本文選題：臂間血壓差異 + 腦白質高信號�。� 參考：《南昌大學》2017年碩士論文

【摘要】：目的:近年來,隨著對臂間血壓差異(inter-arm blood pressure difference,IAD)研究的深入,其與血管疾病的相關性被越來越多的學者提出并接受。通過醫(yī)學病理基礎及多項臨床研究驗證,顯著的臂間血壓差異具有提示外周血管疾病、心血管疾病、腦卒中等疾病的意義,并且還有預測心腦血管疾病發(fā)病、預后和死亡的價值。腦白質高信號(white matter hyperintensities,WMH)是腦小血管病(cerebral small vessel disease,CSVD)多種影像學表現(xiàn)中最為重要的一種,可作為判定CSVD存在及嚴重程度的指標。現(xiàn)在的研究也愈發(fā)傾向腦大、小血管疾病在病理發(fā)生發(fā)展上具有連續(xù)性。本臨床試驗旨在通過測量IAD的大小及評估WMH的程度,探究IAD是否與CSVD的發(fā)生相關,可否作為判斷CSVD存在及嚴重程度的方便易得的臨床指標。方法:回顧性分析南昌大學第二附屬醫(yī)院神經內科2016年8~12月收治的住院病人,排除感染性、中毒性、外傷性等腦病患者后,共318例。對納入病人雙臂同時同步測量血壓2次,計算平均值得出IAD。收集納入病人基本信息與相關病史:年齡、性別、高血壓和糖尿病史、吸煙飲酒史;記錄納入病人檢驗血脂情況:膽固醇、甘油三酯、低密度脂蛋白以及同型半胱氨酸。通過顱腦磁共振評估病人的WMH情況(0-3分)。按照WMH得分將納入病人分為4組,對各組以上收集及測量的信息進行比較分析,找出組間有差異的因素并進行相關性分析。再將患有WMH病人分入組1,與無WMH病人組0進行差異比較。結果:318例入選病人,男性162例(50.94%),女性156例(49.06%),年齡15~92歲,平均年齡(67.36±12.29)歲。WMH得0分者87例(27.36%);1分者155例(48.74%);2分者59例(18.55%);3分者17例(5.35%)。4組平均年齡分別為:(58.83±12.42)歲,(68.96±10.13)歲,(73.54±11.19)歲,(75.00±9.89)歲,4組間比較差異有統(tǒng)計學意義(P0.05)。WMH與年齡相關分析:r值0.462,P值0.000,即兩者存在正相關性。4組平均臂間收縮壓差異(systolic pressure IAD,s IAD)分別為:(3.66±2.36)mmHg,(4.48±3.60)mmHg,(4.58±3.66)mmHg,(8.59±4.41)mmHg,四組間比較差異有統(tǒng)計學意義(P0.05)。4組間平均臂間舒張壓差異(diastolic pressure IAD,dIAD)分別為:(4.06±3.66)mm Hg,(4.06±3.42)mm Hg,(5.01±4.03)mm Hg,(6.88±3.52)mmHg,四組間比較差異有統(tǒng)計學意義(P0.05)。WMH與sIAD相關性檢驗:r值0.164,P值0.003,即存在一定相關性。WMH與d IAD相關性檢驗:r值0.150,P值0.007,即存在一定相關性。患有WMH的組1病人與無WMH組0病人對比分析:兩組間s IAD比較P值0.009(P0.05),差異有統(tǒng)計學意義;兩組間dIAD比較P值0.325(P(29)0.05),差異無統(tǒng)計學意義。結論:1、臂間血壓差與腦小血管病之間可能存在相關性,在一定程度上可能作為判斷腦小血管病存在及嚴重程度的預測因子,需要更大量樣本實驗驗證。2、收縮壓臂間血壓差較舒張壓臂間血壓差可能在判斷腦小血管病上更具有監(jiān)測價值。
[Abstract]:Objective: in recent years, with the in-depth study of inter-arm blood pressure difference (IAD), the correlation with vascular diseases has been put forward and accepted by more and more scholars. The significant difference in the inter arm blood pressure indicates peripheral vascular disease and cardiovascular disease through the medical pathology basis and many clinical studies. White matter hyperintensities (WMH) is the most important one of various imaging manifestations of cerebral small vascular disease (cerebral small vessel disease, CSVD), which can be used as an indicator to determine the existence and severity of CSVD, and to predict the significance of cerebral stroke disease and the prognostic and death value of cerebrovascular disease. The present study is increasingly prone to large brain and small vascular diseases in the progression of pathophysiological development. This clinical trial aims to explore whether IAD is associated with the occurrence of CSVD by measuring the size of IAD and assessing the degree of WMH, and can be used as a convenient and convenient clinical indicator to judge the existence and severity of CSVD. A total of 318 hospitalized patients admitted to the Department of Neurology of the Second Affiliated Hospital of the Second Affiliated Hospital of the Second Affiliated Hospital of the University in 2016 8~12 were excluded from infectious, toxic, traumatic and other encephalopathy. A total of 2 times of blood pressure were measured simultaneously by the simultaneous measurement of the two arms of the patients. The average value of IAD. collection was included in the patient's basic information and related history: age, sex, hypertension and diabetes history. The history of smoking and drinking was recorded in the patients: cholesterol, triglycerides, low density lipoprotein and homocysteine. The patients' WMH status was assessed by craniocerebral MRI (0-3 points). The patients were divided into 4 groups according to the WMH score, and the information of the collection and measurement of each group was compared and analyzed to find the difference between the groups. The WMH patients were divided into group 1 and compared with group 0 without WMH. Results: 318 patients were enrolled, 162 men (50.94%), 156 women (49.06%), age of 15~92, 87 (27.36%) of average age (67.36 + 12.29) years, 0, 1,.4, and.4 The average age of the group was (58.83 + 12.42) years, (68.96 + 10.13) years, (73.54 + 11.19) years and (75 + 9.89) years old. There was a statistically significant difference between the 4 groups (P0.05).WMH and age correlation analysis: the R value 0.462, the P value 0, that is, the difference of the mean inter arm systolic pressure (systolic pressure IAD, s IAD) in the.4 group (3.66 + 2.36) mmH (3.66 + 2.36) mmH G (4.48 + 3.60) mmHg, (4.58 + 3.66) mmHg and (8.59 + 4.41) mmHg, the difference between the four groups was statistically significant (diastolic pressure IAD, dIAD), respectively (4.06 + 3.66) mm Hg, (4.06 + 3.42) AD correlation test: R value 0.164, P value 0.003, that is, the correlation test of correlation.WMH and D IAD: R value 0.150, P value 0.007, that is, there is a certain correlation. The group 1 patients with WMH are compared with the 0 patients without WMH group: two groups of s IAD compared with 0.009, the difference is statistically significant; the difference between two groups is 0.325 (29) 0.05), differences No statistical significance. Conclusion: 1, the correlation between the inter arm blood pressure difference and cerebral small vascular disease may be a predictor of the presence and severity of cerebral small vascular disease to a certain extent. A large number of samples are needed to verify the.2. The difference in systolic pressure between the arm and the systolic pressure between the arms may be used to judge the cerebral small blood vessel disease. It is more valuable in monitoring.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743

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