后循環(huán)梗死與基底動(dòng)脈彎曲的相關(guān)性分析
發(fā)布時(shí)間：2018-11-25 11:20
【摘要】：目的:后循環(huán)梗死(posterior circulation infarction,PCI)的發(fā)病機(jī)制主要為動(dòng)脈粥樣硬化、穿支小動(dòng)脈的病變以及栓塞,隨著核磁共振技術(shù)的廣泛應(yīng)用,后循環(huán)血管出現(xiàn)了多種轉(zhuǎn)變,不僅僅是單純血管危險(xiǎn)因素機(jī)制下促使后循環(huán)梗死的發(fā)生。在不同群體的核磁共振成像中均能發(fā)現(xiàn)后循環(huán)血管的變異,而基底動(dòng)脈彎曲是最常見的血管形態(tài)改變。本文主要研究后循環(huán)梗死與基底動(dòng)脈(basilar artery,BA)彎曲兩者之間的相關(guān)性,探討基底動(dòng)脈彎曲導(dǎo)致后循環(huán)梗死的發(fā)生機(jī)制,同時(shí)分析影響后循環(huán)梗死的相關(guān)危險(xiǎn)因素,以及基底動(dòng)脈彎曲與椎動(dòng)脈優(yōu)勢(shì)(vertebral artery dominance,VAD)之間的關(guān)系,這不僅對(duì)后循環(huán)梗死危險(xiǎn)因素的再認(rèn)識(shí)有重要意義,而且也為腦血管病的預(yù)防與治療開辟新的路徑。方法:回顧性收集314例在河北省保定市第一醫(yī)院神經(jīng)內(nèi)科住院治療的資料完整的急性腦梗死患者(2015年1月-2016年12月),所有患者均完成頭顱MRI(magnetic resonance imaging)+MRA(magnetic resonance angiography)檢查,詳盡記錄每例患者的病史及體征,如病人的性別、年齡及常見腦血管疾病危險(xiǎn)因素,包括高血壓、糖尿病、冠心病、既往短暫性腦缺血發(fā)作史(transient ischemic attack,TIA)、高脂血癥、高同型半胱氨酸血癥(hyperhomocysteinemia,HCY)、吸煙史、飲酒史等,并通過血液化驗(yàn)、心電圖等檢查來評(píng)估危險(xiǎn)因素。根據(jù)頭顱核磁的彌散加權(quán)成像(diffusion weighted imaging,DWI)的表現(xiàn),將患者分為前循環(huán)梗死(anterior circulation nfarction,ACI)組和后循環(huán)梗死組,記錄兩組患者基底動(dòng)脈彎曲的形態(tài)、方向,比較兩組間腦血管病危險(xiǎn)因素以及兩組間基底動(dòng)脈彎曲的比率,將單因素比較的陽性指標(biāo)采用Logistic多因素回歸方法統(tǒng)計(jì),篩查后循環(huán)梗死的獨(dú)立危險(xiǎn)因素,同時(shí)探討后循環(huán)梗死與基底動(dòng)脈彎曲的關(guān)系;進(jìn)一步將后循環(huán)梗死組患者按照基底動(dòng)脈彎曲度標(biāo)準(zhǔn)分為基底動(dòng)脈彎曲組及基底動(dòng)脈無彎曲組,計(jì)算兩組患者中存在椎動(dòng)脈優(yōu)勢(shì)的比例,比較兩組間vad的發(fā)生率,采用χ2檢驗(yàn)分析ba彎曲的方向與椎動(dòng)脈優(yōu)勢(shì)側(cè)的關(guān)系。結(jié)果:1.314例腦梗死患者中,前循環(huán)梗死者212例(212/314,67.5%),男127例,女85例,平均年齡為60.34士11.27歲;后循環(huán)梗死者102例(102/314,32.5%),男67例,女35例,平均年齡為61.41士12.46歲,所有患者中存在64例基底動(dòng)脈彎曲者(64/314,20.4%),基動(dòng)脈彎曲患者在前循環(huán)梗死中34例(34/212,16.0%),后循環(huán)梗死中30例(30/102,29.4%),兩者差異有統(tǒng)計(jì)學(xué)意義(p=0.006)。2.64例基底動(dòng)脈彎曲者中c型彎曲者28例(28/64,43.8%)、反c型彎曲者16例(16/64,25.0%)、s型彎曲者11例(11/64,17.2%),因此基底動(dòng)脈的彎曲形狀以c型為主。3.對(duì)11個(gè)可能影響后循環(huán)梗死發(fā)病的危險(xiǎn)因素進(jìn)行兩組間單因素分析,結(jié)果表明年齡、性別、吸煙、飲酒、高血壓、糖尿病、冠心病、高脂血癥在兩組患者中的發(fā)生率沒有統(tǒng)計(jì)學(xué)意義(p0.05)。而基底動(dòng)脈彎曲、高同型半胱氨酸血癥、既往tia兩組比較,有顯著統(tǒng)計(jì)學(xué)差異(p0.05)。4.采用多因素logistic回歸方法分析基底動(dòng)脈彎曲、高同型半胱氨酸血癥、既往tia史與后循環(huán)梗死的相關(guān)性,結(jié)果表明,基底動(dòng)脈彎曲(or2.74,95%ci1.477~5.112;p=0.001)、高同型半胱氨酸血癥(or5.08,95%ci2.984~8.662;p0.001)、既往tia史(or2.96,95%ci1.499~5.861;p=0.002)是后循環(huán)梗死的獨(dú)立危險(xiǎn)因素。5.102例后循環(huán)梗死患者,基底動(dòng)脈彎曲者30例(30/102,29.4%),伴椎動(dòng)脈優(yōu)勢(shì)者為25例(25/30,83.3%),基底動(dòng)脈無彎曲者72例(72/102,70.6%),伴椎動(dòng)脈優(yōu)勢(shì)者12例(12/72,16.7%),兩組比較差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。30例基底動(dòng)脈彎曲者中,左彎曲者11例,右彎曲者14例。在14例右側(cè)彎曲者中,左側(cè)椎動(dòng)脈優(yōu)勢(shì)者12例,在11例左側(cè)彎曲者中,右側(cè)椎動(dòng)脈優(yōu)勢(shì)者8例,兩組比較差異有統(tǒng)計(jì)學(xué)意義(p=0.003)。結(jié)論:1.基底動(dòng)脈彎曲與后循環(huán)梗死的發(fā)生密切相關(guān),基底動(dòng)脈彎曲是促使后循環(huán)梗死的一個(gè)獨(dú)立危險(xiǎn)因素。2.高同型半胱氨酸血癥、既往卒中史是發(fā)生后循環(huán)梗死的獨(dú)立危險(xiǎn)因素,后循環(huán)梗死的發(fā)生機(jī)制可能與其有關(guān)。3.基底動(dòng)脈彎曲者椎動(dòng)脈優(yōu)勢(shì)發(fā)生率較高,且基底動(dòng)脈彎曲的方向一般朝向椎動(dòng)脈優(yōu)勢(shì)的對(duì)側(cè),且以C型彎曲為多見，椎動(dòng)脈優(yōu)勢(shì)可能是后循環(huán)梗死患者發(fā)生基底動(dòng)脈彎曲的危險(xiǎn)因素。
[Abstract]:Objective: The pathogenesis of post-circulation infarction (PCI) is mainly the atherosclerosis, the pathological changes of the small arteries and the embolization. With the wide application of the nuclear magnetic resonance technique, the post-circulation blood vessel has many changes. It is not only the occurrence of post-circulation infarction under the mechanism of simple vascular risk factors. The change of the posterior circulating blood vessel can be found in the magnetic resonance imaging of different populations, and the bending of the basilar artery is the most common change of the vascular morphology. In this paper, the relationship between the posterior circulation infarction and the basilar artery (BA) was studied, and the mechanism of the post-circulatory infarction was discussed, and the related risk factors of the post-circulatory infarction were also analyzed. and the relationship between the bending of the basilar artery and the advantage of the vertebral artery (vad) is of great significance not only for the re-recognition of the risk factors of the post-circulation infarction, but also for the prevention and treatment of the cerebrovascular disease. Methods: The data of 314 patients with acute cerebral infarction (January-December, 2016) in the first hospital of Baoding City, Hebei Province were retrospectively collected. All patients were examined by magnetic resonance imaging (MRI) and MRA (magnetic resonance imaging), and the medical history and physical signs were recorded in detail. such as the patient's sex, age, and common cerebrovascular disease risk factors, including hypertension, diabetes, coronary heart disease, prior transient ischemic attack (tia), hyperlipidemia, hyperhomocysteinemia (HCY), smoking history, history of alcohol, etc., and the risk factors are assessed by examination of blood tests, electrocardiograms, and the like. according to the performance of the diffusion weighted imaging (DWI) of the head nuclear magnetic field, the patients were divided into the anterior circulation infarction (ACI) group and the post-circulation infarction group, and the patterns and the directions of the bending of the basilar artery of the two groups of patients were recorded, The risk factors of cerebrovascular disease and the ratio of the two groups of basal artery were compared, and the positive index of single factor was compared with logistic multiple factor regression method, and the independent risk factors of the post-screening cycle infarction were analyzed, and the relationship between the post-circulation infarction and the basilar artery was discussed. further, the patients of the post-circulating infarction group are divided into a base artery bending group and a base artery non-bending group according to the bending degree standard of the base artery, the proportion of the advantages of the vertebral artery in the two groups is calculated, the incidence rate of the two groups of vad is compared, The relationship between the direction of the ba-bending and the advantage side of the vertebral artery was analyzed by the method of the second test. Results: Of the 314 patients with cerebral infarction, 212 cases (212/ 314, 67.5%), 127 males and 85 females, the average age was 60. 34 + 11. 27 years old, 102 cases (102/ 314, 32.5%), 67 males and 35 females, the average age was 61.41 鹵 12.46 years. 64 of all patients (64/ 314, 20. 4%), 34 (34/ 212, 16. 0%), 30 (30/ 102, 2.9. 4%) in the anterior circulation infarction, and 28 (28/ 64, 43.8%) of the c-type in the basal artery of 64 patients. In 16 cases (16/ 64, 25. 0%) and 11 (11/ 64, 17. 2%), the curved shape of the basilar artery was c-type. A single-factor analysis of 11 risk factors that could affect the incidence of post-circulatory infarction was carried out. The results showed that age, sex, smoking, alcohol consumption, hypertension, diabetes, coronary heart disease and hyperlipidemia were not statistically significant in the two groups (p0.05). However, there was a significant difference in basal artery bending, hyperhomocysteinemia and prior tia (p0.05). A multi-factor logistic regression was used to analyze the correlation of basal artery bending, hyperhomocysteinemia, and prior tia and post-cycle infarction. The results showed that the basal artery was curved (or2.74, 95% ci1. 477 ~ 5.112; p = 0.001), hyperhomocysteinemia (or5.08, 95% ci2. 984 ~ 8. 662; p0.001). The previous tia history (or2.96, 95% ci1. 499-5.861; p = 0. 002) was an independent risk factor for posterior circulation infarction. There was a significant difference between the two groups (p0.05). Of the 14 cases of right bending, there were 12 cases of the left vertebral artery in the left and 8 in the right vertebral artery in 11 cases of the left vertebral artery, and the difference between the two groups was statistically significant (p = 0.003). Conclusion: 1. The bending of the basilar artery is closely related to the occurrence of post-circulatory infarction, and the bending of the basilar artery is an independent risk factor for the post-circulatory infarction. Hyperhomocysteinemia, a previous history of stroke, is an independent risk factor for post-cycle infarction, and the mechanism of the post-circulatory infarction may be related to it. The incidence of the vertebral artery of the basilar artery is high, and the direction of the basilar artery is generally toward the opposite side of the advantage of the vertebral artery, and in the C-type, the advantage of the vertebral artery may be the risk factor of the basilar artery bending in the patients with post-circulatory infarction.
【學(xué)位授予單位】：承德醫(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)：2355922
[Abstract]:Objective: The pathogenesis of post-circulation infarction (PCI) is mainly the atherosclerosis, the pathological changes of the small arteries and the embolization. With the wide application of the nuclear magnetic resonance technique, the post-circulation blood vessel has many changes. It is not only the occurrence of post-circulation infarction under the mechanism of simple vascular risk factors. The change of the posterior circulating blood vessel can be found in the magnetic resonance imaging of different populations, and the bending of the basilar artery is the most common change of the vascular morphology. In this paper, the relationship between the posterior circulation infarction and the basilar artery (BA) was studied, and the mechanism of the post-circulatory infarction was discussed, and the related risk factors of the post-circulatory infarction were also analyzed. and the relationship between the bending of the basilar artery and the advantage of the vertebral artery (vad) is of great significance not only for the re-recognition of the risk factors of the post-circulation infarction, but also for the prevention and treatment of the cerebrovascular disease. Methods: The data of 314 patients with acute cerebral infarction (January-December, 2016) in the first hospital of Baoding City, Hebei Province were retrospectively collected. All patients were examined by magnetic resonance imaging (MRI) and MRA (magnetic resonance imaging), and the medical history and physical signs were recorded in detail. such as the patient's sex, age, and common cerebrovascular disease risk factors, including hypertension, diabetes, coronary heart disease, prior transient ischemic attack (tia), hyperlipidemia, hyperhomocysteinemia (HCY), smoking history, history of alcohol, etc., and the risk factors are assessed by examination of blood tests, electrocardiograms, and the like. according to the performance of the diffusion weighted imaging (DWI) of the head nuclear magnetic field, the patients were divided into the anterior circulation infarction (ACI) group and the post-circulation infarction group, and the patterns and the directions of the bending of the basilar artery of the two groups of patients were recorded, The risk factors of cerebrovascular disease and the ratio of the two groups of basal artery were compared, and the positive index of single factor was compared with logistic multiple factor regression method, and the independent risk factors of the post-screening cycle infarction were analyzed, and the relationship between the post-circulation infarction and the basilar artery was discussed. further, the patients of the post-circulating infarction group are divided into a base artery bending group and a base artery non-bending group according to the bending degree standard of the base artery, the proportion of the advantages of the vertebral artery in the two groups is calculated, the incidence rate of the two groups of vad is compared, The relationship between the direction of the ba-bending and the advantage side of the vertebral artery was analyzed by the method of the second test. Results: Of the 314 patients with cerebral infarction, 212 cases (212/ 314, 67.5%), 127 males and 85 females, the average age was 60. 34 + 11. 27 years old, 102 cases (102/ 314, 32.5%), 67 males and 35 females, the average age was 61.41 鹵 12.46 years. 64 of all patients (64/ 314, 20. 4%), 34 (34/ 212, 16. 0%), 30 (30/ 102, 2.9. 4%) in the anterior circulation infarction, and 28 (28/ 64, 43.8%) of the c-type in the basal artery of 64 patients. In 16 cases (16/ 64, 25. 0%) and 11 (11/ 64, 17. 2%), the curved shape of the basilar artery was c-type. A single-factor analysis of 11 risk factors that could affect the incidence of post-circulatory infarction was carried out. The results showed that age, sex, smoking, alcohol consumption, hypertension, diabetes, coronary heart disease and hyperlipidemia were not statistically significant in the two groups (p0.05). However, there was a significant difference in basal artery bending, hyperhomocysteinemia and prior tia (p0.05). A multi-factor logistic regression was used to analyze the correlation of basal artery bending, hyperhomocysteinemia, and prior tia and post-cycle infarction. The results showed that the basal artery was curved (or2.74, 95% ci1. 477 ~ 5.112; p = 0.001), hyperhomocysteinemia (or5.08, 95% ci2. 984 ~ 8. 662; p0.001). The previous tia history (or2.96, 95% ci1. 499-5.861; p = 0. 002) was an independent risk factor for posterior circulation infarction. There was a significant difference between the two groups (p0.05). Of the 14 cases of right bending, there were 12 cases of the left vertebral artery in the left and 8 in the right vertebral artery in 11 cases of the left vertebral artery, and the difference between the two groups was statistically significant (p = 0.003). Conclusion: 1. The bending of the basilar artery is closely related to the occurrence of post-circulatory infarction, and the bending of the basilar artery is an independent risk factor for the post-circulatory infarction. Hyperhomocysteinemia, a previous history of stroke, is an independent risk factor for post-cycle infarction, and the mechanism of the post-circulatory infarction may be related to it. The incidence of the vertebral artery of the basilar artery is high, and the direction of the basilar artery is generally toward the opposite side of the advantage of the vertebral artery, and in the C-type, the advantage of the vertebral artery may be the risk factor of the basilar artery bending in the patients with post-circulatory infarction.
【學(xué)位授予單位】：承德醫(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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