本文選題：老年腦梗死 + 頸動脈硬化��； 參考：《吉林大學》2017年碩士論文

【摘要】：研究背景:近年來,中國人口老齡化日益明顯,人類疾病譜發(fā)生了很大變化,腦血管病的發(fā)病率逐年升高,在我國老年患者死亡原因中居首位。腦梗死因其高發(fā)病率、高復發(fā)率、高致殘率及高致死率的特點,已經成為全球關注的公共健康問題。因此,早期篩查、干預和控制腦梗死的危險因素,是目前老年人卒中管理的重要舉措。目的:探討頸動脈硬化及其他危險因素與腦梗死發(fā)生及復發(fā)的相關性,比較兩者對腦梗死的預測價值,為老年腦梗死的預防及改善預后提供臨床指導。方法:在2015年1月至2016年12月吉大一院神經內科住院的患者中隨機抽樣選取年齡60歲及以上的腦梗死患者248例,按照發(fā)病情況分為初發(fā)腦梗死組(144例)及復發(fā)腦梗死組(104例),并在同期住院的患者中選取256例年齡60歲及以上的非腦梗死患者作為對照組。分別比較腦梗死組與對照組、初發(fā)腦梗死組與復發(fā)腦梗死組頸動脈硬化情況及相關因素的差異。對所有變量進行Logistic回歸分析,分析腦梗死發(fā)生和復發(fā)的獨立危險因素,P0.05認為有統計學意義。對危險因素數目(模式1)和頸動脈硬化情況(模式2)進行積分,并綜合兩者情況進行積分(模式3),評估三種積分對腦梗死的預測價值,并分別比較其敏感性和特異性。結果:(1)腦梗死組頸動脈狹窄程度及IMT積分均明顯高于對照組,其差異具有統計學意義(P0.05)。(2)腦梗死組的年齡、FBG、高血壓和糖尿病患病率、吸煙的比例均明顯高于對照組,其差異具有統計學意義(P0.05),而兩組數據中,性別、TC、TG、LDL的差異無統計學意義。(3)上述變量進行Logistic分析,可得出高血壓史、糖尿病史、吸煙史、IMT積分是腦梗死的獨立危險因素。(4)復發(fā)腦梗死組的內-中膜厚度(IMT)積分和頸動脈狹窄程度明顯高于初發(fā)腦梗死組,具有統計學意義(P0.05),而斑塊檢出率差異無統計學意義(P0.05)。(5)復發(fā)腦梗死組患者的高血壓、糖尿病患病率及吸煙比例明顯高于初發(fā)腦梗死組患者,差異具有統計學意義(P0.05),而年齡、性別、膽固醇(TC)、甘油三酯(TG)、低密度脂蛋白膽固醇(LDL)及空腹血糖(FBG)差異沒有統計學意義(P0.05)。(6)上述變量進行Logistic分析,可得出高血壓史、糖尿病史、吸煙史、IMT積分是腦梗死復發(fā)的獨立危險因素。(7)模式1及模式2兩種積分與腦梗死均有相關性,行ROC曲線分析,三種積分曲線下面積均大于0.5,P值均小于0.05,將危險因素數目與頸動脈硬化情況結合的模式3積分的ROC面積遠遠大于模式1和模式2。結論:(1)綜合考慮頸動脈硬化情況的IMT積分是腦梗死發(fā)生和復發(fā)的獨立危險因素,因此,應加強頸動脈彩超的篩查,并及早干預,對預防腦梗死的發(fā)生有重要意義。(2)高血壓、糖尿病、吸煙與腦梗死的發(fā)生及復發(fā)均有明顯相關性,對合并上述危險因素的患者早期干預,是實施有效慢病管理的重要手段。(3)腦梗死的發(fā)生與年齡成正相關,對高齡患者早期干預不容忽視。(4)綜合考慮危險因素及頸動脈硬化情況,可提高對腦梗死的預測價值。
[Abstract]:Background: in recent years, the population aging in China is becoming more and more obvious, the human disease spectrum has changed greatly, the incidence of cerebrovascular disease is increasing year by year, and the cause of death in the elderly is the first. The high incidence, high recurrence rate, high disability rate and high mortality rate have become a global public health question because of the death of cerebral infarction. Therefore, early screening, intervention and control of the risk factors of cerebral infarction are important measures for the management of stroke in the elderly. Objective: To explore the correlation between carotid atherosclerosis and other risk factors and the occurrence and recurrence of cerebral infarction, to compare the predictive value of the two to cerebral infarction, and to provide clinical guidance for the prevention and improvement of the prognosis of cerebral infarction. Methods: from January 2015 to December 2016, 248 patients with cerebral infarction aged 60 and above were randomly selected from the patients who were hospitalized in the neurology department of the University of JDA from January 2015 to December 2016. According to the incidence, the patients were divided into primary cerebral infarction group (144 cases) and recurrent cerebral infarction group (104 cases), and 256 cases of non cerebral infarction aged 60 years old and above were selected in the same period of hospitalization. The patients were compared with the control group, compared with the cerebral infarction group and the control group, the difference between the carotid atherosclerosis and the related factors in the primary cerebral infarction group and the recurrent cerebral infarction group. All the variables were analyzed by Logistic regression analysis to analyze the independent risk factors of the occurrence and recurrence of cerebral infarction. P0.05 thought that the number of risk factors was statistically significant (mode 1). The score of carotid arteriosclerosis (mode 2) was integrated and integrated (mode 3) to evaluate the predictive value of three kinds of integration on cerebral infarction, and their sensitivity and specificity were compared respectively. Results: (1) the degree of carotid stenosis and IMT score in cerebral infarction group were significantly higher than those in the control group (P0.05). (2) brain (2) The age, FBG, the prevalence of hypertension and diabetes and the proportion of smoking in the infarction group were significantly higher than those in the control group, and the difference was statistically significant (P0.05), but there was no significant difference in sex, TC, TG, LDL in the two groups. (3) the above variables were analyzed by Logistic, and the history of hypertension, diabetes, smoking, and IMT points were cerebral infarction. (4) the internal and middle membrane thickness (IMT) integral and the degree of carotid stenosis in the recurrent cerebral infarction group were significantly higher than those in the primary cerebral infarction group, with statistical significance (P0.05), but there was no significant difference in plaque detection rate (P0.05). (5) the incidence of hypertension, diabetes and smoking in the patients with recurrent cerebral infarction were significantly higher than that in the early onset of cerebral infarction. The differences in cerebral infarction group were statistically significant (P0.05), while age, sex, cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL) and fasting blood glucose (FBG) were not statistically significant (P0.05). (6) the above variables were analyzed by Logistic, and the history of hypertension, diabetes, smoking and IMT integral were the recurrence of cerebral infarction. Independent risk factors. (7) model 1 and mode 2, two kinds of integral and cerebral infarction have correlation, ROC curve analysis, three kinds of integral curve under 0.5, P value is less than 0.05, the number of risk factors and carotid artery sclerosis combined with the pattern 3 of the ROC area far greater than the pattern 1 and 2. conclusions: (1) comprehensive consideration of carotid artery The IMT integral of sclerotherapy is an independent risk factor for the occurrence and recurrence of cerebral infarction. Therefore, it is necessary to strengthen the screening of carotid color Doppler ultrasound and intervene early to prevent the occurrence of cerebral infarction. (2) hypertension, diabetes, smoking and cerebral infarction have a significant correlation with the occurrence and recurrence of cerebral infarction, and the patients with these risk factors are dry early. It is an important means to implement effective chronic disease management. (3) the occurrence of cerebral infarction is positively related to age, and early intervention for elderly patients can not be ignored. (4) comprehensive consideration of the risk factors and carotid atherosclerosis can improve the predictive value of cerebral infarction.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

【相似文獻】

相關期刊論文 前10條

1 宋宛竹,王琳;社區(qū)人群258例頸動脈硬化調查[J];中國臨床康復;2003年05期

2 ;頸動脈內膜切除術及其進展學習班暨首屆全國頸動脈硬化狹窄外科治療學術研討會征文通知[J];中華普通外科雜志;2004年09期

3 方衛(wèi)華;田東;陳友東;蘇航;;老年頸動脈硬化患者血清C反應蛋白測定及意義[J];感染 炎癥 修復;2004年04期

4 楊明;吳政;;老年人非酒精性脂肪性肝病與頸動脈硬化關系的探討(附96例分析)[J];福建醫(yī)藥雜志;2008年06期

5 胡玉英;劉泰;胡躍強;張青萍;何乾超;梁妮;;頸動脈硬化研究進展[J];中西醫(yī)結合心腦血管病雜志;2011年07期

6 趙清水;張瓊;黃少平;;北京市房山區(qū)農村中老年人群頸動脈硬化及其影響因素的分析[J];中國慢性病預防與控制;2012年06期

7 蘇雯娟;梅仕屏;張怡文;胡蓓君;丁赫;;540例老年人頸動脈硬化與非高密度脂蛋白膽固醇的關系探討[J];老年醫(yī)學與保健;2005年04期

8 黃位水;方衛(wèi)華;蘇航;;老年頸動脈硬化患者血清中脂聯素測定及意義[J];人民軍醫(yī);2007年09期

9 ;國家級繼續(xù)教育項目第五期“頸動脈硬化狹窄外科治療及進展”學習班通知[J];中國微侵襲神經外科雜志;2008年02期

10 ;國家級繼續(xù)教育項目第五期頸動脈硬化狹窄外科治療及進展學習班[J];診斷學理論與實踐;2008年02期

相關會議論文 前10條

1 何惠瓊;陳薇;林愛珍;郭水英;;頸動脈硬化綜合征61例分析[A];2009全國中西醫(yī)結合周圍血管疾病學術交流會論文集[C];2009年

2 陳莉;;動脈粥樣硬化性腦卒中與頸動脈硬化參數的相關性研究[A];2010年超聲醫(yī)學和醫(yī)學超聲論壇會議論文集[C];2010年

3 朱文暉;張夢璽;;頸動脈硬化的超聲改變與冠狀動脈病變的相關性研究[A];中華醫(yī)學會心血管病分會第八次全國心血管病學術會議匯編[C];2004年

4 崔可飛;王學清;楊一凌;;血漿不對稱二甲基精氨酸水平與頸動脈硬化之間關系的研究[A];中國超聲醫(yī)學工程學會第三次全國淺表器官及外周血管超聲醫(yī)學學術會議（高峰論壇）論文匯編[C];2011年

5 楊文;王曉璐;喬鋒利;劉柏輝;張艷華;于艷春;;老年人脈壓與C-反應蛋白和頸動脈硬化的關系[A];第九次全國中西醫(yī)結合虛證與老年病學術會議論文集[C];2007年

6 劉長建;黃佃;劉晨;王煒;冉峰;;頸動脈內膜剝脫術治療頸動脈硬化狹窄[A];中國中西醫(yī)結合學會周圍血管疾病專業(yè)委員會周圍血管疾病學術會議論文集[C];2007年

7 江朝強;徐琳;林潔明;林大慶;張維森;劉斌;靳雅麗;鄭家強;Thomas GN;;吸煙與戒煙對頸動脈硬化產生截然不同的結局——廣州生物庫心血管疾病亞隊列[A];第15屆全國控制吸煙學術研討會論文集[C];2011年

8 丹倫;徐書真;;44例拉薩市藏族患者頸動脈粥樣硬化斑塊發(fā)病率分析[A];中國超聲醫(yī)學工程學會第十一屆全國超聲醫(yī)學學術大會論文匯編[C];2012年

9 袁喬英;李慧梅;普麗絲;何剛;;老年2型糖尿病患者血尿酸與頸動脈硬化相關性探討[A];中華醫(yī)學會糖尿病學分會第十六次全國學術會議論文集[C];2012年

10 李書兵;藿芝蓉;;頸動脈硬化與心腦血管疾病的相關性研究[A];第十一次全國急診醫(yī)學學術會議暨中華醫(yī)學會急診醫(yī)學分會成立二十周年慶典論文匯編[C];2006年

相關博士學位論文 前2條

1 潘靜;中國南方老年人群肺功能與亞臨床頸動脈硬化的相關性研究[D];南方醫(yī)科大學;2016年

2 向靜;老年認知功能障礙與頸動脈硬化及相關基因多態(tài)性研究[D];第三軍醫(yī)大學;2013年

相關碩士學位論文 前10條

1 代玲芝;MHD患者頸動脈硬化臨床相關因素分析[D];山西醫(yī)科大學;2015年

2 劉萌萌;腹膜透析頸動脈硬化患者蛋白質能量消耗的臨床研究[D];山西醫(yī)科大學;2016年

3 董雪;基于數據挖掘算法的頸動脈硬化斑塊診斷研究[D];陜西科技大學;2016年

4 徐盼盼;頸動脈硬化和其他危險因素與老年腦梗死的相關性分析[D];吉林大學;2017年

5 鐘金鵬;基于實驗室指標的頸動脈硬化模型的建立與評價[D];重慶醫(yī)科大學;2011年

6 吳海蘭;SAA1水平及其SAA1基因rs12218基因多態(tài)性與2型糖尿病及頸動脈IMT的相關性研究[D];延邊大學;2014年

7 盧致富;頸動脈硬化患者中醫(yī)體質特點研究[D];廣州中醫(yī)藥大學;2014年

8 李龍;大理地區(qū)同型半胱氨酸水平與頸動脈硬化的關系[D];大理學院;2015年

9 季業(yè);中老年男性2型糖尿病患者血清雌二醇水平和頸動脈硬化及代謝綜合征的關系[D];蘇州大學;2015年

10 韓延花;糖尿病及其頸動脈硬化患者脂聯素SNP45基因多態(tài)性與長期氧化應激相關性研究[D];延邊大學;2011年

，

本文編號：2096687