【摘要】：目的:探討顱內動脈重度狹窄或閉塞患者側支循環(huán)灌注的影響因素和對腦梗死體積以及臨床癥狀的影響,為該類型病變患者臨床預后及治療提供依據(jù)。方法:分析我院2014年12月至2017年3月在廣西壯族自治區(qū)人民醫(yī)院住院的癥狀性顱內動脈重度狹窄或閉塞患者142例,所有入組患者均登記年齡、性別、血壓、糖尿病、同型半胱氨酸、總膽固醇、低密度脂蛋白、高密度脂蛋白、吸煙飲酒史;記錄入院時的NIHSS評分、ADL評分;所有患者均行磁共振平掃(MRI)+彌散功能成像檢查(DWI),并計算腦梗死體積大小;所有患者行全腦血管造影檢查(DSA),評估側支循環(huán)血流灌注情況、明確狹窄部位和計算血管狹窄程度。參照美國放射介入學會(ASITN/SIR)的側支循環(huán)評估系將入組患者分為側支循環(huán)灌注良好組(3-4級)以及側支循環(huán)灌注不良組(0-2級)。利用t檢驗、卡方檢驗以及l(fā)ogistics回歸分析兩組患者數(shù)據(jù)差異。結果:入組的142例患者當中,側支循環(huán)灌注良好組68例,側支循環(huán)灌注不良組74例;側支循環(huán)灌注良好組與側支循環(huán)灌注不良組比較,兩組患者年齡、性別、糖尿病、同型半胱氨酸、總膽固醇、低密度脂蛋白、吸煙飲酒史差異無統(tǒng)計學意義(P0.05);高血壓、高密度脂蛋白差異有統(tǒng)計學意義(P0.05);側支循環(huán)灌注良好組腦梗死體積明顯減小(P0.05);側支循環(huán)灌注良好組入院時NIHSS評分較小、ADL評分較高(P0.05)。結論:1.高密度脂蛋白增高和輕度高血壓與側支循環(huán)血流灌注良好相關;2.良好的側支循環(huán)血流灌注是急性腦缺血的保護性因素,可減小腦梗死的體積,減輕患者腦缺血的臨床癥狀,改善患者的日常生活能力。
[Abstract]:Objective: to investigate the influencing factors of collateral circulation perfusion in patients with severe stenosis or occlusion of intracranial artery, and to provide evidence for clinical prognosis and treatment of patients with severe intracranial artery stenosis and occlusion. Methods: from December 2014 to March 2017, 142 patients with severe intracranial artery stenosis or occlusion in Guangxi Zhuang Autonomous region people's Hospital were analyzed. All the patients were enrolled in the study, including age, sex, blood pressure, diabetes mellitus. Homocysteine, total cholesterol, low density lipoprotein, high density lipoprotein, smoking and drinking history; The NIHSS and ADL scores were recorded on admission, and all patients were examined by plain Mr (MRI) diffusion function imaging (DWI),) and the size of cerebral infarction was calculated. All patients underwent (DSA), to evaluate the collateral circulation perfusion, to determine the stenosis location and to calculate the degree of stenosis. According to the evaluation of collateral circulation of the American Society of Radiological intervention (ASITN/SIR), the patients were divided into three groups: good collateral circulation perfusion group (grade 3-4) and bad collateral circulation perfusion group (grade 0-2). T test, chi-square test and logistics regression analysis were used. Results: among 142 patients, 68 cases were good collateral circulation perfusion group and 74 cases were bad collateral circulation perfusion group. There was no significant difference in age, sex, diabetes, homocysteine, total cholesterol, low density lipoprotein (LDL) and smoking and drinking history between the good collateral circulation perfusion group and the bad collateral circulation group (P0.05). Hypertension, high-density lipoprotein difference was statistically significant (P0.05); collateral circulation perfusion group cerebral infarction volume significantly decreased (P0.05); collateral circulation perfusion good group NIHSS score was smaller, ADL score was higher (P0.05). Conclusion: 1. High density lipoprotein and mild hypertension were associated with good collateral circulation perfusion. 2. Good collateral circulation perfusion is the protective factor of acute cerebral ischemia, which can reduce the volume of cerebral infarction, alleviate the clinical symptoms of cerebral ischemia, and improve the daily living ability of the patients.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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