TIA患者預(yù)后與腦動脈粥樣硬化狹窄特征的相關(guān)性研究
發(fā)布時間：2018-12-06 20:52
【摘要】：目的：研究短暫性腦缺血發(fā)作（TIA）患者預(yù)后與腦供血動脈粥樣硬化狹窄的程度、狹窄分布部位及粥樣硬化斑塊性質(zhì)的關(guān)系。 方法：選擇2012年4月至2013年7月在山西醫(yī)科大學(xué)第一附屬醫(yī)院住院，確診為TIA的患者，用CTA評價腦血管的狹窄程度，狹窄分布部位及斑塊性質(zhì)。對患者進行90d隨訪，根據(jù)預(yù)后情況分為穩(wěn)定組、頻發(fā)組、腦梗死組。采用SPSS19.0中文統(tǒng)計軟件，分析預(yù)后與血管狹窄特征是否相關(guān)。 結(jié)果： 1.共89例患者入選，失訪8例。隨訪的81例TIA患者中穩(wěn)定組34例（42.0%），頻發(fā)組37例（45.7%），腦梗死組10例（12.3%）。 2.穩(wěn)定組24例存在血管狹窄，狹窄31處；頻發(fā)組35例存在血管狹窄，狹窄65處；腦梗死組10例均有血管狹窄，狹窄39處。穩(wěn)定組血管狹窄程度構(gòu)成比：輕度77.4%（24/31），中度16.1%（5/31），重度3.2%（1/31），閉塞3.2%（1/31）；頻發(fā)組血管狹窄程度構(gòu)成比：輕度73.9%（48/65），中度10.8%（7/65），重度4.6%（3/65），閉塞10.8%（7/65）；腦梗死組血管狹窄程度構(gòu)成比：輕度56.4%（22/39），中度10.3%（4/39），重度15.4%（6/39），閉塞17.9%（7/39）。三組預(yù)后中，預(yù)后越差重度和閉塞血管構(gòu)成比越大，輕度血管狹窄構(gòu)成比越小，進行相關(guān)分析結(jié)果顯示r=0.211，P=0.021，，呈正相關(guān)。 3.發(fā)現(xiàn)斑塊117個，穩(wěn)定組25例患者血管存在斑塊，共35個，頻發(fā)組29例患者血管存在斑塊，共51個，腦梗組均有斑塊，共31個。穩(wěn)定組斑塊構(gòu)成比：鈣化斑51.4%（18/35），混合斑34.3%（12/35），軟斑14.3%（5/35）；頻發(fā)組斑塊構(gòu)成比：鈣化斑23.5%（12/51），混合斑47.1%（24/51），軟斑29.4%（15/51）；腦梗死組斑塊構(gòu)成比：鈣化斑12.9%(4/31)，混合斑48.4%(15/31)，軟斑38.7%(12/31)。三組預(yù)后中預(yù)后越差混合斑和軟斑構(gòu)成比越大，鈣化斑構(gòu)成比越小。相關(guān)分析顯示r=0.364，P=0.001，呈正相關(guān)。4.本實驗中穩(wěn)定組前循環(huán)血管狹窄以ICA顱外段38.9%（7/18）最多見，后循環(huán)以VA顱外段38.5%（5/13）多見；頻發(fā)組和腦梗死組前循環(huán)狹窄均以MCA40.0%（16/40）、42.1%（8/19）多見，后循環(huán)以VA顱內(nèi)段36.0%（9/25）、35.0%（7/20），PCA32.0%(8/25)、35.0%（7/20）多見。 結(jié)論： 1. TIA預(yù)后與血管狹窄程度和斑塊性質(zhì)有關(guān)。隨著預(yù)后嚴(yán)重程度的增加，重度和閉塞血管狹窄比例逐漸增多，輕度血管狹窄所占比例逐漸減少，不穩(wěn)定斑塊（軟斑、混合斑）所占比例逐漸增多，穩(wěn)定斑塊所占比例逐漸減少。 2.TIA預(yù)后良好者前循環(huán)以顱外頸動脈狹窄多見，后循環(huán)以顱外椎動脈狹窄多見；TIA預(yù)后差者前循環(huán)以大腦中動脈狹窄多見，后循環(huán)以顱內(nèi)椎動脈和大腦后動脈狹窄多見。
[Abstract]:Aim: to study the relationship between prognosis of patients with transient ischemic attack (TIA) and the degree of atherosclerotic stenosis, distribution of stenosis and the nature of atherosclerotic plaque. Methods: selected patients who were hospitalized in the first affiliated Hospital of Shanxi Medical University from April 2012 to July 2013 and were diagnosed with TIA. The degree of stenosis, the location of stenosis and the character of plaque were evaluated by CTA. The patients were followed up for 90 days. According to the prognosis, the patients were divided into stable group, frequent group and cerebral infarction group. SPSS19.0 Chinese software was used to analyze the correlation between prognosis and vascular stenosis. Results: 1. A total of 89 patients were selected and 8 cases were lost. There were 34 cases (42.0%) in stable group, 37 cases (45.7%) in frequent incidence group and 10 cases (12.3%) in cerebral infarction group. 2. Vascular stenosis was found in 24 cases in stable group, in 31 places in vascular stenosis, in 35 cases in frequent incidence group (65 places), and in 10 cases in cerebral infarction group (39 places). In the stable group, the proportion of stenosis was mild 77.4% (24 / 31), moderate 16.1% (5 / 31), severe 3.2% (1 / 31), occlusion 3.2% (1 / 31). The proportion of the degree of stenosis was 73.9% (48 / 65), 10.8% (7 / 65), 4.6% (3 / 65) and 10.8% (7 / 65) in the frequent incidence group. The proportion of stenosis in cerebral infarction group was mild 56.4% (22 / 39), moderate 10.3% (4 / 39), severe 15.4% (6 / 39), occlusion 17.9% (7 / 39). In the three groups, the worse the prognosis was and the greater the ratio of occlusion and stenosis was, the smaller the ratio of stenosis was. The results of correlation analysis showed that there was a positive correlation between the severity of prognosis and the ratio of occlusion and stenosis. 3. The results showed that there were 117 plaques in 25 patients in stable group, 35 in stable group, 51 in frequently occurring group and 31 in cerebral infarction group. In the stable group, the plaque composition was 51.4% (18 / 35), 34. 3% (12 / 35), 14. 3% (5 / 35) for calcified plaque, 34. 3% (12 / 35) for mixed plaque and 14. 3% (5 / 35) for soft spot. The ratio of plaque composition in frequent group: calcified plaque 23.5% (12 / 51), mixed plaque 47.1% (24 / 51), soft plaque 29.4% (15 / 51); The plaque composition of cerebral infarction group was as follows: calcified plaque 12.9% (4 / 31), mixed plaque 48.4% (15 / 31), soft plaque 38.7% (12 / 31). In the three groups, the worse the prognosis was, the greater the compositional ratio of mixed plaque and soft spot was, and the smaller the ratio of calcified plaque was. Correlation analysis showed that there was a positive correlation between 0. 364 and 0. 001, with a positive correlation of 4. 4. In the stable group, 38.9% (7 / 18) of the anterior circulation stenosis was found in the extracranial segment of ICA, and 38.5% (5 / 13) of the posterior circulation was found in the extracranial segment of VA. MCA40.0% (16 / 40), 42.1% (8 / 19), 36.0% (9 / 25), 35.0% (7 / 20), PCA32.0% (8 / 25) of the intracranial segment of VA were found in the recurrent and cerebral infarction groups. 35.0% (7 / 20) are more common. Conclusion: 1. The prognosis of TIA is related to the degree of stenosis and the nature of plaque. With the increase of prognosis severity, the proportion of severe and occluded vascular stenosis gradually increased, the proportion of mild vascular stenosis gradually decreased, and the proportion of unstable plaque (soft plaque, mixed plaque) gradually increased. The proportion of stable plaques decreased gradually. In the patients with good prognosis of 2.TIA, the anterior circulation was more common in the extracranial carotid artery stenosis and the posterior circulation in the extracranial vertebral artery stenosis, the anterior circulation in the poor prognosis of TIA was the middle cerebral artery stenosis, and the posterior circulation was the intracranial vertebral artery and the posterior cerebral artery stenosis.
【學(xué)位授予單位】：山西醫(yī)科大學(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：2366641
[Abstract]:Aim: to study the relationship between prognosis of patients with transient ischemic attack (TIA) and the degree of atherosclerotic stenosis, distribution of stenosis and the nature of atherosclerotic plaque. Methods: selected patients who were hospitalized in the first affiliated Hospital of Shanxi Medical University from April 2012 to July 2013 and were diagnosed with TIA. The degree of stenosis, the location of stenosis and the character of plaque were evaluated by CTA. The patients were followed up for 90 days. According to the prognosis, the patients were divided into stable group, frequent group and cerebral infarction group. SPSS19.0 Chinese software was used to analyze the correlation between prognosis and vascular stenosis. Results: 1. A total of 89 patients were selected and 8 cases were lost. There were 34 cases (42.0%) in stable group, 37 cases (45.7%) in frequent incidence group and 10 cases (12.3%) in cerebral infarction group. 2. Vascular stenosis was found in 24 cases in stable group, in 31 places in vascular stenosis, in 35 cases in frequent incidence group (65 places), and in 10 cases in cerebral infarction group (39 places). In the stable group, the proportion of stenosis was mild 77.4% (24 / 31), moderate 16.1% (5 / 31), severe 3.2% (1 / 31), occlusion 3.2% (1 / 31). The proportion of the degree of stenosis was 73.9% (48 / 65), 10.8% (7 / 65), 4.6% (3 / 65) and 10.8% (7 / 65) in the frequent incidence group. The proportion of stenosis in cerebral infarction group was mild 56.4% (22 / 39), moderate 10.3% (4 / 39), severe 15.4% (6 / 39), occlusion 17.9% (7 / 39). In the three groups, the worse the prognosis was and the greater the ratio of occlusion and stenosis was, the smaller the ratio of stenosis was. The results of correlation analysis showed that there was a positive correlation between the severity of prognosis and the ratio of occlusion and stenosis. 3. The results showed that there were 117 plaques in 25 patients in stable group, 35 in stable group, 51 in frequently occurring group and 31 in cerebral infarction group. In the stable group, the plaque composition was 51.4% (18 / 35), 34. 3% (12 / 35), 14. 3% (5 / 35) for calcified plaque, 34. 3% (12 / 35) for mixed plaque and 14. 3% (5 / 35) for soft spot. The ratio of plaque composition in frequent group: calcified plaque 23.5% (12 / 51), mixed plaque 47.1% (24 / 51), soft plaque 29.4% (15 / 51); The plaque composition of cerebral infarction group was as follows: calcified plaque 12.9% (4 / 31), mixed plaque 48.4% (15 / 31), soft plaque 38.7% (12 / 31). In the three groups, the worse the prognosis was, the greater the compositional ratio of mixed plaque and soft spot was, and the smaller the ratio of calcified plaque was. Correlation analysis showed that there was a positive correlation between 0. 364 and 0. 001, with a positive correlation of 4. 4. In the stable group, 38.9% (7 / 18) of the anterior circulation stenosis was found in the extracranial segment of ICA, and 38.5% (5 / 13) of the posterior circulation was found in the extracranial segment of VA. MCA40.0% (16 / 40), 42.1% (8 / 19), 36.0% (9 / 25), 35.0% (7 / 20), PCA32.0% (8 / 25) of the intracranial segment of VA were found in the recurrent and cerebral infarction groups. 35.0% (7 / 20) are more common. Conclusion: 1. The prognosis of TIA is related to the degree of stenosis and the nature of plaque. With the increase of prognosis severity, the proportion of severe and occluded vascular stenosis gradually increased, the proportion of mild vascular stenosis gradually decreased, and the proportion of unstable plaque (soft plaque, mixed plaque) gradually increased. The proportion of stable plaques decreased gradually. In the patients with good prognosis of 2.TIA, the anterior circulation was more common in the extracranial carotid artery stenosis and the posterior circulation in the extracranial vertebral artery stenosis, the anterior circulation in the poor prognosis of TIA was the middle cerebral artery stenosis, and the posterior circulation was the intracranial vertebral artery and the posterior cerebral artery stenosis.
【學(xué)位授予單位】：山西醫(yī)科大學(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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