本文選題：顱內(nèi)動脈狹窄 + 血管內(nèi)皮功能��； 參考：《湖北中醫(yī)藥大學》2014年碩士論文

【摘要】：目的： 探討缺血性腦卒中病患者血管內(nèi)皮功能與顱內(nèi)動脈狹窄的相關性；研究顱內(nèi)顱內(nèi)動脈狹窄程度與親環(huán)素A和網(wǎng)膜素的關系，探討顱內(nèi)動脈狹窄的危險因素和親環(huán)素A、網(wǎng)膜素與顱內(nèi)動脈狹窄程度的關系；研究中藥制劑三七通舒膠囊對缺血性腦卒中復發(fā)高危人群預后的影響及在缺血性腦卒中二級預防中的療效。 方法： 1、將67例缺血性腦卒中患者根據(jù)有無顱內(nèi)血管狹窄分為兩組，顱內(nèi)血管狹窄組和對照組。對兩組患者一般資料及肱動脈血流介導的血管擴張功能、非內(nèi)皮依賴性血管舒張功能進行對比分析，并進一步分析肱動脈血流介導的血管擴張功能、非內(nèi)皮依賴性血管舒張功能與顱內(nèi)血管狹窄數(shù)量的相關性； 2、將89例缺血性腦卒中患者分為顱內(nèi)動脈多發(fā)狹窄組（n=29）、顱內(nèi)動脈單發(fā)狹窄組（n=24）和對照組（n=36），應用ELISA方法測定血清親環(huán)素A和網(wǎng)膜素濃度。比較三組間既往史、血清親環(huán)素A和網(wǎng)膜素水平的差異； 3、按照納入標準篩選出202例缺血性腦卒中患者。按出院后服用的藥物分為兩組，拜阿司匹林合并三七通舒膠囊的患者設為中西結合治療組，共81例；拜阿司匹林的患者設為對照治療組，共121例。對所有患者進行隨訪，隨訪內(nèi)容包括有無復發(fā)卒中癥狀，服用藥物情況等，并將療效結果分為復發(fā)、未復發(fā)兩種，并對兩組的療效結果進行統(tǒng)計。 結果： 1、顱內(nèi)動脈狹窄組有50例，對照組有17例，年齡、肱動脈血流介導的血管擴張功能、非內(nèi)皮依賴性血管舒張功能、高血壓病、糖尿病、既往卒中或短暫性腦缺血發(fā)作史與顱內(nèi)動脈狹窄相關，且肱動脈血流介導的血管擴張功能(rs=-0.869,p=0.000＜0.05)與非內(nèi)皮依賴性血管舒張功能(rs=-0.490,p=0.000＜0.05)分別與顱內(nèi)動脈狹窄的數(shù)量存在負相關關系。非條件Logistic回歸分析得出肱動脈血流介導的血管擴張可作為評估顱內(nèi)動脈狹窄的獨立因素，以肱動脈血流介導的血管擴張功能值為2.95%時診斷顱內(nèi)動脈狹窄的可能性最大； 2、在顱內(nèi)動脈多發(fā)狹窄組、顱內(nèi)動脈單發(fā)狹窄組、對照組既往史的比較中，糖尿病史和既往卒中史具有顯著差異性（P0.017），顱內(nèi)動脈多發(fā)狹窄組的患者合并糖尿病史、既往卒中史的概率比另兩組的概率顯著增高；三組中血清親環(huán)素A濃度有顯著差異性（P0.05），顱內(nèi)動脈多發(fā)狹窄組較顱內(nèi)動脈單發(fā)狹窄組患者的血清親環(huán)素A濃度升高，且二者與對照組比較均有升高；與對照組相比，顱內(nèi)動脈多發(fā)狹窄組和顱內(nèi)動脈單發(fā)狹窄組血清網(wǎng)膜素-1濃度均有降低（P0.05），但二者之間血清網(wǎng)膜素濃度無顯著差異性； 3、拜阿司匹林合并三七通舒膠囊治療組和拜阿司匹林治療組比較年齡、性別、高血壓、糖尿病、冠心病、吸煙史、既往卒中史、ESRS評分平均總分均無顯著差異(P＞0.05)；拜阿司匹林合并三七通舒膠囊治療組中患者腦卒中復發(fā)率明顯低于對照組，，且比較具有統(tǒng)計學意義（P＜0.05）。 結論: 1、顱內(nèi)動脈狹窄患者存在肱動脈血流介導的血管擴張功能的降低，且肱動脈血流介導的血管擴張功能可能對顱內(nèi)動脈狹窄有一定的預測價值； 2、有糖尿病史或既往卒中史的患者更容易合并顱內(nèi)動脈狹窄，糖尿病、既往卒中史可能是顱內(nèi)動脈狹窄的危險因素；顱內(nèi)動脈多發(fā)狹窄組血清親環(huán)素A水平明顯升高、網(wǎng)膜素水平明顯降低，提示親環(huán)素A可能參與顱內(nèi)動脈狹窄的形成發(fā)展；血清網(wǎng)膜素與顱內(nèi)動脈狹窄相關，但與顱內(nèi)動脈狹窄數(shù)量無關，提示顱內(nèi)動脈狹窄患者可能存在內(nèi)皮功能的受損； 3、在ESRS評分≥3分的缺血性腦卒中高危復發(fā)患者中，三七通舒膠囊聯(lián)合拜阿司匹林預防腦卒中的再發(fā)比單用拜阿司匹林治療效果更好，故在腦卒中復發(fā)高危人群患者的二級預防中，三七通舒膠囊與拜阿司匹林聯(lián)合用藥的治療方案可能較單用拜阿司匹林其效果更佳。
[Abstract]:Purpose :

To investigate the correlation between vascular endothelial function and intracranial arterial stenosis in patients with ischemic stroke .
To study the relationship between the degree of intracranial arterial stenosis and the relationship between cyclophilin A and omental , and to explore the risk factors of intracranial arterial stenosis and the relationship between cyclophilin A and the degree of intracranial arterial stenosis .
To study the effect of Sanqi Tongshu capsule on the prognosis of patients with high risk of ischemic stroke recurrence and its curative effect in secondary prevention of ischemic stroke .

Method :

1 . Sixty - seven patients with ischemic stroke were divided into two groups , intracranial vessel stenosis group and control group according to the presence or absence of intracranial vascular stenosis .


2 . 89 patients with ischemic stroke were divided into multiple intracranial arterial stenosis group ( n = 29 ) , intracranial arterial stenosis group ( n = 24 ) and control group ( n = 36 ) .


3 . 202 patients with ischemic stroke were screened according to the inclusion criteria . The drug taken after discharge was divided into two groups .
All patients were followed up . The follow - up included the presence or absence of recurrent stroke symptoms , drug administration , etc . The results were divided into two groups : recurrence , no recurrence , and statistical analysis of the results of the two groups .

Results :

1 . There were 50 cases of intracranial arterial stenosis , 17 cases in the control group , age , brachial artery blood flow - mediated dilatation function , non - endothelium - dependent vasodilatation function , hypertension , diabetes mellitus , previous stroke or transient ischemic attack history had negative correlation with the number of intracranial arterial stenosis .


2 . There was a significant difference between the history of diabetes mellitus ( P < 0.01 ) and the history of previous stroke ( P 0 . 017 ) .
There was a significant difference in the serum levels of cyclophilin A in three groups ( P0.05 ) . Compared with the control group , the serum levels of cyclophilin A in the patients with intracranial arterial stenosis group were higher than those in control group .
Compared with the control group , there was a decrease in the serum levels of the serum levels in the patients with intracranial arterial stenosis group and intracranial arterial stenosis group ( P0.05 ) , but there was no significant difference between the serum levels of serum and the serum .


3 . There was no significant difference in the mean total score between the treatment group and the aspirin - treated group ( P > 0.05 ) .
Compared with the control group , the recurrence rate of stroke in the treatment group was significantly lower than that of the control group ( P < 0.05 ) .

Conclusion :

1 . The vascular dilatation function mediated by brachial artery flow is decreased in patients with intracranial arterial stenosis , and the function of brachial artery blood flow - mediated dilatation may have some predictive value for intracranial arterial stenosis ;


2 . Patients with history of diabetes or previous stroke are more likely to combine intracranial arterial stenosis , diabetes , and the history of previous stroke may be a risk factor for intracranial arterial stenosis ;
The levels of serum pro - cytolysin A in the patients with intracranial arterial stenosis were significantly increased , and the level of serum levels decreased significantly , suggesting that cyclophilin A might be involved in the development of intracranial arterial stenosis .
The results showed that the patients with intracranial arterial stenosis might be damaged by endothelial function .


3 . In the patients with high risk of ischemic stroke with the ESRS score 鈮

本文編號：2036624