應(yīng)用高分辨率磁共振成像對顱內(nèi)動脈狹窄斑塊危險因素的臨床研究
發(fā)布時間：2018-08-13 19:43
【摘要】：目的:腦卒中在我國人口死亡原因中占第二位,其發(fā)病率高、復發(fā)率高、致殘率高和死亡率高,給社會及家庭帶來沉重的負擔。其中,以缺血性卒中最為常見。在國內(nèi),顱內(nèi)動脈粥樣硬化疾病(intracranial atherosclerotic disease,ICAD)是最常見的缺血性卒中。在國外,ICAD的致死率較前下降,而在我國,其發(fā)病率和復發(fā)率都呈逐年增高的趨勢,成為目前臨床上急需解決的醫(yī)學難題之一。顱內(nèi)動脈粥樣硬化(intracranial atherosclerosis,ICAS)是指腦底部動脈出現(xiàn)一系列改變進而導致臨床事件的發(fā)生,包括內(nèi)膜損傷、脂質(zhì)聚集、纖維增生,進一步導致管壁增厚,管腔狹窄。探討ICAS引發(fā)腦卒中的機制,可以達到預測缺血性腦卒中風險,指導早期預防治療并減少腦卒中發(fā)生的目的。因此對ICAS斑塊性質(zhì)進行進一步研究,進而采用有針對性治療方案,具有重要的臨床意義。目前傳統(tǒng)的血管檢查技術(shù)(血管彩超、經(jīng)顱多普勒、磁共振血管造影、螺旋CT血管造影、腦血管造影術(shù))僅能顯示顱外動脈粥樣硬化斑塊情況,不能檢測ICAS斑塊,無法進一步區(qū)分斑塊的穩(wěn)定性,限制了臨床進行顱內(nèi)動脈斑塊的研究。隨著近年來醫(yī)學影像技術(shù)的發(fā)展,高分辨率磁共振成像(high-resolution magnetic resonance imaging,HR-MRI)檢查作為一種新型檢查項目,能清晰的顯示動脈血管管壁的形態(tài)及成分,具有較高的特異性及靈敏性。本研究旨在通過HR-MRI檢查明確顱內(nèi)動脈粥樣硬化性狹窄斑塊的性質(zhì),研究腦血管病危險因素與斑塊穩(wěn)定性之間的關(guān)系,為缺血性腦血管病二級預防提供依據(jù)。方法:選擇2016年01月至2017年02月期間,于我院住院的符合入組標準的伴有顱內(nèi)動脈粥樣硬化性血管狹窄的缺血性腦血管病患者共59例,收集患者的腦血管病危險因素(年齡、性別、吸煙、高血壓病、糖尿病、冠心病、體重指數(shù)、hs-CRP、低密度脂蛋白膽固醇及甘油三酯),行HR-MRI檢查后根據(jù)斑塊性質(zhì)分為穩(wěn)定性斑塊組(n=36)和不穩(wěn)定性斑塊組(n=23)。分別對兩組患者的危險因素進行單因素和多因素分析,研究腦血管病危險因素與顱內(nèi)動脈粥樣硬化性狹窄斑塊穩(wěn)定性的相關(guān)性。統(tǒng)計學分析采用SPSS 17.0統(tǒng)計學軟件。計量資料:正態(tài)分布以均數(shù)±標準差表示,非正態(tài)分布以中位數(shù)(四分位數(shù)間距)表示。兩組比較采用兩個獨立樣本t檢驗或t′檢驗。計數(shù)資料以頻數(shù)、率或百分比(%)表示,兩組比較采用χ2檢驗。多因素分析采用logistic回歸分析,P0.05表示差異有統(tǒng)計學意義。結(jié)果:1兩組患者單因素分析不穩(wěn)定斑塊組中吸煙及糖尿病患者均明顯高于穩(wěn)定斑塊組,差異有統(tǒng)計學意義(吸煙:卡方值5.281,P=0.022;糖尿病:卡方值4.768,P=0.029)。而兩組其他臨床資料之間,并無統(tǒng)計學差異。2對以上腦血管病危險因素進行多因素logistic回歸分析吸煙[P=0.021,OR值(95%CI)=3.983(1.234-12.860)]及糖尿病[P=0.027,OR值(95%CI)=3.753(1.161-12.134)]為不穩(wěn)定性斑塊的危險因素。結(jié)論:1 3.0T HR-MRI能夠?qū)︼B內(nèi)動脈粥樣硬化斑塊進行定性分析,判定斑塊的易損性,為腦血管病的預防和治療提供一種新的科學依據(jù)。2 ICAS斑塊的易損性與吸煙、糖尿病有明顯相關(guān)性,出現(xiàn)進展性卒中及腦卒中復發(fā)風險更高,所以防止顱內(nèi)動脈粥樣硬化及斑塊的形成需強調(diào)早期戒煙及強化糖尿病管理,會在腦血管疾病的預防和治療中起到重要作用。
[Abstract]:Objective: Stroke is the second leading cause of death in China. It has a high incidence, high recurrence rate, high disability rate and high mortality rate, which brings heavy burden to society and families. Among them, ischemic stroke is the most common. In China, intracranial atherosclerotic disease (ICAD) is the most common ischemia. In foreign countries, the fatality rate of ICAD has declined earlier. In China, the incidence and recurrence rate of ICAD have been increasing year by year, which has become one of the medical problems that need to be solved urgently. To explore the mechanism of ICAS-induced stroke can predict the risk of ischemic stroke, guide early prevention and treatment and reduce the incidence of stroke. Therefore, further study on the nature of ICAS plaque, and then adopt targeted. At present, the traditional angiographic techniques (color Doppler, transcranial Doppler, magnetic resonance angiography, spiral CT angiography, cerebral angiography) can only show the situation of extracranial atherosclerotic plaques, can not detect ICAS plaques, can not further distinguish the stability of plaques, limiting clinical progress. With the development of medical imaging technology in recent years, high-resolution magnetic resonance imaging (HR-MRI) is a new type of examination, which can clearly show the morphology and composition of the arterial wall and has high specificity and sensitivity. HR-MRI was used to determine the nature of intracranial atherosclerotic stenosis plaque, and to study the relationship between risk factors of cerebrovascular disease and plaque stability, so as to provide evidence for secondary prevention of ischemic cerebrovascular disease. The risk factors (age, sex, smoking, hypertension, diabetes, coronary heart disease, body mass index, hs-CRP, low density lipoprotein cholesterol and triglyceride) were collected from 59 patients with ischemic cerebrovascular disease. The patients were divided into stable plaque group (n=36) and unstable plaque group (n=36) according to the nature of the plaque. Group (n = 23). Univariate and multivariate analyses were performed to study the correlation between the risk factors of cerebrovascular disease and the stability of intracranial atherosclerotic stenosis plaques. SPSS 17.0 was used for statistical analysis. Statistical data: Normal distribution was expressed by mean (+) standard deviation, and non-normal distribution was expressed by median. Two independent sample t test or t'test were used for comparison between the two groups. Counting data were expressed by frequency, rate or percentage (%) and_2 test was used for comparison between the two groups. Multivariate analysis was used for logistic regression analysis. P 0.05 showed significant difference between the two groups. Smoking: Chi-square value 5.281, P = 0.022; diabetes: Chi-square value 4.768, P = 0.029). There was no significant difference between the two groups in other clinical data. 2 Multiple logistic regression analysis of the above risk factors of cerebrovascular disease smoking [P = 0.021, OR (95% CI) = 3.983 (1.983). 234-12.860) and diabetes mellitus [P = 0.027, OR value (95% CI) = 3.753 (1.161-12.134)] were risk factors for unstable plaques. Conclusion: 13.0T HR-MRI can be used to qualitative analysis of intracranial atherosclerotic plaques, determine the vulnerability of plaques, and provide a new scientific basis for the prevention and treatment of cerebrovascular diseases. Smoking and diabetes mellitus are significantly associated with a higher risk of recurrence of progressive stroke and stroke. Therefore, prevention of intracranial atherosclerosis and plaque formation should emphasize early smoking cessation and strengthening diabetes management, which will play an important role in the prevention and treatment of cerebrovascular diseases.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
本文編號：2181987
[Abstract]:Objective: Stroke is the second leading cause of death in China. It has a high incidence, high recurrence rate, high disability rate and high mortality rate, which brings heavy burden to society and families. Among them, ischemic stroke is the most common. In China, intracranial atherosclerotic disease (ICAD) is the most common ischemia. In foreign countries, the fatality rate of ICAD has declined earlier. In China, the incidence and recurrence rate of ICAD have been increasing year by year, which has become one of the medical problems that need to be solved urgently. To explore the mechanism of ICAS-induced stroke can predict the risk of ischemic stroke, guide early prevention and treatment and reduce the incidence of stroke. Therefore, further study on the nature of ICAS plaque, and then adopt targeted. At present, the traditional angiographic techniques (color Doppler, transcranial Doppler, magnetic resonance angiography, spiral CT angiography, cerebral angiography) can only show the situation of extracranial atherosclerotic plaques, can not detect ICAS plaques, can not further distinguish the stability of plaques, limiting clinical progress. With the development of medical imaging technology in recent years, high-resolution magnetic resonance imaging (HR-MRI) is a new type of examination, which can clearly show the morphology and composition of the arterial wall and has high specificity and sensitivity. HR-MRI was used to determine the nature of intracranial atherosclerotic stenosis plaque, and to study the relationship between risk factors of cerebrovascular disease and plaque stability, so as to provide evidence for secondary prevention of ischemic cerebrovascular disease. The risk factors (age, sex, smoking, hypertension, diabetes, coronary heart disease, body mass index, hs-CRP, low density lipoprotein cholesterol and triglyceride) were collected from 59 patients with ischemic cerebrovascular disease. The patients were divided into stable plaque group (n=36) and unstable plaque group (n=36) according to the nature of the plaque. Group (n = 23). Univariate and multivariate analyses were performed to study the correlation between the risk factors of cerebrovascular disease and the stability of intracranial atherosclerotic stenosis plaques. SPSS 17.0 was used for statistical analysis. Statistical data: Normal distribution was expressed by mean (+) standard deviation, and non-normal distribution was expressed by median. Two independent sample t test or t'test were used for comparison between the two groups. Counting data were expressed by frequency, rate or percentage (%) and_2 test was used for comparison between the two groups. Multivariate analysis was used for logistic regression analysis. P 0.05 showed significant difference between the two groups. Smoking: Chi-square value 5.281, P = 0.022; diabetes: Chi-square value 4.768, P = 0.029). There was no significant difference between the two groups in other clinical data. 2 Multiple logistic regression analysis of the above risk factors of cerebrovascular disease smoking [P = 0.021, OR (95% CI) = 3.983 (1.983). 234-12.860) and diabetes mellitus [P = 0.027, OR value (95% CI) = 3.753 (1.161-12.134)] were risk factors for unstable plaques. Conclusion: 13.0T HR-MRI can be used to qualitative analysis of intracranial atherosclerotic plaques, determine the vulnerability of plaques, and provide a new scientific basis for the prevention and treatment of cerebrovascular diseases. Smoking and diabetes mellitus are significantly associated with a higher risk of recurrence of progressive stroke and stroke. Therefore, prevention of intracranial atherosclerosis and plaque formation should emphasize early smoking cessation and strengthening diabetes management, which will play an important role in the prevention and treatment of cerebrovascular diseases.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
【參考文獻】
相關(guān)期刊論文 前10條
1 彭雯佳;詹茜;陳士躍;陳錄廣;張雪鳳;劉崎;陸建平;;高分辨磁共振對癥狀性大腦中動脈粥樣硬化斑塊易損性的研究[J];實用放射學雜志;2015年12期
2 劉力生;;中國高血壓防治指南2010[J];中華高血壓雜志;2011年08期
3 王婷;吳衛(wèi)平;;老年人頸動脈內(nèi)膜-中層厚度增厚與斑塊形成的相關(guān)危險因素分析[J];中西醫(yī)結(jié)合心腦血管病雜志;2011年04期
4 洪玉娥;吳倩;賀軍;;頸動脈粥樣硬化斑塊及其危險因素與腦梗死的關(guān)系[J];臨床神經(jīng)病學雜志;2009年03期
5 張濤;周華東;;頸動脈粥樣硬化斑塊的臨床研究進展[J];重慶醫(yī)學;2007年24期
6 馮民;張梅;張運;;吸煙與動脈粥樣硬化的關(guān)系[J];中國動脈硬化雜志;2006年11期
7 Mazighi M.;Tanasescu R.;Ducrocq X.;樊慧婷;;癥狀性腦內(nèi)動脈粥樣硬化性血栓形成性狹窄的前瞻性研究:GESICA研究[J];世界核心醫(yī)學期刊文摘(神經(jīng)病學分冊);2006年09期
8 呂敏,師綠江,史平,康晟,武留信,武陽豐;中老年自然人群中高血壓和亞臨床頸動脈粥樣硬化的關(guān)聯(lián)研究[J];中華流行病學雜志;2004年10期
9 季建中,李華,候惠鳴,翟江,陳宗羨;腦梗塞患者頸動脈粥樣硬化斑塊與血脂變化的研究[J];中國誤診學雜志;2001年08期
10 楊功煥;1996年全國吸煙行為的流行病學調(diào)查[J];中國腫瘤;1998年02期
，本文編號：2181987
本文鏈接：http://sikaile.net/yixuelunwen/shenjingyixue/2181987.html
最近更新
教材專著
