【作者】 王辉；

【导师】 沈雪莉；

【作者基本信息】 中国医科大学 ， 神经病学， 2009， 硕士

【摘要】 前言脑梗死(cerebral infarction,CI)是脑部血液供应障碍,缺血、缺氧引起的局灶性脑组织坏死或脑软化。目前,脑梗死已经成为老年人常见的致残和死亡原因。国内外大量研究证实,颈动脉粥样硬化是脑梗死最主要的病因和危险因素之一,与脑梗死的发生、发展以及梗死部位密切相关。近年来,颈动脉粥样硬化作为许多心脑血管病临床实验的一个“替代终点”,已成为反映全身动脉粥样硬化病变的一个窗口。许多研究表明,脑梗死患者颈动脉内.中膜厚度明显增厚,由此导致颈动脉部分或完全堵塞,使远端血流缓慢、灌注压下降形成低灌注性梗死;斑块脱落则导致血栓性脑梗死。临床研究证实,高血压、男性、高血脂、纤维蛋白原增高、高尿酸血症和糖尿病、吸烟等是颈动脉粥样硬化发生的危险因素。充分认识颈动脉粥样硬化斑块发生发展的情况,并采取相应的干预措施,对有效防治脑梗死具有非常重要的意义。资料与方法1、临床资料本研究对象系2007年1月～2008年11月丹东解放军230医院神经内科收治的急性脑梗死患者100例,全部符合1995年全国第四届脑血管病学术会议修订的诊断标准。排除标准:(1)多次发作的脑梗死;(2)心脏瓣膜病、心房颤动者所致脑梗死;(3)脑血管畸形、脑出血、脑外伤、血管炎或血液病、肿瘤后所致梗死;(4)头颅CT确诊,脑CT显示一个低密度影者为单灶脑梗死,两个及两个以上病灶者为多灶脑梗死。100例患者中,男性65名,女性35名,年龄60—94岁,从发病到就诊时间为半小时到73小时,合并高血压者50例,合并糖尿病2型者41名,吸烟者37名。同期门诊健康体检者40例作为对照组,入选标准为无脑血管病,并全部经头CT证实排除脑梗死,其中男性22名,女性18名,年龄60—92岁,合并高血压者14名,合并糖尿病2型者10名,吸烟者10名。利用彩色多普勒超声检查颈动脉粥样硬化程度、全自动生化仪化验详细记录血脂、血糖、血尿酸、纤维蛋白原,同时进行高血压、年龄、性别、吸烟史等相关因素研究,探索颈动脉粥样硬化及相关因素与脑梗死的关系。2、实验方法(1)彩色多普勒超声诊断仪,分别探查患者双侧颈总动脉(CCA)、颈总动脉分叉处(BIF)及颈内动脉(ICA)颅外段,观察内.中膜厚度(IMT)和管壁内径,颈动脉收缩期峰值流速(SPV),阻力指数(RI);内-中膜厚度正常小于1.0mm,大于1.2 mm为有斑块形成。根据彩色多普勒超声提示的颈动脉斑块的情况分为斑块组和无斑块组。(2)血液生物化学指标测定全自动生化测定仪1台,脑梗死组于住院后、健康对照组于体检日分别抽取禁食12 h静脉血8毫升,离心取血浆。测定血糖、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、血尿酸、纤维蛋白原等。入院次日清晨安静状态下手工水银血压计测量血压3次,记平均值。3、统计学处理计量资料数据以均数±标准差((?)±S)表示,比较采用t检验;计数资料以率表示,组间比较用X~2检验,P＜0.05表示差异,有统计学意义。全部资料采用SPSS 13.0软件进行统计分析。实验结果(1)实验组中的血糖、血脂中总胆固醇、甘油三酯、低密度脂蛋白、血尿酸、纤维蛋白原、高血压、吸烟史均高于对照组,高密度脂蛋白低于实验组,两者之间有统计学差异(P＜0.05)。(2)在100例脑梗死患者中,颈动脉粥样硬化斑块发生有85例,其中70-79岁斑块发生率32.94%,高于60-69岁的21.18%发生率,而80岁以上颈动脉粥样硬化斑块发生率最高,为45.88%。(3)在60例单灶脑梗死中,左侧脑梗死为18例,颈动脉粥样硬化斑块发生在左侧为13例,侧向符合率72.22%,而右侧脑梗死为42例,斑块发生在右侧为34例,侧向符合率80.95%。(4)60例单灶脑梗死患者中,其中无斑块13例,占21.7%,有斑块组47例,占78.3%;40例多灶脑梗死患者中,无斑块组2例,占5%,有斑块38例,占95%;而40例对照组中,无斑块35例,占87.5%,有斑块组5例,占12.5%。结论颈动脉粥样硬化程度同脑梗死密切相关,而高血脂、高血糖、高血尿酸、纤维蛋白原增高、高血压、男性、吸烟史等是颈动脉粥样硬化发生的危险因素,随着年龄的增长,颈动脉粥样硬化程度加重;颈动脉粥样硬化斑块的形成的侧别同脑梗死的侧别有关系。更多还原

【Abstract】 IntroductionCerebral infarction(cerebral infarction,CI) is the focal brain tissue necrosis or cerebral softening.It’s coursed by the ischemia,hypoxia At present,cerebral infarction has become the main reason that the old pepple are disabilities and dead.At home and abroad A large number of studies from home and abroad confirm that carotid atherosclerosis is the main reason and one of the most dangers for the CI.And it is related closedly to the cerebral infarction’s happening development and the place of CI.In recent years,carotid atherosclerosis,as a number of clinical trials of cardio-cerebral vascular diseases as a "surrogate" has become reflected in the body of atherosclerosis lesions in a window.Many studies have shown that cerebral infarction in patients with carotid artery - the intima-media thickness was significantly thicker, leading to partially or completely blocked carotid artery,so that distal slow down the formation of a low perfusion pressure perfusion infarct;plaque off the lead to thrombosis cerebral infarction.Clinical studies have proven that the most dangerous reasons that caused carotid artery atherosclerosis are high blood pressure,male,high blood lipids,fibrinogen increased,hyperuricemia and diabetes,smoking,and so on. Please know enough about the situation of carotid atherosclerotic plaque occurrence and development and take appropriate intervention measures to prevent effectively cerebral infarction has very important significance.Materials and methods1.Clinical dataThe persons who are studied:100 patients from Dandong People’s Liberation Army 230 Hospital,Department of Neurology,admitted with acute cerebral infarction (from January 2007～November 2008) in full compliance with the Fourth National Cerebrovascular Disease in 1995,the revised diagnostic criteria of academic conferences.Exclusion criteria:(1) repeated episodes of cerebral infarction;(2) valvular heart disease,atrial fibrillation,are caused by cerebral infarction;(3) cerebral vascular malformation,cerebral hemorrhage,brain trauma,vascular inflammation or blood disease,after cancer induced infarction;(4) diagnosed with head CT,brain CT showed a low-density shadow by a single stove cerebral infarction,two and two or more lesions were multiple foci of cerebral infarction.100 patients,male 65,female 35, age 60-94 years,from onset to treatment time for half an hour to 73 hours,50 cases with hypertension,type 2 diabetes were 41 smokers,37.Over the same period were 40 cases of out-patient health check as the control group,inclusion criteria for non-cerebrovascular disease,and all were confirmed by head CT to exclude cerebral infarction,22 males,18 females,aged 60-92 years old,with hypertension were 14,with diabetes mellitus type 2 were 10 smokers,10.Use the color Doppler ultrasound examination of carotid atherosclerosis,automatic biochemical analyzer for testing detailed record of blood lipids,blood glucose,serum uric acid,fibrinogen,at the same time we study the relationship between the high blood pressure,age,sex,smoking history and other relevant factors,Explore the relationship between the carotid atherosclerosis and the cerebral infarction.2.Experimental methods(1) Color Doppler ultrasonic diagnostic apparatus,respectively,in patients with carotid artery probe(CCA),common carotid artery bifurcation(BIF) and carotid artery (ICA) of extracranial observed in - in the film thickness(IMT) and wall diameter, carotid artery peak systolic velocity(SPV),resistive index(RI);in - the normal thickness of less than 1.0mm,larger than 1.2 mm to have plaque formation.According to color Doppler ultrasound of carotid artery plaque tips were divided into plaque group and non-plaque group. (2) The determination of blood biochemical indicators of an automatic biochemical analyzer units,cerebral infarction in the hospital,the healthy control group taking the examination on 12 h fasting venous blood 8 milliliters,centrifugal obtain plasma.Determination of glucose,total cholesterol,triglyceride,low-density lipoprotein,high-density lipoprotein,serum uric acid,fibrinogen.Admitted to hospital the next morning quiet state manual mercury sphygmomanometer blood pressure three times the average mind.3.Statistical methodsMeasurement information and data to the mean±standard deviation((?)+S) that was used to compare T test orX~2 test;count data to the rate indicated,P＜0.05 indicated that differences are statistically significant.All the information using SPSS 13.0 software for statistical analysis.Experimental Results(1) The experimental group in the blood glucose,blood lipids,total cholesterol, triglyceride,low-density lipoprotein,serum uric acid,fibrinogen,hypertension, smoking history were higher,high-density lipoprotein less than the experimental group the two are statistically significant difference(P＜0.05).(2) in 100 patients with cerebral infarction in the carotid atherosclerotic plaque occurred with 85 cases,of which 70-79 plaque incidence of 32.94%,higher than the 60-69 years of age the incidence of 21.18%,while the 80-year-old above carotid atherosclerotic plaque incidence of the highest,45.88%.(3) cerebral infarction in 60 patients with single lesions in the left cerebral infarction and 18 cases of carotid artery atherosclerotic plaque occurred in the left in 13 cases,the lateral line with the rate of 72.22%,while the fight side of the 42 cases of cerebral infarction in and plaques on the right side of 34 cases,lateral line with the rate of 80.95%.(4) 60 cases of single lesions in patients with cerebral infarction,in which no plaque in 13 cases,accounting for 21.7%,with plaque group 47 cases,accounting for 78.3%;40 cases of multiple lesions in patients with cerebral infarction,non-plaque group 2 cases,5%,there are plaques in 38 cases,95%;and 40 cases of the control group,35 patients with no plaque,accounting for 87.5%,there are five cases of plaque group,accounting for 12.5%.ConclusionThe degree of carotid atherosclerosis is closely related with cerebral infarction, and high blood lipids,high blood sugar,high blood uric acid,fibrinogen increased, hypertension,male,smoking history and other carotid artery atherosclerosis risk factors, with age growth,degree of carotid atherosclerosis increased;carotid artery atherosclerotic plaque formation of other side do not have the same side of the relationship between the cerebral infarction.更多还原