本文選題：腦白質(zhì)高信號(hào) + 腦微出血��； 參考：《浙江大學(xué)》2014年碩士論文

【摘要】：研究背景 在腦白質(zhì)高信號(hào)(white matter hyperintensities,WMH)嚴(yán)重的患者中,大部分合并有腦內(nèi)微出血(cerebral microbleeds, CMB s),且臨床研究表明,WMH的嚴(yán)重程度和CMBs的數(shù)目呈明顯正相關(guān),但WMH卻不是CMBs的獨(dú)立危險(xiǎn)因素。病理檢查證實(shí),不同部位的CMBs病理改變存在差異,其中深部的CMBs主要病理改變?yōu)樾?dòng)脈管壁增厚、玻璃樣變性及微動(dòng)脈瘤的形成,而腦葉的微出血主要病理改變是腦淀粉樣血管病變。 研究目的 探究腦白質(zhì)高信號(hào)病人中不同部位CMBs發(fā)生的危險(xiǎn)因素及CMBs對(duì)將來(lái)卒中發(fā)生的影響。 研究方法 前瞻性連續(xù)性收集自2011年7月到2014年1月在我院就診的具有腦白質(zhì)高信號(hào),且知情同意接受頭顱磁共振ESWAN序列檢查的病人。在nagnitude圖上評(píng)估腦微出血,按照微出血解剖評(píng)定量表(Microbleed Anatomical Rating Scale)將其分成深部微出血和腦葉微出血。分別分析深部微出血組與無(wú)深部微出血組、腦葉微出血組與無(wú)腦葉微出血的基線資料,并行多因素分析。隨訪研究對(duì)象在實(shí)驗(yàn)期內(nèi)發(fā)生的腦卒中事件,并分析發(fā)生了將來(lái)卒中人群與未發(fā)生將來(lái)卒中人群之間差異,用二元Logotic回歸分析探究將來(lái)卒中發(fā)生的獨(dú)立危險(xiǎn)因素。 研究結(jié)果 納入151例患者,年齡(68.0±12.3)歲,男性82例(54.3%),存在微出血90例(60.3%),其中深部83例(55.0%),腦葉68例(45.0%),深部CMBs合并腦葉CMBs者61例。存在深部微出血患者高血壓發(fā)病率高(84.3%vs70.6%,p=0.049)、同型半胱氨酸高(16.5±7.3vs12.5±3.9umol/1, p0.001),血維生素B12低(335.3±172.9vs468.3±387.9ug/ml,,p=0.017),TT4低(92.1±27.7vs108.1±56.5pmol/l,p=0.013),用logistic回歸進(jìn)行多因素分析后發(fā)現(xiàn)只有血清高同型半胱氨酸濃度(OR=1.16,95%CI：1.05-1.28,p=0.004)是深部CMBs的獨(dú)立危險(xiǎn)因素。腦葉微出血組男性比例高(67.5%vs43.4%,p=0.003),血TT4含量低(88.9±27.1vs107.7±51.8, nmol/1, p=0.010),多因素校正后男性(OR=2.36,95%CI：1.16-4.83, p=0.018)及較高的血清TT4(OR=0.98,95%CI：0.97-0.99,p=0.013)是腦葉CMBs的獨(dú)立危險(xiǎn)因素。 隨訪期內(nèi)共有18例患者發(fā)生了卒中,其中腦梗塞11例,腦出血7例。發(fā)生了將來(lái)卒中組患者糖尿病的患病率更高(55.6%vs21.8%,p=0.007)；既往卒中史比例更高(52.9%vs22.6%,p=0.015)；基線CMBs的發(fā)生率更高(88.9%vs55.6%,p=0.009)以及基線深部CMBs發(fā)生率更高(88.3%vs51.5%,p=0.011)經(jīng)二元Logistic回歸分析校正混雜因素后發(fā)現(xiàn),糖尿病(OR=6.07,95%CI：1.94-18.97,p=0.002)、既往卒中史(OR=4.29,95%CI：1.39-13.23,p=0.011)CMBs(OR=6.24,95%CI：1.28-30.49,p=0.024)以及深部CMBs是將來(lái)卒中發(fā)生的獨(dú)立預(yù)測(cè)因素。 結(jié)論 1.WMH患者中,較高的血Hcy和既往卒中史是深部CMBs的獨(dú)立危險(xiǎn)因素男性及較低的血TT4是腦葉CMBs的獨(dú)立危險(xiǎn)因素,深部CMBs與腦葉CMBs的危險(xiǎn)因素存在差異。 2.WMH患者中CMBs及深部CMBs均可預(yù)測(cè)將來(lái)卒中,尤其是出血性卒中的發(fā)生。
[Abstract]:Background most of the patients with severe white matter hyperintensity (WMHs) have intracerebral microbleeds and cerebral microbleeds, and clinical studies have shown that there is a significant positive correlation between the severity of WMH and the number of CMBs. But WMH is not an independent risk factor for CMBs. Pathological examination showed that there were differences in pathological changes of CMBs in different sites. The main pathological changes of deep CMBs were thickening of arterioles wall, vitreous degeneration and the formation of microaneurysms. The main pathological change of cerebral lobar hemorrhage is cerebral amyloid angiopathy. Objective to investigate the risk factors of CMBs in patients with high signal in white matter and the influence of CMBs on future stroke. Methods prospective consecutive patients with white matter hyperintensity and informed consent to head MRI ESWAN sequence were collected from July 2011 to January 2014. Intracerebral microhaemorrhage was evaluated on nagnitude and divided into deep microhemorrhage and lobar microhemorrhage according to microbleed Anatomical rating scale. The baseline data of deep microhemorrhage group and non-deep microhemorrhage group, cerebral lobe microhemorrhage group and anencephalic microhemorrhage group were analyzed respectively. The stroke events occurred in the experimental period were followed up, and the differences between the future stroke population and the non-future stroke population were analyzed. The independent risk factors of future stroke were analyzed by binary Logotic regression analysis. Results 151 patients, aged 68.0 鹵12.3 years, were included in this study. 82 cases of male were diagnosed as 54.3%. There were 90 cases of microhemorrhage, including 83 cases in deep part, 68 cases in lobes and 61 cases in deep CMBs complicated with lobar CMBs. 瀛樺湪娣遍儴寰嚭琛，

本文編號(hào)：2047358