大動(dòng)脈粥樣硬化腦梗死的危險(xiǎn)因素分析
發(fā)布時(shí)間：2018-10-17 22:36
【摘要】：背景我國(guó)腦梗死發(fā)病率正逐年上升,受到人們的關(guān)注,腦梗死危險(xiǎn)因素的篩查是預(yù)防腦梗死的有效手段,對(duì)其危險(xiǎn)因素的掌握已成為臨床診治的關(guān)鍵。目前國(guó)內(nèi)公認(rèn)的中國(guó)缺血性卒中亞型(Chinese ischemic stroke subclassification,CISS)將腦梗死分5型。其中,大動(dòng)脈粥樣硬化(LAA)腦梗死是最常見的一種亞型,往往病情發(fā)展迅速,后果嚴(yán)重,預(yù)后差。國(guó)內(nèi)外針對(duì)該亞型腦梗死發(fā)病的危險(xiǎn)因素目前公認(rèn)的有很多,也有研究表明Willis環(huán)變異是其危險(xiǎn)因素,但目前缺少包括Willis環(huán)變異在內(nèi)的多因素分析。目的按照CISS分型的標(biāo)準(zhǔn),探討LAA腦梗死發(fā)病的相關(guān)危險(xiǎn)因素。研究Willis環(huán)變異與LAA腦梗死的相關(guān)性,以及應(yīng)用多因素Logistic回歸分析了解Willis環(huán)變異對(duì)LAA腦梗死的影響力以及篩選出LAA腦梗死的高危因素。為臨床提供LAA腦梗死發(fā)生的相關(guān)因素,為今后LAA腦梗死的預(yù)防起到指導(dǎo)作用。方法回顧性選取2015年01月01日-2016年12月31日于我院住院的患者,LAA組為根據(jù)最新國(guó)內(nèi)急性腦梗死診斷標(biāo)準(zhǔn),MRI/CT證實(shí)有急性腦梗死發(fā)生,且符合CISS分型中LAA診斷標(biāo)準(zhǔn)的急性腦梗死患者;對(duì)照組為臨床表現(xiàn)主要為頭暈,不符合急性腦梗死診斷標(biāo)準(zhǔn),頭顱MRI/CT未見明顯異常的非腦梗死患者。先采用單因素分析篩選出與LAA有關(guān)的危險(xiǎn)因素,再采用多因素非條件logistic回歸篩選出相應(yīng)的高危因素。結(jié)果(1)單因素分析:性別、高血壓級(jí)別、Willis環(huán)類型、Willis環(huán)中前交通動(dòng)脈變異、空腹血糖、甘油三脂、體質(zhì)指數(shù)與對(duì)照組相比,差異有統(tǒng)計(jì)學(xué)意義(P0.05),余差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(2)相關(guān)因素分析:Willis環(huán)類型與ACoA成正相關(guān);吸煙、飲酒與男性成正相關(guān);頸動(dòng)脈斑塊與HDL成負(fù)相關(guān),與年齡、高血壓級(jí)別成正相關(guān);LDL與TC成正相關(guān)。(3)啞變量賦值:Willis環(huán)類型生成3個(gè)啞變量,選用Willis環(huán)Ⅰ型做參考類型,結(jié)果顯示:與Willis環(huán)Ⅰ型比較,Willis環(huán)Ⅱ型、Ⅳ型的β0、OR=2.603、8.409;對(duì)于高血壓級(jí)別生成3個(gè)啞變量,選用高血壓0級(jí)做參考類型,結(jié)果顯示:與高血壓0級(jí)相比,高血壓2級(jí)、3級(jí)的β0、OR=4.331、4.5。(4)多因素logistic回歸分析:Willis環(huán)Ⅳ型、高血壓2級(jí)、高血壓3級(jí)3個(gè)變量經(jīng)Wald檢驗(yàn)差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論(1)本研究中單因素分析發(fā)現(xiàn):性別、高血壓級(jí)別、Willis環(huán)類型、Willis環(huán)中前交通動(dòng)脈變異、空腹血糖、甘油三脂、體質(zhì)指數(shù)與LAA腦梗死發(fā)生有關(guān)。(2)啞變量Logistic回歸結(jié)果顯示:與Willis環(huán)Ⅰ型比較,Willis環(huán)Ⅱ型、Ⅳ型為L(zhǎng)AA腦梗死的危險(xiǎn)因素(OR=2.603、8.409);與高血壓0級(jí)相比,高血壓2級(jí)、3級(jí)為L(zhǎng)AA腦梗死的危險(xiǎn)因素(OR=4.331、4.5)。(3)多因素Logistic回歸分析顯示:Willis環(huán)Ⅳ型、高血壓2級(jí)、高血壓3級(jí)與LAA腦梗死相關(guān)性高。
[Abstract]:Background the incidence of cerebral infarction in China is increasing year by year. People pay close attention to it. Screening for risk factors of cerebral infarction is an effective means to prevent cerebral infarction, and mastering its risk factors has become the key of clinical diagnosis and treatment. At present, cerebral infarction is classified into 5 types of cerebral infarction (Chinese ischemic stroke subclassification,CISS), which is recognized as ischemic stroke type in China. Among them, atherosclerosis (LAA) cerebral infarction is the most common subtype, the disease often develops rapidly, the consequence is serious, the prognosis is poor. There are many risk factors for this subtype of cerebral infarction at home and abroad, and some studies show that the variation of Willis ring is its risk factor, but there is a lack of multivariate analysis, including Willis loop variation. Objective to investigate the risk factors of cerebral infarction in LAA according to the criteria of CISS classification. To study the correlation between Willis ring variation and LAA cerebral infarction, and to use multivariate Logistic regression analysis to understand the influence of Willis ring variation on LAA cerebral infarction and to screen out the high risk factors of LAA cerebral infarction. To provide clinical related factors for the occurrence of LAA cerebral infarction, and to play a guiding role in the prevention of LAA cerebral infarction in the future. Methods the patients in our hospital from January 01, 2015 to December 31, 2016 were selected retrospectively. According to the latest diagnostic criteria of acute cerebral infarction in China, MRI/CT confirmed the occurrence of acute cerebral infarction. The patients with acute cerebral infarction in accordance with the diagnostic criteria of LAA in CISS classification, the control group were mainly dizziness, not in accordance with the diagnostic criteria of acute cerebral infarction, and there was no obvious abnormality in head MRI/CT in patients with non-cerebral infarction. The risk factors related to LAA were screened by univariate analysis, and then the risk factors were screened by multivariate unconditioned logistic regression. Results (1) single factor analysis: sex, grade of hypertension, type of Willis ring, variation of anterior communicating artery in Willis ring, fasting blood glucose, triglyceride, body mass index compared with control group. The difference was statistically significant (P0.05), the other differences were not statistically significant (P0.05). (2) related factors analysis: Willis loop type and ACoA positive correlation; smoking, drinking and male positive correlation; carotid plaque and HDL negative correlation, and age, (3) the assignment of mute variables: Willis ring type generated 3 dummy variables, and Willis ring 鈪，
本文編號(hào)：2278246
[Abstract]:Background the incidence of cerebral infarction in China is increasing year by year. People pay close attention to it. Screening for risk factors of cerebral infarction is an effective means to prevent cerebral infarction, and mastering its risk factors has become the key of clinical diagnosis and treatment. At present, cerebral infarction is classified into 5 types of cerebral infarction (Chinese ischemic stroke subclassification,CISS), which is recognized as ischemic stroke type in China. Among them, atherosclerosis (LAA) cerebral infarction is the most common subtype, the disease often develops rapidly, the consequence is serious, the prognosis is poor. There are many risk factors for this subtype of cerebral infarction at home and abroad, and some studies show that the variation of Willis ring is its risk factor, but there is a lack of multivariate analysis, including Willis loop variation. Objective to investigate the risk factors of cerebral infarction in LAA according to the criteria of CISS classification. To study the correlation between Willis ring variation and LAA cerebral infarction, and to use multivariate Logistic regression analysis to understand the influence of Willis ring variation on LAA cerebral infarction and to screen out the high risk factors of LAA cerebral infarction. To provide clinical related factors for the occurrence of LAA cerebral infarction, and to play a guiding role in the prevention of LAA cerebral infarction in the future. Methods the patients in our hospital from January 01, 2015 to December 31, 2016 were selected retrospectively. According to the latest diagnostic criteria of acute cerebral infarction in China, MRI/CT confirmed the occurrence of acute cerebral infarction. The patients with acute cerebral infarction in accordance with the diagnostic criteria of LAA in CISS classification, the control group were mainly dizziness, not in accordance with the diagnostic criteria of acute cerebral infarction, and there was no obvious abnormality in head MRI/CT in patients with non-cerebral infarction. The risk factors related to LAA were screened by univariate analysis, and then the risk factors were screened by multivariate unconditioned logistic regression. Results (1) single factor analysis: sex, grade of hypertension, type of Willis ring, variation of anterior communicating artery in Willis ring, fasting blood glucose, triglyceride, body mass index compared with control group. The difference was statistically significant (P0.05), the other differences were not statistically significant (P0.05). (2) related factors analysis: Willis loop type and ACoA positive correlation; smoking, drinking and male positive correlation; carotid plaque and HDL negative correlation, and age, (3) the assignment of mute variables: Willis ring type generated 3 dummy variables, and Willis ring 鈪，
本文編號(hào)：2278246
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