本文選題：大動脈粥樣硬化型腦卒中 + 白質(zhì)疏松�。� 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：背景與目的： 白質(zhì)疏松（white matter hyperintensities， WMHs）是小血管病主要的表現(xiàn)類型之一，腦卒中合并WMHs的占有44%-86.4％，更常與腔隙性梗塞、微出血等伴隨出現(xiàn)。大動脈粥樣硬化型腦卒中（1arge artery atherosclerosis，LAA）是常見的缺血性腦卒中類型，估計(jì)在亞洲卒中人群中占20％-50％。而流行病學(xué)資料顯示W(wǎng)MHs也可伴隨LAA。白質(zhì)疏松區(qū)域白質(zhì)纖維聯(lián)系障礙，腦組織灌注減少，合并WMHs可能增加LAA預(yù)后不良的風(fēng)險(xiǎn)。WMHs可以根據(jù)解剖定位于分為兩部分：側(cè)腦室旁白質(zhì)疏松(periventricular WMHs PVWMHs)和深部白質(zhì)疏松分(subcortical WMHs SWMHs)。既往的研究大都聚焦于LAA或WMHs。很少關(guān)注同時合并的WMHs，特別是不同部位WMHs對缺血性卒中的結(jié)局影響。本研究對此進(jìn)行探索。 對象與方法： 研究對象：來自基于鄭州大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科的單中心的前瞻性卒中登記數(shù)據(jù)庫，篩選數(shù)據(jù)庫中自2009年11月至2012年10月住院發(fā)病14天內(nèi)的急性缺血性卒中患者。 研究方法：連續(xù)納入符合標(biāo)準(zhǔn)的缺血性卒中患者，記錄患者基線臨床資料，完成標(biāo)準(zhǔn)入院登記表。 1知情同意：書面告知符合納入標(biāo)準(zhǔn)的患者和/或家屬本研究的目的、方法及可能對患者及其家屬帶來的益處及風(fēng)險(xiǎn)，患者和/或家屬決定是否加入本研究，并可在研究過程任一階段退出。 2記錄基線資料：收集患者的年齡、性別、吸煙史、高血壓史、糖尿病史、心房顫動史、卒中史。收集入院時美國國立健康研究院卒中評分(NIHSS)、實(shí)驗(yàn)室檢查、心電圖(EKG)、胸片，頸部血管彩超、CTA結(jié)果、TOAST分型、WMHs嚴(yán)重程度評分。所有患者均行3.0Tesla MRI檢查，，包括常規(guī)序列T1加權(quán)像、T2加權(quán)像、液體衰減反轉(zhuǎn)回復(fù)（FLAIR）序列、彌散加權(quán)成像（DWI）序列。 3隨訪：在患者發(fā)病后12月后進(jìn)行電話隨訪，由經(jīng)統(tǒng)一培訓(xùn)且未參加納入工作的研究人員對患者進(jìn)行記錄臨床結(jié)局（卒中復(fù)發(fā)、生活依賴或死亡）、二級預(yù)防藥物使用情況等。 4輸機(jī)及統(tǒng)計(jì)分析：上述資料輸入SPSS17.0保存并分析，通過Kaplan-Meier方法進(jìn)行生存分析（p0.05），通過多因素Cox回歸、Logistic回歸分析卒中復(fù)發(fā)以及生活依賴事件發(fā)生的危險(xiǎn)因素（p0.05）。 結(jié)果： 在1003例連續(xù)缺血性卒中患者中，51例（5.1%）資料不齊全，541例(心源型97例（10.2%），小血管型189例（19.8%），其他型92例（9.7%），不明原因型163例（17.1%）。最終411例符合研究標(biāo)準(zhǔn)而入選，男278例，女133例，平均年齡59.55±17.41歲（16-94歲），復(fù)發(fā)50例（12.2%），預(yù)后不佳（生活依賴或死亡）116例（28.2%），失訪22例（5.3%）。在411例大動脈粥樣硬化型腦卒中患者中，129例（32.4％）合并重度WMHs,193例（49.6％）合并重度PVWMHs，146例（36.7％）合并重度SWMHs。 通過K-M生存分析，對數(shù)秩檢驗(yàn)顯示合并重度WMHs（P＜0.001）、重度PVWMHs（P＜0.001），卒中復(fù)發(fā)風(fēng)險(xiǎn)均增加。合并重度SWMHs（P=0.06），LAA復(fù)發(fā)風(fēng)險(xiǎn)均無統(tǒng)計(jì)學(xué)差異。為了控制其他中風(fēng)危險(xiǎn)因素，分別采用多因素logistic回歸分析、Cox生存分析來探討不同位置的重度WMHs對LAA復(fù)發(fā)及生活依賴的影響。為了避免白質(zhì)疏松的交互作用，重度WMHs （根據(jù)Fazekas＞3）進(jìn)入模型一進(jìn)行分析，不同位置的重度WMHs進(jìn)入模型二分析。在模型一，重度WMHs與LAA復(fù)發(fā)（P＜0.001HR=6.7795%CI3.30-13.89）、生活依賴(P＜0.001HR=3.0495%CI1.69-5.44)呈正相關(guān)。另外，LDL（P=0.021HR=1.5095%CI1.06-2.11）與復(fù)發(fā)呈正相關(guān)。年齡（P=0.021HR=1.0395%CI1.01-1.06），NIHSS評分（P＜0.001HR=1.1995%CI1.12-1.25）、LDL（P=0.037HR=1.4295%CI1.02-1.97）與生活依賴呈正相關(guān)。在模型二中，年齡（P=0.035HR=1.03CI95%1.00-1.07）、LDL（P=0.040HR=1.4895%CI1.02-2.15）、重度PVWMHs（P=0.013HR=2.4195%CI1.21-4.81）與復(fù)發(fā)呈正相關(guān)；但重度SWMHs（P=0.721HR=0.8995%CI0.46-1.71）與LAA復(fù)發(fā)無相關(guān)性。年齡(P=0.017HR=1.0395%CI1.01-1.06)、NHISS評分(P＜0.001HR=1.1895%CI1.11-1.24)、重度PVWMH(P＜0.001HR=3.3495%CI1.83-6.07)與生活依賴呈正相關(guān)；但重度SWMHs（P=0.806HR=1.0895%CI0.59-1.95）與生活依賴無相關(guān)性。 結(jié)論： 合并重度白質(zhì)疏松、重度側(cè)腦室旁白質(zhì)疏松的大動脈粥樣硬化型腦卒中病人的卒中復(fù)發(fā)以及生活依賴風(fēng)險(xiǎn)顯著高于對照組。
[Abstract]:Background and purpose:
Leukoaraiosis (white matter hyperintensities, WMHs) is one of the major manifestations of small vascular disease. Cerebral Apoplexy Combined with WMHs is 44%-86.4%, more often associated with lacunar infarction and micro bleeding. Large atherosclerotic stroke (1arge artery atherosclerosis, LAA) is a common type of ischemic stroke, estimated in subtype The population of stroke in the continent is 20%-50%. and epidemiological data show that WMHs can also be associated with leukofibrinous disorders in the LAA. leukoaraiosis area and the decrease in cerebral tissue perfusion. The combination of WMHs may increase the risk of poor prognosis of LAA,.WMHs can be divided into two parts according to the anatomical location: lateral ventricle leukoaraiosis (periventricular WMHs PVWMHs). Deep leukoaraiosis (subcortical WMHs SWMHs). Previous studies have mostly focused on LAA or WMHs. with little attention to simultaneous WMHs, especially the effects of WMHs on ischemic stroke in different sites. This study explored this study.
Objects and methods:
Participants: a single center prospective stroke registration database based on the neurology department of the First Affiliated Hospital of Zhengzhou University was selected to screen for acute ischemic stroke patients in the database for 14 days from November 2009 to October 2012.
Research methods: continuous ischemic stroke patients with standard compliance, record baseline clinical data and complete the standard admission registration form.
1 informed consent: the purpose, method, and risk of the patient and / or family members of the patient and / or family members of the patient and / or family members in writing to meet the inclusion criteria, and whether the patient and / or family members decide whether to join this study and exit at any stage of the study.
2 baseline data: the age, sex, smoking history, history of hypertension, diabetes, atrial fibrillation, stroke history. The National Institutes of Health Stroke score (NIHSS), laboratory examination, electrocardiogram (EKG), chest radiography, neck vascular color Doppler, CTA results, TOAST classification, WMHs severity score were collected at the admission. All patients received 3.0T Esla MRI examination, including conventional sequence T1 weighted images, T2 weighted images, fluid attenuated inversion recovery (FLAIR) sequences, and diffusion weighted imaging (DWI) sequences.
3 follow up: the patients were followed up after December after the onset of the disease. The researchers who had been trained and did not participate in the work recorded the patient's clinical outcome (the recurrence of stroke, life dependence or death), and the use of two levels of preventive drugs.
4 transmission and statistical analysis: the above data were stored and analyzed by SPSS17.0, and the survival analysis (P0.05) was carried out by the Kaplan-Meier method. By multiple factor Cox regression, Logistic regression was used to analyze the risk factors for the recurrence of stroke and the occurrence of life dependent events (P0.05).
Result錛

本文編號：1837150