【摘要】：缺血性卒中20%發(fā)生在后循環(huán)，前后循環(huán)梗死的發(fā)病原因及機(jī)制不盡相同，目前，有關(guān)血管病變?cè)谇把h(huán)梗死中的作用，已得到肯定的認(rèn)可，而在后循環(huán)中的作用亦逐漸被認(rèn)識(shí)，本研究首先確定血管病變?cè)诤笱h(huán)梗死中的作用，繼而探討影像學(xué)及臨床特征對(duì)于后循環(huán)相關(guān)血管病變的預(yù)測(cè)作用。 【目的】 1、探討血管病變與后循環(huán)梗死間的相關(guān)性及其影響因素； 2、探討后循環(huán)血管病變的相關(guān)危險(xiǎn)因素； 3、探討后循環(huán)梗死影像學(xué)部位在血管病變預(yù)測(cè)中的作用； 4、探討后循環(huán)梗死臨床特征（包括嚴(yán)重程度和臨床表現(xiàn)）在血管病變預(yù)測(cè)中的作用； 【方法】 回顧分析2010年3月至2013年12月在南京大學(xué)醫(yī)學(xué)院附屬鼓樓醫(yī)院、靖江市人民醫(yī)院神經(jīng)內(nèi)科、神經(jīng)外科住院治療的172例后循環(huán)缺血患者，根據(jù)頭顱磁共振結(jié)果分為有無(wú)新發(fā)梗死存在，梗死部位分為近段、中段和遠(yuǎn)段梗死，梗死嚴(yán)重程度采用美國(guó)國(guó)立衛(wèi)生研究院卒中量表（NIHSS）評(píng)分。經(jīng)數(shù)字減影血管造影（DSA）判定其血管病變情況，并記錄其性別、年齡、生化指標(biāo)及相關(guān)病史、臨床表現(xiàn)等。（1）比較不同程度血管狹窄在有無(wú)腦梗死組間的分布差異，進(jìn)一步分析血管重度狹窄-閉塞在腦梗死發(fā)病中的作用及其相關(guān)危險(xiǎn)因素；（2）分析后循環(huán)梗死病灶分布模式及與血管重度狹窄-閉塞間的相關(guān)性；（3）分析后循環(huán)梗死臨床特征與血管重度狹窄-閉塞間的相關(guān)性。 【結(jié)果】 1、不同程度的血管狹窄在有無(wú)腦梗死組間存在顯著的分布差異（Χ2=7.881，P=0.019），腦梗死組具有更高的重度狹窄-閉塞發(fā)生率（63%vs41%，P0.05）；回歸分析顯示，血管重度狹窄-閉塞為后循環(huán)梗死的重要危險(xiǎn)因素（OR=2.293，，95%CI=1.180-4.455，P=0.014），以上數(shù)值雖然經(jīng)過(guò)高密度脂蛋白、膽固醇、甘油三酯和纖維蛋白原等相關(guān)因素校正后，仍為其獨(dú)立的危險(xiǎn)因素（OR=2.947，95%CI=1.407-6.174，P=0.004）；對(duì)于重度血管狹窄-閉塞的發(fā)生，回歸分析顯示高血壓和尿酸為其重要危險(xiǎn)因素，OR（95%CI，P值）分別為3.574（1.774-7.204，0.000）和1.004（1.001-1.007，0.010）； 2、重度血管狹窄-閉塞在不同梗死部位的后循環(huán)梗死中發(fā)生率不同，近段組發(fā)生率顯著升高（82%vs51%or59%，P=0.006or0.039），進(jìn)一步的logistic回歸分析顯示，以中段組為參照，遠(yuǎn)段組和近段組OR（95%CI，P值）分別為1.357（0.592-3.110，0.470）和4.423（1.455-13.448，0.009）；由于重度血管狹窄-閉塞發(fā)生在椎動(dòng)脈呈優(yōu)勢(shì)性選擇，對(duì)于椎動(dòng)脈重度狹窄-閉塞與近段梗死的相關(guān)性分析顯示兩者密切相關(guān)，其R和P值為0.343和0.000；對(duì)于后循環(huán)梗死是否發(fā)生在近段的回歸分析顯示，以椎動(dòng)脈無(wú)重度狹窄-閉塞為參照，重度狹窄和閉塞組的OR（95%CI，P值）分別為3.167（1.023-9.802，0.046）和15.437（4.567-52.180，0.000）； 3、重度血管狹窄-閉塞在不同嚴(yán)重程度的后循環(huán)梗死中發(fā)生率不同，表現(xiàn)為輕癥患者相對(duì)較低而重癥患者較高，與NIHSS評(píng)分小于4分組相比，大于8分組顯著升高（73%vs47%，P=0.023）；進(jìn)一步的logistic回歸分析顯示，以小于4分組為參照，4到7分組和大于8分組OR（95%CI，P值）分別為2.228（0.952-5.215，0.065）和3.162（1.155-8.656，0.025）；對(duì)于重度血管狹窄-閉塞與具體臨床癥狀間的回歸分析顯示，均未表現(xiàn)出明顯的相關(guān)性。 【結(jié)論】 1、后循環(huán)梗死的發(fā)生與其相關(guān)血管重度狹窄-閉塞的存在密切相關(guān)； 2、近段梗死易于合并存在后循環(huán)的重度狹窄-閉塞，尤其是椎動(dòng)脈； 3、臨床癥狀較重的后循環(huán)梗死更易于合并存在重度血管狹窄-閉塞。
[Abstract]:20% of ischemic stroke occurs in the posterior circulation. The causes and mechanisms of anterior and posterior circulation infarction are different. At present, the role of vascular lesions in anterior circulation infarction has been recognized, and the role of vascular lesions in the posterior circulation has been gradually recognized. Prediction of posterior circulation related vascular diseases by imaging and clinical features.
[Objective]
1, to explore the correlation between vascular lesions and posterior circulation infarction and its influencing factors.
2, to explore the related risk factors of posterior circulation vascular disease.
3, to explore the role of posterior circulation infarct imaging site in prediction of vascular disease.
4. To explore the role of clinical features (including severity and clinical manifestations) of posterior circulation infarction in predicting vascular disease.
[method]
A retrospective analysis of 172 patients with posterior circulation ischemia admitted to the Department of Neurology and Neurosurgery of Jingjiang People's Hospital, Gulou Hospital Affiliated to Medical College of Nanjing University from March 2010 to December 2013 was carried out. According to the results of cranial magnetic resonance imaging, the patients were divided into new infarction or not. The infarction sites were divided into proximal, middle and distal infarctions. The National Institutes of Health Stroke Scale (NIHSS) score. The angiopathy was assessed by digital subtraction angiography (DSA), and its sex, age, biochemical parameters and related medical history, clinical manifestations were recorded. (1) To compare the distribution of different degrees of vascular stenosis between groups with and without cerebral infarction, and to further analyze the severity of vascular stenosis-occlusion in patients with or without cerebral infarction. The role of cerebral infarction in the pathogenesis and related risk factors; (2) To analyze the distribution pattern of posterior circulation infarction and its correlation with severe stenosis-occlusion; (3) To analyze the correlation between the clinical characteristics of posterior circulation infarction and severe stenosis-occlusion.
[results]
1. There was a significant difference in the distribution of vascular stenosis between groups with and without cerebral infarction (_2 = 7.881, P = 0.019), and the incidence of severe stenosis-occlusion was higher in cerebral infarction group (63% vs 41%, P 0.05); regression analysis showed that severe stenosis-occlusion was an important risk factor for posterior circulation infarction (OR = 2.293, 95% CI = 1.180-4.455, P = 0.014). Although adjusted for high-density lipoprotein, cholesterol, triglyceride and fibrinogen, the above values were independent risk factors (OR = 2.947, 95% CI = 1.407-6.174, P = 0.004); for the occurrence of severe vascular stenosis-occlusion, regression analysis showed that hypertension and uric acid were important risk factors, and OR (95% CI, P value) were respectively. 3.574 (1.774-7.204,0.000) and 1.004 (1.001-1.007,0.010);
2. The incidence of severe stenosis-occlusion in different infarction sites was different. The incidence of proximal infarction was significantly higher (82% vs 51% or 59%, P = 0.006 or 0.039). Further logistic regression analysis showed that the OR (95% CI, P value) of distal infarction and proximal infarction were 1.357 (0.592-3.110, 0.470) and 4.423 (1.455-13.448, 0.448, 0.470) respectively. Because severe stenosis-occlusion occurred in the vertebral artery was the dominant choice, the correlation analysis between severe stenosis-occlusion and proximal infarction showed that they were closely related, the R and P values were 0.343 and 0.000; Regression analysis of whether posterior circulation infarction occurred in the proximal segment showed that no severe stenosis-occlusion of the vertebral artery was the best choice. The OR (95% CI, P) values in severe stenosis and occlusion groups were 3.167 (1.023-9.802, 0.046) and 15.437 (4.567-52.180, 0.000), respectively.
3. The incidence of severe vessel stenosis-occlusion in different severity of posterior circulation infarction was different, manifested as mild patients were relatively low and severe patients were higher, compared with the NIHSS score less than 4 groups, greater than 8 groups significantly increased (73% vs 47%, P = 0.023); further logistic regression analysis showed that less than 4 groups as a reference, 4 to 7 groups and The OR (95% CI, P value) of more than 8 groups were 2.228 (0.952-5.215, 0.065) and 3.162 (1.155-8.656, 0.025), respectively. Regression analysis showed no significant correlation between severe stenosis-occlusion and specific clinical symptoms.
[Conclusion]
1, the occurrence of posterior circulation infarction is closely related to the existence of severe stenosis and occlusion.
2, proximal infarction is easy to merge with severe stenosis and occlusion after posterior circulation, especially vertebral artery.
3, severe posterior circulation infarction is more likely to be associated with severe vascular stenosis and occlusion.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

【共引文獻(xiàn)】

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