腔隙性腦梗死患者顱內(nèi)動(dòng)脈狹窄與腦白質(zhì)病變發(fā)生的關(guān)系
發(fā)布時(shí)間：2018-07-22 10:31
【摘要】：研究背景:腦白質(zhì)病變(white matter lesions,WML)是指腦室周圍及半卵圓中心區(qū)腦白質(zhì)的帽狀或斑片狀對(duì)稱性病變。WML在老年人群中有較高的發(fā)生率,嚴(yán)重的WML則會(huì)導(dǎo)致認(rèn)知功能下降、行走不穩(wěn)、吞咽困難等臨床表現(xiàn),嚴(yán)重影響老年人健康。WML由于病因和發(fā)病機(jī)制不清楚,治療困難,所以是臨床防治的難題。一些研究認(rèn)為WML主要是由小血管病引起,與高血壓、糖尿病、血脂異常以及吸煙、飲酒等血管危險(xiǎn)因素關(guān)系密切。腔隙性腦梗死與WML同為腦小血管病,在臨床中發(fā)現(xiàn)許多腔隙性腦梗死患者同時(shí)伴有WML,腔隙性腦梗死伴WML會(huì)加重WML的臨床癥狀和體征。50歲以上的中老年人群中顱內(nèi)動(dòng)脈狹窄主要是由動(dòng)脈粥樣硬化導(dǎo)致的,顱內(nèi)動(dòng)脈狹窄不僅是急性腦梗死發(fā)生的重要原因,而且還與WML的發(fā)生密切相關(guān)。但是,很少有文獻(xiàn)報(bào)道在腔隙性腦梗死患者中顱內(nèi)動(dòng)脈狹窄對(duì)WML發(fā)生、發(fā)展的影響。所以,我們將深入開展在腔隙性腦梗死患者中顱內(nèi)動(dòng)脈狹窄與WML發(fā)生關(guān)系的臨床研究,希望能對(duì)WML的防治起到重要作用。目的:探討腔隙性腦梗死患者顱內(nèi)動(dòng)脈狹窄與腦白質(zhì)病變(WML)發(fā)生之間的關(guān)系。方法:2015年1月-2016年10月連續(xù)收集在第三軍醫(yī)大學(xué)大坪醫(yī)院神經(jīng)內(nèi)科住院50歲以上529例腔隙性腦梗死患者的臨床資料。通過頭顱MRI評(píng)估是否存在WML,并根據(jù)Fazekas視覺評(píng)分法評(píng)估其嚴(yán)重程度。應(yīng)用64排螺旋CT進(jìn)行顱內(nèi)血管檢查,并參照癥狀性顱內(nèi)動(dòng)脈疾病華法林—阿司匹林研究方法評(píng)估顱內(nèi)動(dòng)脈狹窄率(管徑狹窄率≥50%診斷成立)。使用多因素logistic回歸模型分析顱內(nèi)動(dòng)脈狹窄與WML之間的關(guān)系。結(jié)果:1.共入組529例腔隙性腦梗死患者,平均年齡為65.8±7.9歲,273例(51.6%)為女性。WML有295例(55.7%),其中50-59歲,WML發(fā)生率是27.8%;60-69歲,WML發(fā)生率是56.0%;70-79歲,WML發(fā)生率是75.3%;80歲以上,WML發(fā)生率是88.7%。2.與無WML組比較,WML組年齡更大,高血壓、糖尿病、冠心病和顱內(nèi)動(dòng)脈狹窄的患病率更高(P0.05),收縮壓更高(P0.01),血漿TC濃度水平(P0.05)更高。WML組大腦中動(dòng)脈狹窄、大腦前動(dòng)脈狹窄和大腦后動(dòng)脈狹窄的發(fā)生率較無WML顯著增高(P0.05)。3.不同程度顱內(nèi)動(dòng)脈狹窄的WML評(píng)分有顯著的差異(P0.01)。與顱內(nèi)動(dòng)脈狹窄50%組相比,顱內(nèi)動(dòng)脈狹窄70-90%和90%組的WML評(píng)分更高(P0.01)。不同數(shù)目顱內(nèi)動(dòng)脈狹窄的WML評(píng)分有顯著的差異(P0.01)。與無顱內(nèi)動(dòng)脈狹窄組相比,顱內(nèi)動(dòng)脈狹窄2處和≥3處組的WML評(píng)分更高(P0.05;P0.01)。大腦中動(dòng)脈狹窄、大腦前動(dòng)脈狹窄和大腦后動(dòng)脈狹窄的程度與WML嚴(yán)重程度呈正相關(guān)關(guān)系(P0.01;P0.05;P0.05)。4.在調(diào)整了年齡、性別、高血壓、糖尿病、冠心病和總膽固醇這些危險(xiǎn)因素的影響后,logistic回歸分析顯示年齡(OR=1.42,95%CI=1.15-1.79,P0.01)、高血壓(OR=2.29,95%CI=1.54-3.02,P0.01)、糖尿病(OR=1.29,95%CI=1.19-1.45,P0.01)和顱內(nèi)動(dòng)脈狹窄(OR=1.94,95%CI=1.35-2.54,P0.01)與WML的發(fā)生風(fēng)險(xiǎn)有關(guān)。5.在調(diào)整了相關(guān)混雜因素后,大腦中動(dòng)脈狹窄(OR=2.91,95%CI=1.54-4.02,P0.01)與WML之間存在顯著的相關(guān)性。與顱內(nèi)動(dòng)脈狹窄50%組比,顱內(nèi)動(dòng)脈狹窄70-90%組(OR=1.74,95%CI=1.26-2.05,P0.01)和90%組(OR=2.38,95%CI=1.48-3.17,P0.01)與WML之間也存在顯著的相關(guān)性。此外,與無顱內(nèi)動(dòng)脈狹窄相比,顱內(nèi)動(dòng)脈狹窄2處(OR=1.34,95%CI=1.14-1.65,P0.05)和顱內(nèi)動(dòng)脈狹窄≥3處(OR=3.49,95%CI=1.78-4.77,P0.01)與WML之間同樣存在顯著的相關(guān)性。結(jié)論:1.在腔隙性腦梗死中,發(fā)現(xiàn)顱內(nèi)動(dòng)脈狹窄與WML的發(fā)生顯著相關(guān)。此外,年齡、高血壓、糖尿病也與WML的發(fā)生顯著相關(guān)。2.在腔隙性腦梗死中,發(fā)現(xiàn)大腦中動(dòng)脈狹窄、大腦前動(dòng)脈狹窄和大腦后動(dòng)脈狹窄程度與WML的嚴(yán)重程度呈正相關(guān)。3.在腔隙性腦梗死不同部位的顱內(nèi)動(dòng)脈狹窄中,大腦中動(dòng)脈狹窄增加2.9倍WML發(fā)生的風(fēng)險(xiǎn)。不同程度的顱內(nèi)動(dòng)脈狹窄中,發(fā)現(xiàn)顱內(nèi)動(dòng)脈狹窄70-90%和90%與WML發(fā)生有顯著的相關(guān)性,使WML的發(fā)生風(fēng)險(xiǎn)分別增加1.7和2.4倍。不同數(shù)目的顱內(nèi)動(dòng)脈狹窄中,發(fā)現(xiàn)顱內(nèi)動(dòng)脈狹窄2處和≥3處與WML的發(fā)生顯著相關(guān),使WML的發(fā)生風(fēng)險(xiǎn)分別增加1.3倍和3.5倍。
[Abstract]:Background: white matter lesions (WML) refers to the cap like or flaky symmetrical lesion of the white matter around the ventricle and the center of the oval circle..WML has a higher incidence in the elderly. Severe WML will lead to cognitive decline, unstable walking, dysphagia and other clinical manifestations, which seriously affect the healthy.WML in the elderly. Some studies suggest that WML is mainly caused by small vascular disease, which is closely related to hypertension, diabetes, dyslipidemia, and smoking, drinking and other vascular risk factors. Lacunar cerebral infarction and WML are small cerebrovascular diseases, and many lacunae are found in the clinic. The patients with cerebral infarction are accompanied with WML, lacunar cerebral infarction with WML will aggravate the clinical symptoms and signs of WML, and the intracranial artery stenosis is mainly caused by atherosclerosis in the middle aged and elderly people over.50 years old. The intracranial artery stenosis is not only an important cause of acute cerebral infarction, but also closely related to the occurrence of WML. However, few of them are related to the occurrence of WML. There are reports on the effects of intracranial artery stenosis on the occurrence and development of WML in patients with lacunar cerebral infarction. Therefore, we will carry out a clinical study on the relationship between intracranial artery stenosis and WML in patients with lacunar cerebral infarction and hope to play an important role in the prevention and control of WML. The relationship between narrow and white matter lesions (WML). Methods: the clinical data of 529 patients with lacunar infarction over 50 years of age in the neurology department of Daping Hospital of Third Military Medical University in October January 2015 were collected. WML was assessed by MRI in the head, and the severity of the patients was evaluated according to the Fazekas visual score. 64 The intracranial vascular examination was performed with a spiral CT, and the intracranial artery stenosis rate (the stenosis rate was more than 50%) was evaluated according to the warfarin aspirin study of symptomatic intracranial artery disease. Multiple factor Logistic regression model was used to analyze the relationship between intracranial artery stenosis and WML. Results: 529 cases of lacunar cerebral infarction in the 1. co group. The average age was 65.8 + 7.9 years, 273 (51.6%) women.WML had 295 (55.7%), of which 50-59 years, the incidence of WML was 27.8%; 60-69 years old, the incidence of WML was 56%; 70-79 years of age, the incidence of WML was 75.3%; the incidence of WML was 88.7%.2. and no WML group, the WML group was older, hypertension, diabetes, CHD, and intracranial artery stenosis. The prevalence rate is higher (P0.05), the systolic pressure is higher (P0.01), the plasma TC concentration (P0.05) is higher in the.WML group, the incidence of the stenosis of the anterior cerebral artery and the posterior cerebral artery is higher than that without WML (P0.05), the WML score of the intracranial artery stenosis in different degrees is significantly different (P0.01). Compared with the 50% groups of intracranial artery stenosis, The WML score of 70-90% and 90% groups was higher (P0.01). The WML score of different number of intracranial artery stenosis was significantly different (P0.01). Compared with the group without intracranial artery stenosis, the WML score of the intracranial artery stenosis group was higher (P0.05; P0.01). The middle cerebral artery stenosis, the anterior cerebral artery stenosis and the posterior cerebral artery stenosis were higher than those in the group without intracranial artery stenosis. Degree has a positive correlation with WML severity (P0.01; P0.05; P0.05).4. after adjusting the risk factors of age, sex, hypertension, diabetes, coronary heart disease and total cholesterol, logistic regression analysis showed age (OR=1.42,95%CI=1.15-1.79, P0.01), hypertension (OR=2.29,95%CI=1.54-3.02, P0.01), and diabetes (OR=1.29,95%CI=1.19-) 1.45, P0.01) and intracranial artery stenosis (OR=1.94,95%CI=1.35-2.54, P0.01) were associated with the risk of WML..5. had a significant correlation with WML (OR=2.91,95%CI=1.54-4.02, P0.01) after adjusting the related confounding factors. The 50% groups of intracranial stenosis were compared with the intracranial artery stenosis group 70-90% (OR=1.74,95%CI=1.26-2.05, There was a significant correlation between P0.01 and 90% groups (OR=2.38,95%CI=1.48-3.17, P0.01) and WML. In addition, there was a significant correlation between 2 intracranial artery stenosis (OR=1.34,95%CI=1.14-1.65, P0.05) and intracranial stenosis more than 3 (OR=3.49,95%CI=1.78-4.77, P0.01) and WML compared with no intracranial artery stenosis. Conclusion: 1. in the lacunar space. There is a significant correlation between intracranial artery stenosis and the occurrence of WML in cerebral infarction. In addition, age, hypertension, and diabetes are also associated with the occurrence of WML,.2. in lacunar cerebral infarction, the stenosis of middle cerebral artery, the degree of anterior cerebral artery stenosis and the degree of posterior cerebral artery stenosis are positively related to the severity of WML,.3. is not in lacunar infarction. In the same part of the intracranial artery stenosis, middle cerebral artery stenosis increased by 2.9 times the risk of WML. In different degrees of intracranial artery stenosis, there was a significant correlation between the occurrence of intracranial artery stenosis 70-90% and 90% and WML, which increased the risk of WML by 1.7 and 2.4 times respectively. A narrow 2 and more than 3 locations were significantly associated with the occurrence of WML, which increased the risk of WML by 1.3 times and 3.5 times respectively.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
本文編號(hào)：2137142
[Abstract]:Background: white matter lesions (WML) refers to the cap like or flaky symmetrical lesion of the white matter around the ventricle and the center of the oval circle..WML has a higher incidence in the elderly. Severe WML will lead to cognitive decline, unstable walking, dysphagia and other clinical manifestations, which seriously affect the healthy.WML in the elderly. Some studies suggest that WML is mainly caused by small vascular disease, which is closely related to hypertension, diabetes, dyslipidemia, and smoking, drinking and other vascular risk factors. Lacunar cerebral infarction and WML are small cerebrovascular diseases, and many lacunae are found in the clinic. The patients with cerebral infarction are accompanied with WML, lacunar cerebral infarction with WML will aggravate the clinical symptoms and signs of WML, and the intracranial artery stenosis is mainly caused by atherosclerosis in the middle aged and elderly people over.50 years old. The intracranial artery stenosis is not only an important cause of acute cerebral infarction, but also closely related to the occurrence of WML. However, few of them are related to the occurrence of WML. There are reports on the effects of intracranial artery stenosis on the occurrence and development of WML in patients with lacunar cerebral infarction. Therefore, we will carry out a clinical study on the relationship between intracranial artery stenosis and WML in patients with lacunar cerebral infarction and hope to play an important role in the prevention and control of WML. The relationship between narrow and white matter lesions (WML). Methods: the clinical data of 529 patients with lacunar infarction over 50 years of age in the neurology department of Daping Hospital of Third Military Medical University in October January 2015 were collected. WML was assessed by MRI in the head, and the severity of the patients was evaluated according to the Fazekas visual score. 64 The intracranial vascular examination was performed with a spiral CT, and the intracranial artery stenosis rate (the stenosis rate was more than 50%) was evaluated according to the warfarin aspirin study of symptomatic intracranial artery disease. Multiple factor Logistic regression model was used to analyze the relationship between intracranial artery stenosis and WML. Results: 529 cases of lacunar cerebral infarction in the 1. co group. The average age was 65.8 + 7.9 years, 273 (51.6%) women.WML had 295 (55.7%), of which 50-59 years, the incidence of WML was 27.8%; 60-69 years old, the incidence of WML was 56%; 70-79 years of age, the incidence of WML was 75.3%; the incidence of WML was 88.7%.2. and no WML group, the WML group was older, hypertension, diabetes, CHD, and intracranial artery stenosis. The prevalence rate is higher (P0.05), the systolic pressure is higher (P0.01), the plasma TC concentration (P0.05) is higher in the.WML group, the incidence of the stenosis of the anterior cerebral artery and the posterior cerebral artery is higher than that without WML (P0.05), the WML score of the intracranial artery stenosis in different degrees is significantly different (P0.01). Compared with the 50% groups of intracranial artery stenosis, The WML score of 70-90% and 90% groups was higher (P0.01). The WML score of different number of intracranial artery stenosis was significantly different (P0.01). Compared with the group without intracranial artery stenosis, the WML score of the intracranial artery stenosis group was higher (P0.05; P0.01). The middle cerebral artery stenosis, the anterior cerebral artery stenosis and the posterior cerebral artery stenosis were higher than those in the group without intracranial artery stenosis. Degree has a positive correlation with WML severity (P0.01; P0.05; P0.05).4. after adjusting the risk factors of age, sex, hypertension, diabetes, coronary heart disease and total cholesterol, logistic regression analysis showed age (OR=1.42,95%CI=1.15-1.79, P0.01), hypertension (OR=2.29,95%CI=1.54-3.02, P0.01), and diabetes (OR=1.29,95%CI=1.19-) 1.45, P0.01) and intracranial artery stenosis (OR=1.94,95%CI=1.35-2.54, P0.01) were associated with the risk of WML..5. had a significant correlation with WML (OR=2.91,95%CI=1.54-4.02, P0.01) after adjusting the related confounding factors. The 50% groups of intracranial stenosis were compared with the intracranial artery stenosis group 70-90% (OR=1.74,95%CI=1.26-2.05, There was a significant correlation between P0.01 and 90% groups (OR=2.38,95%CI=1.48-3.17, P0.01) and WML. In addition, there was a significant correlation between 2 intracranial artery stenosis (OR=1.34,95%CI=1.14-1.65, P0.05) and intracranial stenosis more than 3 (OR=3.49,95%CI=1.78-4.77, P0.01) and WML compared with no intracranial artery stenosis. Conclusion: 1. in the lacunar space. There is a significant correlation between intracranial artery stenosis and the occurrence of WML in cerebral infarction. In addition, age, hypertension, and diabetes are also associated with the occurrence of WML,.2. in lacunar cerebral infarction, the stenosis of middle cerebral artery, the degree of anterior cerebral artery stenosis and the degree of posterior cerebral artery stenosis are positively related to the severity of WML,.3. is not in lacunar infarction. In the same part of the intracranial artery stenosis, middle cerebral artery stenosis increased by 2.9 times the risk of WML. In different degrees of intracranial artery stenosis, there was a significant correlation between the occurrence of intracranial artery stenosis 70-90% and 90% and WML, which increased the risk of WML by 1.7 and 2.4 times respectively. A narrow 2 and more than 3 locations were significantly associated with the occurrence of WML, which increased the risk of WML by 1.3 times and 3.5 times respectively.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【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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