側(cè)支循環(huán)對中青年大腦中動脈慢性閉塞的影響
發(fā)布時間：2018-08-07 07:41
【摘要】：研究背景： 近年來，腦梗死發(fā)病年齡逐漸呈現(xiàn)出年輕化趨勢，中青年腦梗死發(fā)病原因、其危險因素及發(fā)病的內(nèi)在機制是近年來研究的焦點。在腦的供血動脈發(fā)生嚴(yán)重狹窄或閉塞時，腦的側(cè)支循環(huán)建立可以通過增加腦血流量來防止腦缺血的發(fā)生，腦側(cè)支循環(huán)網(wǎng)絡(luò)的建立和發(fā)展對缺血性腦血管病的預(yù)防和治療具有極其重要的作用。小血管梗死是一個非常復(fù)雜的現(xiàn)象，它的內(nèi)在機制更是近年來研究的熱點。目前大多數(shù)的研究主要探討的是大血管的梗死的臨床特點、影響因素和治療方法，而對于一些不明原因的腦梗死，例如大腦中動脈慢性閉塞后發(fā)生的腦梗死的研究卻比較少見，對中青年小血管梗死的研究則更少，這對于腦梗死機制的闡明和小血管梗死臨床針對性治療造成極大的限制。本研究的患者都是單側(cè)大腦中動脈M1段慢性閉塞的患者，他們之中新發(fā)小血管梗死的患者的比例很高，由此可以對小血管梗死的特點進行研究。同時，這部分患者的側(cè)支循環(huán)建立與其小血管梗死之間有怎樣的關(guān)系？以往關(guān)于腦血管傳統(tǒng)危險因素與側(cè)支循環(huán)之間的關(guān)系的結(jié)論存在的不一致性，那么對于單側(cè)大腦中動脈M1段慢性閉塞的患者其危險因素又和側(cè)支循環(huán)的建立有怎樣的關(guān)系？這是本研究要探索的問題。 研究目的： 探討中青年單側(cè)大腦中動脈起始段（M1段）慢性閉塞后新發(fā)腦梗死患者的側(cè)支循環(huán)與腦梗死的關(guān)系，腦血管危險因素與腦梗死的關(guān)系，以及腦血管危險因素對中青年單側(cè)大腦中動脈起始段（M1段）慢性閉塞患者側(cè)支循環(huán)建立的影響。 研究方法: 分析2009年7月—2013年6月就診于我院神經(jīng)內(nèi)科的90例單純M1段慢性閉塞患者的臨床資料，其中男48例，女42例，平均（44.6±9.7）歲，并將其分為新發(fā)腦梗死組和無腦梗死組兩組，有新發(fā)梗死灶者50例，無腦梗死灶者40例。并對其腦梗死發(fā)病情況、腦血管危險因素情況、及其側(cè)支循環(huán)建立的情況，以及它們之間的相互關(guān)系進行分析。 研究結(jié)果: 1.90例M1段慢性閉塞患者年齡分布趨勢為50~59歲組最多，占37.8%，20~29歲組最少，占8.9%。有無腦梗死兩組患者年齡分布差異無統(tǒng)計學(xué)意義，χ2=4.394，P0.05。 2.高血脂、糖尿病、吸煙、高血壓、高同型半胱氨酸血癥等危險因素與是否發(fā)生腦梗死無顯著相關(guān)性。 3.大腦中動脈慢性閉塞患者側(cè)支血流分級與其是否有腦梗死呈顯著的負(fù)相關(guān)（r=-0.76，p0.01），新發(fā)腦梗死組側(cè)支血流分級（采用ASITN/SIR的血流分級系統(tǒng)評估）1、2級占84%，而無腦梗死組1、2級只占10%，3、4級占90%，高于有腦梗死者，，側(cè)支血流分級與腦梗死發(fā)生呈負(fù)相關(guān)，γs=-0.76，P0.01。 4.有無腦血管危險因素兩組的側(cè)支開放程度1級（前交通動脈和后交通動脈）、2級（眼動脈逆流和軟腦膜側(cè)支）和3級（新生血管）是否開放的差異均無統(tǒng)計學(xué)意義（P均＞0.05）。Spearman相關(guān)分析顯示，側(cè)支開放程度1級是否開放與年齡、發(fā)生高血壓、高血脂、糖尿病、吸煙呈正相關(guān)，與高同型半胱氨酸血癥呈負(fù)相關(guān)，但差異均無統(tǒng)計學(xué)意義（P均＞0.05）；側(cè)支開放程度2級是否開放與年齡、發(fā)生高血壓、吸煙、高同型半胱氨酸血癥呈負(fù)相關(guān)，與高血脂、糖尿病呈正相關(guān)，但差異均無統(tǒng)計學(xué)意義（P均＞0.05）；側(cè)支開放程度3級是否開放與高血壓、高血脂、糖尿病、吸煙呈正相關(guān)，與年齡、同型半胱氨酸血癥呈負(fù)相關(guān)，但差異均無統(tǒng)計學(xué)意義（P均＞0.05）。 5.側(cè)支血流分級與高血壓、同型半胱氨酸血癥、吸煙之間的相關(guān)為負(fù)相關(guān)，而側(cè)支血流分級與高血脂、糖尿病之間的相關(guān)為正相關(guān)，但差異均無統(tǒng)計學(xué)意義（P均＞0.05）。只有糖尿病與側(cè)支血流之間的相關(guān)在統(tǒng)計學(xué)上顯著。 結(jié)論: 1.本研究未顯示腦血管病的傳統(tǒng)危險因素與腦梗死發(fā)生，以及腦血管病的傳統(tǒng)危險因素與側(cè)支循環(huán)開放程度和側(cè)支血流分級具有相關(guān)性。 2.MCA-M1段慢性閉塞使得側(cè)支循環(huán)有充分時間建立，其側(cè)支循環(huán)的血流分級起到重要作用，血流分級越高越不容易發(fā)生腦梗死。 3.本研究結(jié)果從側(cè)面支持大腦中動脈慢性閉塞后，如果血管神經(jīng)網(wǎng)絡(luò)建立不充分，動脈的上游神經(jīng)血管單元灌注阻力則會增加，從而會減少下游神經(jīng)血管單元的灌注，使其供血不完全而導(dǎo)致梗死，可能是發(fā)生此類梗死重要的機制之一。 4.本研究結(jié)果顯示，側(cè)支血流分級是側(cè)支循環(huán)評估指標(biāo)中一個較為敏感和有效的指標(biāo)，未來關(guān)于側(cè)支循環(huán)的研究要充分考慮側(cè)支隨時間的動態(tài)變化的特點，且有必要將其納入重要的研究指標(biāo)，來探索側(cè)支循環(huán)的形成、建立和發(fā)揮代償作用的內(nèi)在機理。 5.未來的在腦卒中研究中，要將那些動脈慢性閉塞且有充分時間建立側(cè)支，但是其側(cè)支代償很差的患者重點納入到研究當(dāng)中。
[Abstract]:Research background:
In recent years, the age of cerebral infarction is becoming more and more young, the cause of cerebral infarction, the risk factors and the internal mechanism of the disease are the focus of research in recent years. In the case of severe stenosis or occlusion of the cerebral blood supply artery, the cerebral collateral circulation can be established through increasing the cerebral blood flow to prevent the occurrence of cerebral ischemia. The establishment and development of the collateral circulation network plays an extremely important role in the prevention and treatment of ischemic cerebrovascular disease. Small vascular infarction is a very complicated phenomenon. Its internal mechanism is a hot spot in recent years. Most of the research mainly focuses on the clinical characteristics, influencing factors and treatment of large vascular infarction. Methods, but for some unexplained cerebral infarction, such as the cerebral infarction that occurs after the chronic occlusion of the middle cerebral artery, the study of small and middle infarcts of small vessels is less, which makes a great limitation on the clarification of the mechanism of cerebral infarction and the clinical targeted treatment of small vascular infarction. In patients with chronic M1 segment of the middle cerebral artery, the proportion of the patients with new small vascular infarction is very high, which can be used to study the characteristics of small vascular infarction. At the same time, what is the relationship between the establishment of the collateral circulation and the small vascular infarction in this part of the patients? What is the relationship between the risk factors and the establishment of collateral circulation in patients with M1 segment chronic occlusion of the unilateral middle cerebral artery? This is a question to be explored in this study.
The purpose of the study is:
To investigate the relationship between collateral circulation and cerebral infarction, the relationship between cerebral vascular risk factors and cerebral infarction, and the effect of cerebrovascular risk factors on collateral circulation in patients with chronic occlusion of middle middle cerebral artery (M1 segment) of middle cerebral artery (M1 segment) after chronic occlusion of middle cerebral artery in young and middle-aged patients.
Research methods:
The clinical data of 90 patients with simple M1 segment chronic occlusion in the Department of Neurology from July 2009 to June 2013 were analyzed, including 48 males and 42 females, averaging (44.6 + 9.7) years old. They were divided into new onset cerebral infarction group and two group without cerebral infarction, 50 cases with new infarcts and 40 patients without cerebral infarction. The situation of vascular risk factors, the establishment of collateral circulation, and the relationship between them were analyzed.
The results of the study:
The age distribution trend of 1.90 patients with M1 segment chronic occlusion was the most in 50~59 years old group, accounting for 37.8%, and the least in 20~29 year old group. There was no statistical difference in age distribution between the two groups of 8.9%. patients with cerebral infarction, X 2=4.394, P0.05..
2. Hyperlipidemia, diabetes mellitus, smoking, hypertension, hyperhomocysteinemia and other risk factors have no significant correlation with the occurrence of cerebral infarction.
3. the lateral branch blood flow classification of the patients with chronic cerebral artery occlusion was significantly negatively correlated with cerebral infarction (r=-0.76, P0.01). The level of lateral branch blood flow in the new cerebral infarction group (using the ASITN/SIR blood flow classification system) was 84%, while the 1,2 level in the non cerebral infarction group was 10%, and the 3,4 level was 90%, which was higher than that of the cerebral infarction and the lateral branch blood flow classification. The incidence of cerebral infarction was negative correlation, gamma s=-0.76, P0.01.
4. there were 1 levels of lateral branch openness (anterior communicating artery and posterior communicating artery) in two groups without cerebral vascular risk factors, and there was no significant difference in the opening of level 2 (ocular artery countercurrent and lateral branch of MMA) and 3 (P > 0.05). Hyperlipidemia, diabetes and smoking were positively correlated with hyperhomocysteinemia, but the difference was not statistically significant (P > 0.05). The opening degree of lateral branch 2 was negatively correlated with high blood pressure, smoking and hyperhomocysteinemia, and was positively correlated with hyperlipidemia and diabetes, but the difference was not statistically significant. Meaning (P > 0.05); the opening degree of lateral branch 3 was positively correlated with hypertension, hyperlipidemia, diabetes and smoking, and was negatively correlated with age and homocysteine, but the difference was not statistically significant (P > 0.05).
5. lateral branch blood flow classification was negatively correlated with hypertension, homocysteine and smoking, but the correlation between collateral flow classification and hyperlipidemia and diabetes was positively correlated, but the difference was not statistically significant (P > 0.05). Only the correlation between diabetes and collateral flow was statistically significant.
Conclusion:
1. the traditional risk factors for cerebrovascular disease and cerebral infarction, as well as the traditional risk factors for cerebrovascular disease, are related to the degree of collateral circulation opening and the classification of collateral flow.
The chronic occlusion of the 2.MCA-M1 segment makes the collateral circulation fully established. The blood flow classification of the collateral circulation plays an important role. The higher the blood flow classification, the less prone to cerebral infarction.
3. the results of this study support the chronic occlusion of the middle cerebral artery. If the vascular neural network is not established sufficiently, the perfusion resistance of the upstream neurovascular unit will increase, which will reduce the perfusion of the downstream neurovascular units and make the blood supply incomplete and lead to infarction, which may be one of the important mechanisms of this kind of infarction.
4. the results of the study show that the lateral branch flow classification is a more sensitive and effective indicator of collateral circulation assessment. The future study of collateral circulation should take full account of the characteristics of the dynamic changes in the collateral circulation with time, and it is necessary to incorporate it into important research indicators to explore the formation of collateral circulation and to establish and play compensation for the collateral circulation. The internal mechanism of use.
5. in the future study of cerebral apoplexy, those arteries should be blocked by chronic occlusion and have sufficient time to establish collateral, but the patients with very poor collateral compensatory focus are included in the study.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3
本文編號：2169334
[Abstract]:Research background:
In recent years, the age of cerebral infarction is becoming more and more young, the cause of cerebral infarction, the risk factors and the internal mechanism of the disease are the focus of research in recent years. In the case of severe stenosis or occlusion of the cerebral blood supply artery, the cerebral collateral circulation can be established through increasing the cerebral blood flow to prevent the occurrence of cerebral ischemia. The establishment and development of the collateral circulation network plays an extremely important role in the prevention and treatment of ischemic cerebrovascular disease. Small vascular infarction is a very complicated phenomenon. Its internal mechanism is a hot spot in recent years. Most of the research mainly focuses on the clinical characteristics, influencing factors and treatment of large vascular infarction. Methods, but for some unexplained cerebral infarction, such as the cerebral infarction that occurs after the chronic occlusion of the middle cerebral artery, the study of small and middle infarcts of small vessels is less, which makes a great limitation on the clarification of the mechanism of cerebral infarction and the clinical targeted treatment of small vascular infarction. In patients with chronic M1 segment of the middle cerebral artery, the proportion of the patients with new small vascular infarction is very high, which can be used to study the characteristics of small vascular infarction. At the same time, what is the relationship between the establishment of the collateral circulation and the small vascular infarction in this part of the patients? What is the relationship between the risk factors and the establishment of collateral circulation in patients with M1 segment chronic occlusion of the unilateral middle cerebral artery? This is a question to be explored in this study.
The purpose of the study is:
To investigate the relationship between collateral circulation and cerebral infarction, the relationship between cerebral vascular risk factors and cerebral infarction, and the effect of cerebrovascular risk factors on collateral circulation in patients with chronic occlusion of middle middle cerebral artery (M1 segment) of middle cerebral artery (M1 segment) after chronic occlusion of middle cerebral artery in young and middle-aged patients.
Research methods:
The clinical data of 90 patients with simple M1 segment chronic occlusion in the Department of Neurology from July 2009 to June 2013 were analyzed, including 48 males and 42 females, averaging (44.6 + 9.7) years old. They were divided into new onset cerebral infarction group and two group without cerebral infarction, 50 cases with new infarcts and 40 patients without cerebral infarction. The situation of vascular risk factors, the establishment of collateral circulation, and the relationship between them were analyzed.
The results of the study:
The age distribution trend of 1.90 patients with M1 segment chronic occlusion was the most in 50~59 years old group, accounting for 37.8%, and the least in 20~29 year old group. There was no statistical difference in age distribution between the two groups of 8.9%. patients with cerebral infarction, X 2=4.394, P0.05..
2. Hyperlipidemia, diabetes mellitus, smoking, hypertension, hyperhomocysteinemia and other risk factors have no significant correlation with the occurrence of cerebral infarction.
3. the lateral branch blood flow classification of the patients with chronic cerebral artery occlusion was significantly negatively correlated with cerebral infarction (r=-0.76, P0.01). The level of lateral branch blood flow in the new cerebral infarction group (using the ASITN/SIR blood flow classification system) was 84%, while the 1,2 level in the non cerebral infarction group was 10%, and the 3,4 level was 90%, which was higher than that of the cerebral infarction and the lateral branch blood flow classification. The incidence of cerebral infarction was negative correlation, gamma s=-0.76, P0.01.
4. there were 1 levels of lateral branch openness (anterior communicating artery and posterior communicating artery) in two groups without cerebral vascular risk factors, and there was no significant difference in the opening of level 2 (ocular artery countercurrent and lateral branch of MMA) and 3 (P > 0.05). Hyperlipidemia, diabetes and smoking were positively correlated with hyperhomocysteinemia, but the difference was not statistically significant (P > 0.05). The opening degree of lateral branch 2 was negatively correlated with high blood pressure, smoking and hyperhomocysteinemia, and was positively correlated with hyperlipidemia and diabetes, but the difference was not statistically significant. Meaning (P > 0.05); the opening degree of lateral branch 3 was positively correlated with hypertension, hyperlipidemia, diabetes and smoking, and was negatively correlated with age and homocysteine, but the difference was not statistically significant (P > 0.05).
5. lateral branch blood flow classification was negatively correlated with hypertension, homocysteine and smoking, but the correlation between collateral flow classification and hyperlipidemia and diabetes was positively correlated, but the difference was not statistically significant (P > 0.05). Only the correlation between diabetes and collateral flow was statistically significant.
Conclusion:
1. the traditional risk factors for cerebrovascular disease and cerebral infarction, as well as the traditional risk factors for cerebrovascular disease, are related to the degree of collateral circulation opening and the classification of collateral flow.
The chronic occlusion of the 2.MCA-M1 segment makes the collateral circulation fully established. The blood flow classification of the collateral circulation plays an important role. The higher the blood flow classification, the less prone to cerebral infarction.
3. the results of this study support the chronic occlusion of the middle cerebral artery. If the vascular neural network is not established sufficiently, the perfusion resistance of the upstream neurovascular unit will increase, which will reduce the perfusion of the downstream neurovascular units and make the blood supply incomplete and lead to infarction, which may be one of the important mechanisms of this kind of infarction.
4. the results of the study show that the lateral branch flow classification is a more sensitive and effective indicator of collateral circulation assessment. The future study of collateral circulation should take full account of the characteristics of the dynamic changes in the collateral circulation with time, and it is necessary to incorporate it into important research indicators to explore the formation of collateral circulation and to establish and play compensation for the collateral circulation. The internal mechanism of use.
5. in the future study of cerebral apoplexy, those arteries should be blocked by chronic occlusion and have sufficient time to establish collateral, but the patients with very poor collateral compensatory focus are included in the study.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3
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