本文選題：白質(zhì)疏松 + 大腦中動(dòng)脈病變　； 參考：《南京大學(xué)》2017年碩士論文

【摘要】：目的:基于腦血管造影檢查探討大腦中動(dòng)脈病變及側(cè)支循環(huán)與腦白質(zhì)疏松(leukoaraiosis,LA)的相關(guān)性。方法:回顧性連續(xù)納入2009年6月至2012年12月于南京軍區(qū)總醫(yī)院神經(jīng)內(nèi)科住院且經(jīng)腦血管造影檢查證實(shí)存在大腦中動(dòng)脈M1段狹窄或閉塞患者299例,收集患者的相關(guān)臨床資料。所有入選的研究對(duì)象入院后均行頭顱MRI和全腦血管造影檢查。采用Fazekas量表評(píng)分標(biāo)準(zhǔn)分別對(duì)雙側(cè)側(cè)腦室旁白質(zhì)和深部白質(zhì)LA進(jìn)行評(píng)分,大腦中動(dòng)脈狹窄程度的判定采用的是北美癥狀性頸動(dòng)脈內(nèi)膜切除術(shù)試驗(yàn)組(NASCET)標(biāo)準(zhǔn)分級(jí)方法,側(cè)支循環(huán)分級(jí)的評(píng)定采用的是美國介入治療神經(jīng)放射學(xué)學(xué)會(huì)/介入放射學(xué)學(xué)會(huì)側(cè)支循環(huán)評(píng)估系統(tǒng)(ASTIN/SIR)標(biāo)準(zhǔn)分級(jí)方法。統(tǒng)計(jì)學(xué)方法:所有統(tǒng)計(jì)數(shù)據(jù)的處理采用SPSS statistics22.0統(tǒng)計(jì)軟件包進(jìn)行分析,計(jì)數(shù)資料采用卡方檢驗(yàn),非正態(tài)分布計(jì)量資料采用非參數(shù)檢驗(yàn),正態(tài)分布計(jì)量資料用t檢驗(yàn),采用Logistic回歸分析大腦中動(dòng)脈嚴(yán)重狹窄、側(cè)支循環(huán)分級(jí)與LA的關(guān)系。P0.05表示有統(tǒng)計(jì)學(xué)意義。結(jié)果:本研究最終納入299例患者,男性占68.6%,平均年齡(57 ±13)歲。側(cè)腦室旁中重度LA組的年齡、高血壓病、糖尿病、高脂血癥、冠心病、卒中史均高于無或輕度LA組,兩組比較其差異有統(tǒng)計(jì)學(xué)意義(均P0.05),而兩組間在性別、吸煙史、TIA史上無顯著統(tǒng)計(jì)學(xué)差異(均P0.05)。深部白質(zhì)中重度LA組年齡、高血壓病和冠心病患病率高于無或輕度LA組,而吸煙例數(shù)少于無或輕度LA組,差異有顯著統(tǒng)計(jì)學(xué)意義(均P0.05),而性別、糖尿病、高脂血癥、卒中史、TIA史與無或輕度LA組比較無統(tǒng)計(jì)學(xué)差異(均P0.05)。雙側(cè)側(cè)腦室旁中重度LA組腔�；疾÷始扒还�(shù)目均高于無或輕度LA組(均P0.05);右側(cè)深部白質(zhì)中重度LA組腔�；疾÷始扒还�(shù)目高于無或輕度LA組(P0.05),而左側(cè)深部白質(zhì)兩組間腔�；疾÷始扒还�(shù)目無統(tǒng)計(jì)學(xué)差異(P0.05)。大腦中動(dòng)脈狹窄程度和側(cè)支循環(huán)分級(jí)在雙側(cè)不同程度側(cè)腦室旁白質(zhì)以及深部白質(zhì)LA中無統(tǒng)計(jì)學(xué)差異(均P0.05)。Spearman相關(guān)分析顯示雙側(cè)半球側(cè)腦室旁白質(zhì)和深部白質(zhì)LA程度與側(cè)支循環(huán)分級(jí)和MCA狹窄程度均無相關(guān)性(均P0.05)。將單因素分析中P0.1的變量進(jìn)行非條件多因素Logistic回歸分析顯示,調(diào)整相關(guān)混雜因素后,年齡(OR:1.107,95%CI:1.068～1.147,P0.01)、高血壓病(OR:4.456,95%CI:1.612～12.318,P=0.004),卒中史(OR:2.278,95%CI:1.150～4.513,P=0.018)以及腔梗數(shù)目(OR:1.295,95%CI:1.005～1.668,P=0.046)與左側(cè)側(cè)腦室旁LA獨(dú)立相關(guān);年齡(OR:1.068,95%CI:1.032～1.105,P0.01)、高血壓病(OR:4.481,95%CI:1.497～13.409,P=0.007)與左側(cè)深部白質(zhì) LA獨(dú)立相關(guān);年齡(OR:1.097,95%CI:1.060～1.136,P0.01)、高血壓病(OR:3.332,95%CI:1.301～8.529,P=0.012)以及腔梗數(shù)目(OR:1.265,95%CI:1.037～1.544,P=0.021)與右側(cè)側(cè)腦室旁LA獨(dú)立相關(guān);年齡(OR:1.085,95%CI:1.046～1.126,P0.01)、高血壓病(OR:3.857,95%CI:1.275～11.670,P=0.017)、腔梗數(shù)目(OR:1.365,95%CI:1.107～1.682,P=0.004)與右側(cè)深部白質(zhì) LA獨(dú)立相關(guān)。結(jié)論:對(duì)于大腦中動(dòng)脈病變患者,年齡、高血壓病、腔梗數(shù)目是側(cè)腦室旁LA的獨(dú)立危險(xiǎn)因素,年齡、高血壓病是深部白質(zhì)LA的獨(dú)立危險(xiǎn)因素,而MCA狹窄程度和側(cè)支循環(huán)與兩個(gè)部位的LA均無明顯相關(guān)性,提示LA可能更傾向于是由小血管病變引起,但這一研究結(jié)果尚待進(jìn)一步更大樣本量的前瞻性研究加以證實(shí)。
[Abstract]:Objective: To investigate the correlation between the middle cerebral artery disease and the collateral circulation and leukoaraiosis (LA) based on cerebral angiography. Methods: retrospective and continuous admission from June 2009 to December 2012 in the General Hospital of Nanjing Military Region neurology department and the cerebral angiography confirmed the existence of M1 segment stenosis or occlusion of the middle cerebral artery. The clinical data of 299 patients were collected. All the selected subjects were performed head MRI and whole brain angiography after admission. The Fazekas scale score was used to score the bilateral lateral ventricle white matter and deep white matter LA. The degree of middle cerebral artery stenosis was determined by symptomatic carotid endarterosis in North America. In addition to the standard classification method of the operation test group (NASCET), the evaluation of collateral circulation classification is the standard classification method of the American Association of Interventional Neurology Association / Interventional Radiology Association (ASTIN/SIR). Statistical method: all statistical data are analyzed by SPSS statistics22.0 statistical package. The data were checked with chi square test, non normal distribution measurement data were tested by nonparametric test, normal distribution measurement data were tested with T, Logistic regression analysis was used to analyze the serious stenosis of middle cerebral artery, and the relationship between collateral circulation classification and LA was statistically significant. Results: 299 cases were included in this study, male accounted for 68.6%, average age (57). Age, hypertension, diabetes, hyperlipidemia, hyperlipidemia, coronary heart disease, and stroke history were higher than those in the non or mild LA group. The difference was statistically significant between the two groups (all P0.05), but there was no significant difference between the two groups in sex, smoking history, and TIA history (P0.05). The age of severe LA group in deep white matter, hypertension, and hypertension were all in the two groups. The incidence of coronary heart disease was higher than that in the non or mild LA group, but the number of smoking cases was less than that of the non or mild LA group. The difference was statistically significant (P0.05), while sex, diabetes, hyperlipidemia, stroke history, the history of TIA and the mild LA group had no statistical difference (P0.05). The incidence of infarction and the number of cavities in the moderate and severe LA group were higher in both sides of the lateral lateral ventricle. In the non or mild LA group (P0.05), the morbidity and the number of cavities in the moderate and severe group LA of the right deep white matter were higher than those in the non or mild LA group (P0.05), but there was no statistical difference between the two groups of the left deep white matter and the number of the cavities (P0.05). No statistical difference (P0.05).Spearman correlation analysis in deep white matter LA showed that there was no correlation between the degree of LA and the degree of collateral circulation and MCA stenosis in bilateral hemisphere lateral ventricle and deep white matter (P0.05). Unconditional multiple factor Logistic regression analysis of the variables of P0.1 in single factor analysis showed the adjustment of related confounding. After factors, age (OR:1.107,95%CI:1.068 to 1.147, P0.01), hypertension (OR:4.456,95%CI:1.612 to 12.318, P=0.004), stroke history (OR:2.278,95%CI:1.150 to 4.513, P=0.018) and the number of cavities (OR:1.295,95%CI:1.005 to 1.668, P=0.046) independent of the left lateral ventricle LA; age (OR:1.068,95%CI:1.032 to 1.105, P0.01), hypertension (OR:4.481,95%CI:1.497 ~ 13.409, P=0.007) was independent of the left deep white matter LA; age (OR:1.097,95%CI:1.060 ~ 1.136, P0.01), hypertension (OR:3.332,95%CI:1.301 ~ 8.529, P=0.012) and the number of cavities (OR:1.265,95%CI:1.037 to 1.544, P=0.021) were independent of the right lateral paraventricular LA; age (OR:1.085,95%CI:1.046 to 1.126, P0) .01), hypertension (OR:3.857,95%CI:1.275 ~ 11.670, P=0.017), the number of cavities (OR:1.365,95%CI:1.107 ~ 1.682, P=0.004) is independent of the right deep white matter LA. Conclusion: for patients with middle cerebral artery disease, age, hypertension, and the number of cavities are independent risk factors for LA near the lateral ventricle. Age, hypertension is the only one in deep white matter LA. There is no significant correlation between the risk factors and the degree of MCA stenosis and collateral circulation and the LA of two sites, suggesting that LA may be more likely to be caused by small vascular lesions, but the result of this study remains to be confirmed by further prospective studies of larger samples.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
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本文編號(hào)：2019175