duì)于動(dòng)脈粥樣硬化,年齡、高血壓、糖尿病、LDL-C升高、HDL-C降低與頸動(dòng)脈內(nèi)-中膜厚度、頸動(dòng)脈斑塊、顱內(nèi)動(dòng)脈狹窄均獨(dú)立相關(guān)(p均0.05)。2.對(duì)于動(dòng)脈彈性,年齡、收縮壓、糖尿病與主動(dòng)脈彈性(baPWV)和頸動(dòng)脈彈性(carotid PWV)下降相關(guān)(p均0.05),但血脂異常(LDL-C、HDL-C)與動(dòng)脈彈下降無明顯相關(guān)性;傳統(tǒng)血管病危險(xiǎn)因素可以解釋baPWV 41.1%的變異,但僅能解釋頸動(dòng)脈PWV 19.8%的變異。3.對(duì)于動(dòng)脈迂曲擴(kuò)張,年齡、腦體積與CCA外徑、BA和ICA內(nèi)徑呈正相關(guān),收縮壓升高與CCA外徑擴(kuò)張相關(guān),但收縮壓升高、糖尿病與ICA內(nèi)徑狹窄相關(guān),而且LDL-C和TG升高是BA內(nèi)徑狹窄的危險(xiǎn)因素。基底動(dòng)脈延長(zhǎng)擴(kuò)張(BADE)的主要危險(xiǎn)因素是年齡,與其他血管病危險(xiǎn)因素?zé)o明顯相關(guān)性。傳統(tǒng)血管病危險(xiǎn)因素共可以解釋大血管病變約8%-42%的變異。結(jié)論:年齡、高血壓是顱內(nèi)、外動(dòng)脈粥樣硬化、動(dòng)脈彈性下降、頸總動(dòng)脈擴(kuò)張的主要危險(xiǎn)因素,血脂異常與動(dòng)脈粥樣硬化相關(guān),但與動(dòng)脈彈性、動(dòng)脈延長(zhǎng)擴(kuò)張無明顯相關(guān)性�；讋�(dòng)脈延長(zhǎng)擴(kuò)張的主要危險(xiǎn)因素是年齡,與其他血管病危險(xiǎn)因素?zé)o明顯相關(guān)性。年齡和傳統(tǒng)血管病危險(xiǎn)因素對(duì)不同部位動(dòng)脈、不同病變類型的貢獻(xiàn)不同。第二部分大血管病變與腦小血管病相關(guān)性研究研究背景和目的:大動(dòng)脈結(jié)構(gòu)和功能改變與腦小血管病相關(guān)。但既往研究大多只關(guān)注某一級(jí)動(dòng)脈、某一種類型血管病變與腦小血管病某些影像學(xué)指標(biāo)的相關(guān)性,本研究系統(tǒng)性評(píng)估多級(jí)血管(主動(dòng)脈、頸動(dòng)脈、顱內(nèi)動(dòng)脈)、多種病變類型(動(dòng)脈粥樣硬化、彈性下降、迂曲擴(kuò)張)與多種腦小血管病影像學(xué)改變(腔隙、白質(zhì)高信號(hào)、微出血、血管周圍間隙、腦萎縮)之間的相關(guān)性。研究方法:本研究基于順義地區(qū)社區(qū)人群研究。對(duì)大動(dòng)脈結(jié)構(gòu)和功能評(píng)估包括以下指標(biāo):用內(nèi)-中膜厚度(IMT)、頸動(dòng)脈斑塊和顱內(nèi)動(dòng)脈狹窄評(píng)估頸顱內(nèi)、外動(dòng)脈粥樣硬化,用肱-踝脈搏波速度(baPWV)、頸動(dòng)脈脈搏波速度等評(píng)估主動(dòng)脈和頸動(dòng)脈彈性,用頸總動(dòng)脈外徑(CCA-IAD)、基底動(dòng)脈(BA)管腔直徑、頸內(nèi)動(dòng)脈(ICA)顱內(nèi)段直徑、基底動(dòng)脈分叉高度及側(cè)方偏移評(píng)估頸動(dòng)脈和顱內(nèi)動(dòng)脈迂曲擴(kuò)張。在頭核磁共振成像(MRI)上評(píng)估腔隙、腦白質(zhì)高信號(hào)體積(WMHV)、微出血、血管周圍間隙和腦實(shí)質(zhì)分?jǐn)?shù)(BPF),作為腦小血管病影像學(xué)指標(biāo)。采用多因素線性回歸模型及多因素logistic回歸模型評(píng)估大動(dòng)脈結(jié)構(gòu)和功能指標(biāo)與腦小血管病的相關(guān)性。研究結(jié)果:共有1323人完成頭MRI檢查,平均年齡55.5歲(SD,9.7歲)。腔隙、局限腦葉微出血、深部或幕下微出血、嚴(yán)重基底節(jié)區(qū)和白質(zhì)區(qū)血管周圍間隙的患病率分別是 17.9%、5.2%、6.6%、13.4%、14.3%,WMHV 中位數(shù) 0.9ml(四分位數(shù)間距,0.3-2.9),腦實(shí)質(zhì)分?jǐn)?shù)平均值0.76(SD,0.03)。1.動(dòng)脈粥樣硬化性改變:頸動(dòng)脈斑塊、顱內(nèi)動(dòng)脈狹窄與腔隙、WMHV、腦萎縮相關(guān),且頸動(dòng)脈斑塊和顱內(nèi)動(dòng)脈狹窄與腦萎縮的相關(guān)性獨(dú)立于腔隙和WMHV;頸動(dòng)脈IMT與WMHV相關(guān)。2.動(dòng)脈彈性參數(shù):主動(dòng)脈彈性(baPWV)與腔隙和WMHV相關(guān);頸動(dòng)脈彈性與所有腦小血管病標(biāo)志物均無明顯相關(guān)性。3.動(dòng)脈迂曲擴(kuò)張參數(shù):顱內(nèi)動(dòng)脈迂曲擴(kuò)張(頸內(nèi)動(dòng)脈顱內(nèi)段和基底動(dòng)脈)主要與深部或幕下微出血、基底節(jié)區(qū)血管周圍間隙擴(kuò)張相關(guān);頸總動(dòng)脈外徑擴(kuò)張與腔隙、WMHV、深部或幕下微出血、基底節(jié)區(qū)血管周圍間隙擴(kuò)張均相關(guān),而且這些相關(guān)性獨(dú)立于血管病危險(xiǎn)因素和IMT增厚。結(jié)論:大動(dòng)脈不同結(jié)構(gòu)和功能特征與腦小血管病相關(guān)性不同。大動(dòng)脈粥樣硬化、彈性下降主要與腔隙和白質(zhì)高信號(hào)相關(guān),顱內(nèi)動(dòng)脈迂曲擴(kuò)張與深部微出血和血管周圍間隙擴(kuò)張相關(guān)。這提示小血管病不同影像學(xué)表現(xiàn)的機(jī)制存在差異。
[Abstract]:Research background and purpose of the first part of the study of the risk factors for major artery lesions: the current study of major arterial lesions is mainly concerned with atherosclerosis, and the study of other types of vascular wall pathological changes (such as arterial elasticity and arterial circuitous dilatation) is relatively less. Arterial, intracranial artery), a variety of arterial structure and functional indicators (including atherosclerosis, arterial elasticity, tortuous dilation) and the risk factors of traditional vascular disease. Methods: This study was based on community population studies in Shunyi. Arterial structure and function assessment included carotid artery and middle membrane thickness (I MT) assessment of carotid artery plaque and intracranial artery stenosis; arterial elasticity with brachial ankle pulse wave velocity (baPWV) and carotid pulse wave velocity assessment; arterial external diameter (CCA-IAD), basilar artery (BA) diameter of the basilar artery (BA), intracranial diameter of the internal carotid artery (ICA), the bifurcation height of the basilar artery and lateral migration assessment. Risk factors for vascular disease include age, sex, body mass index, systolic pressure, antihypertensive therapy, diabetes, low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), lipid lowering drug therapy, homocysteine concentration. The multifactor linear model and multiple factor Logistic regression model were used to evaluate these arteries. The correlation between pathological changes and age, sex and risk factors of traditional vascular disease. Results: a total of 1787 people were enrolled in this study, with a mean age of 56.4 years (10.6 years of standard deviation).1. for atherosclerosis, age, hypertension, diabetes, LDL-C, HDL-C reduction and carotid artery and middle membrane thickness, carotid plaque, and intracranial artery stenosis. The correlation (P 0.05).2. was associated with arterial elasticity, age, systolic pressure, diabetes and the decrease of aortic elasticity (baPWV) and carotid elasticity (carotid PWV) (P 0.05), but blood lipid abnormalities (LDL-C, HDL-C) had no significant correlation with the decline of arterial elasticity; the risk factors for traditional vascular disease could explain the variation of baPWV 41.1%, but only the carotid artery PWV 19. could be explained. 8% of the variant.3. was associated with arterial circuitous dilatation. Age, brain volume was positively correlated with the diameter of CCA, BA and ICA diameter, the increase of systolic pressure was associated with the expansion of the outer diameter of CCA, but the systolic pressure increased, and diabetes was associated with the narrowing of the diameter of ICA, and the increase of LDL-C and TG was a risk factor for the stenosis of the inner diameter of BA. The major risk factors for extending the dilatation of the basilar artery (BADE) were the main risk factors Age, there is no significant correlation between the risk factors of other vascular diseases. The risk factors of traditional vascular disease can explain the variation of 8%-42% in large vascular lesions. Conclusion: age, hypertension is the intracranial, external atherosclerosis, arterial elasticity decline, the main risk factor for the expansion of the common carotid artery, blood lipid abnormality associated with atherosclerosis, but with the artery There is no significant correlation between elasticity and extension of artery dilatation. The main risk factor for extended dilatation of the basilar artery is age. There is no significant correlation between the risk factors of other vascular diseases. The contribution of risk factors of age and traditional vascular disease to different parts of the arteries and types of lesions is different. The correlation of second parts of large vascular lesions and small cerebrovascular diseases Study background and purpose: the changes in the structure and function of the large arteries are associated with cerebral microvascular disease. However, most of the previous studies only focus on a certain primary artery, the correlation of certain types of vascular lesions and some imaging indexes of cerebral small vascular disease, and the systematic assessment of multilevel vessels (main artery, carotid artery, intracranial artery), and multiple pathological types (movement) The correlation between angiosclerosis, elastic decline, tortuous dilation) and the imaging changes of various cerebral microvascular diseases (lacunar, white matter high signal, microhaemorrhage, perivascular space, atrophy of the brain). Methods: This study was based on community population studies in the Shunyi region. The structure and function assessment of the large arteries included the following indicators: the internal and medium thickness (IMT), Carotid artery and intracranial artery stenosis were used to assess the intracranial and external carotid artery atherosclerosis. The elasticity of the aorta and carotid artery was evaluated with the brachial ankle pulse wave velocity (baPWV), the carotid artery pulse wave velocity, and the external diameter of the common carotid artery (CCA-IAD), the diameter of the basilar artery (BA), the diameter of the intracranial segment of the internal carotid artery (ICA), the bifurcation height of the basilar artery and the lateral deviation. Carotid artery and intracranial artery dilatation were evaluated. The lacunar, high signal volume (WMHV), micro hemorrhage, perivascular space and brain parenchyma fraction (BPF) were evaluated on head NMR imaging (MRI) as the imaging index of cerebral small vascular disease. Multifactor linear regression model and multiple factor Logistic regression model were used to evaluate the structure of the large artery. A total of 1323 people completed head MRI examination, with an average age of 55.5 years (SD, 9.7 years), lacunar, limited cerebral lobes, deep or sub episodes of microbleeding, and the incidence of the severe basal ganglia and white matter peripheral space were 17.9%, 5.2%, 6.6%, 13.4%, 14.3%, and WMHV median 0.9ml (four). Quantile spacing, 0.3-2.9), 0.76 (SD, 0.03).1. atherosclerotic changes in the average brain fraction (SD, 0.03): carotid plaque, intracranial artery stenosis and lacunar, associated with cerebral atrophy, and the correlation between carotid plaque and intracranial artery stenosis and brain atrophy independent of the cavity and WMHV; the elastic parameters of the carotid artery IMT and WMHV related.2. arteries: Initiative Pulse elasticity (baPWV) is associated with lacunar and WMHV; carotid elasticity has no significant correlation with all the markers of cerebral microvascular disease..3. artery circuitous dilatation parameters: intracranial artery circuitous dilation (internal carotid artery and basilar artery) mainly with deep or sub episodes of microhemorrhage, dilatation of the perivascular space in the basal ganglia; external diameter expansion of the common carotid artery Lacunar, WMHV, deep or sub episodes of microhaemorrhage were correlated with the diffusion of the perivascular space in the basal ganglia, and these correlations were independent of the risk factors of vascular disease and the thickening of the IMT. Conclusion: the different structural and functional characteristics of the large arteries are related to the cerebral small vascular disease. In conclusion, the tortuous expansion of intracranial arteries is associated with deep micro bleeding and perivascular space expansion. This suggests that there are differences in the mechanism of different imaging findings of small vessel disease.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743

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6 俞穎哲;誤診為變應(yīng)性血管炎的青斑樣血管病3例并文獻(xiàn)復(fù)習(xí)[D];浙江大學(xué);2016年

7 傅君嫻;尿酸與腦小血管病影像學(xué)特征的相關(guān)性研究[D];福建醫(yī)科大學(xué);2016年

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9 張艷霞;腦小血管病認(rèn)知功能障礙與血清炎癥因子關(guān)系的研究[D];吉林大學(xué);2017年

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