發(fā)布時間：2019-05-06 08:42

【摘要】：背景——由于中國人口老齡化,腦卒中發(fā)病率逐年增長,而腦梗死和腦出血占絕大部分。相對于腦梗死,腦出血發(fā)病急,病情重,病死率高。低密度脂蛋白膽固醇增高被認為是腦梗死的一項危險因素,臨床上對于有腦梗死危險因素或腦梗死患者要求降低LDL-C,甚至很低。但有研究提出,LDL-C水平過低可增加腦出血的風險,尤其對于有高血壓病史患者,因此LDL-C不應降的過低。但關于低水平的LDL-C是否可以增加腦出血風險仍有爭論。方法——收集山東大學齊魯醫(yī)院2007-2016年滿足18-80歲高血壓患者以及只有高血壓一項危險因素的腦梗死和腦出血患者,排除有吸煙、糖尿病、冠心病、血液病、房顫、甲亢、動靜脈畸形及動脈瘤等與腦梗死或腦出血相關的危險因素或病因。對收集患者的性別、年齡、口服降壓藥情況以及腦梗死和腦出血患者的血清膽固醇的差異性進行統(tǒng)計學分析。結(jié)果——1261名患者中,高血壓患者344名,平均年齡55.4歲(19.0-80.0歲);腦梗死患者538名,平均年齡59.4歲(26.0-80.0歲);腦出血379名,平均年齡54.2歲(28.0-80.0歲),占所有患者的30.1%。腦梗死和腦出血患者中未服用降壓藥或未規(guī)律服藥的患者有395名(40%),規(guī)律服藥的僅有282名(30.8%);而高血壓患者中規(guī)律服用降壓藥的患者有223名(64.8%)。高血壓性腦出血及腦梗死兩組中患者的高血壓病史時間和高血壓分級與高血壓組患者無統(tǒng)計學差異,但腦梗死組患者的年齡較腦出血組明顯增高(P0.001),腦梗死和腦出血患者未規(guī)律服藥和未服藥患者較高血壓患者明顯增多。腦梗死組患者LDL-C(3.12mmol/L,P0.001)和腦出血組患者LDL-C(2.68mmol/L,P0.001)與高血壓組患者LDL-C均有明顯差異性,腦梗死組患者TC(P=0.026)和腦出血組患者TC(P0.001)與高血壓組患者同樣有顯著差異性。在男性和女性患者中,腦出血組患者LDL-C和TC與高血壓患者均有明顯差異性。在腦出血患者組中,只有50-59歲和70-80歲年齡組中LDL-C與高血壓患者LDL-C是有顯著差異性,而TC是在50-59歲、60-69歲和70-80歲年齡組均有差異性。腦出血組患者LDL-C和TC在高血壓病史5-10年和10-20年分組中較高血壓組患者明顯降低。在不同高血壓分級組中,腦出血組患者與高血壓組患者的膽固醇水平均無統(tǒng)計學差異。而在根據(jù)患者服用降壓藥情況的分組中,腦出血患者LDL-C(P=0.020)和TC(P=0.013)水平只有在規(guī)律服用降壓藥組與高血壓患者有明顯差異性。隨著LDL-C值和TC值降低,腦出血患者比例明顯增加,而腦梗死比例降低。在LDL-C2.59mmol/L不同分組和TC2.86mmol/L分組中均為腦出血患者所占比例較未分組患者中腦出血患者所占比例明顯增高;而在LDL-C3.37mmol/L和TC5.98mmol/L患者中腦出血患者所占比例較未分組患者中腦出血患者所占比例明顯降低。結(jié)論——LDL-C和TC對不同類型的腦卒中影響不同,高水平的LDL-C和TC增加腦梗死發(fā)生的風險,而低水平的LDL-C和TC是發(fā)生腦出血的危險因素。不管在男性還是女性患者中,尤其在老年患者、高血壓病史20年以下以及規(guī)律服用降壓藥的患者中,低水平的LDL-C和TC增加腦出血風險。但對于高血壓患者,仍需要進行積極的降壓治療。并且LDL-C水平越低發(fā)生腦出血的風險越大。
[Abstract]:Background _ The incidence of stroke is increasing year by year due to the aging of the Chinese population, and the cerebral infarction and the cerebral hemorrhage account for a large part. Compared with cerebral infarction, the incidence of cerebral hemorrhage is acute, the disease is heavy and the case fatality rate is high. The increase of low-density lipoprotein cholesterol is considered a risk factor for cerebral infarction, and is clinically relevant to the risk factors of cerebral infarction or the requirements of patients with cerebral infarction to lower the LDL-C and even lower. However, it is suggested that low levels of LDL-C may increase the risk of cerebral hemorrhage, especially for patients with a history of hypertension, so that the LDL-C refractory should not be reduced. But there is a debate about whether low levels of LDL-C can increase the risk of cerebral hemorrhage. Method _ Collect the patients with hypertension of 18 to 80 years of age in Qilu Hospital of Shandong University from 2007 to 2016, and the patients with cerebral infarction and cerebral hemorrhage with only one risk factor of hypertension, and exclude smoking, diabetes, coronary heart disease, hemopathy, atrial fibrillation, hyperthyroidism, The risk factors or causes associated with cerebral infarction or cerebral hemorrhage such as arteriovenous malformations and aneurysms. The difference of serum cholesterol in patients with cerebral infarction and cerebral hemorrhage was analyzed statistically. Results Among the 1261 patients,344 patients with hypertension, mean age of 55.4 years (19.0-80.0 years),538 patients with cerebral infarction, mean age of 59.4 years (26.0-80.0 years), and 379 patients with cerebral hemorrhage, the average age was 54.2 years (28.0-80.0 years), accounting for 30.1% of all patients. In the patients with cerebral infarction and cerebral hemorrhage, there were 395 (40%) of the patients who had not taken the drugs or the non-regular drugs, and only 282 (30.8%) of the regular drugs were taken; and 223 (64.8%) of the patients with the regular administration of the hypotensive drugs in the patients with hypertension. There was no statistical difference between the history of hypertension and the level of hypertension in the patients with hypertensive cerebral hemorrhage and cerebral infarction, but the age of the patients with cerebral infarction was significantly higher than that in the group with cerebral hemorrhage (P 0.001). In the patients with cerebral infarction and cerebral hemorrhage, the patients with non-regular administration and non-drug administration were significantly higher than those in the patients with high blood pressure. LDL-C (3.12 mmol/ L, P0.001) in patients with cerebral infarction and LDL-C (2.68 mmol/ L, P0.001) in patients with cerebral hemorrhage were significantly different from those in patients with hypertension. In both male and female patients, there was a significant difference between the levels of LDL-C and TC in patients with cerebral hemorrhage. In the group of patients with cerebral hemorrhage, LDL-C in the 50-59 and 70-80-year-old age group was significantly different, and the TC was in the age group of 50-59,60-69, and 70-80 years. The levels of LDL-C and TC in the patients with cerebral hemorrhage were significantly lower in the hypertension group than in the 5-10 and 10-20 years of hypertension. There was no statistical difference between the levels of cholesterol in the patients with the ICH group and the hypertension group in the different hypertension grade group. In the patients with cerebral hemorrhage, the levels of LDL-C (P = 0.020) and TC (P = 0.013) in patients with cerebral hemorrhage were significantly different from those of patients with hypertension. With the decrease of LDL-C and TC, the proportion of patients with cerebral hemorrhage increased significantly, and the proportion of cerebral infarction decreased. In that LDL-C2.59 mmol/ L and TC2.86 mmol/ L, the proportion of patients with cerebral hemorrhage in the patients with cerebral hemorrhage was significantly increased, while the proportion of patients with cerebral hemorrhage in the patients with cerebral hemorrhage was significantly lower in the patients with cerebral hemorrhage in the patients with cerebral hemorrhage in the patients with low density of LDL-3.37 mmol/ L and TC5.98 mmol/ L. Conclusion _ LDL-C and TC have different effects on different types of stroke, and high levels of LDL-C and TC increase the risk of cerebral infarction, while low levels of LDL-C and TC are the risk factors for cerebral hemorrhage. Low levels of LDL-C and TC increase the risk of cerebral hemorrhage, whether in male or female patients, especially in the elderly, in patients with a history of hypertension of less than 20 years, and in patients with regular administration of the drug. However, a positive step-down treatment is still required for patients with high blood pressure. And the lower the ldl-c level, the greater the risk of cerebral hemorrhage.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.34

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