【作者】 杨阳；

【导师】 王惠娟；

【作者基本信息】 河北医科大学 ， 神经病学（专业学位）， 2024， 硕士

【摘要】 目的:卒中会使控制睡眠和觉醒的脑内结构和内环境发生改变,进而改变睡眠与觉醒发生的时间和节律,出现睡眠障碍。目前,越来越多的研究发现,与正常人群相比,卒中患者更易罹患睡眠障碍。而睡眠障碍则从多个方面对卒中患者造成负面影响,影响患者的康复质量、使患者的血压、血糖等脑血管病相关危险因素不稳定,神经功能的恢复周期延长,甚至可能再次诱发卒中。由此可见,卒中与睡眠障碍之间存在相互促进的关系。本研究旨在通过收集并分析卒中患者的临床资料,探讨卒中相关睡眠障碍的发生率及可能相关的危险因素,为卒中相关睡眠障碍的早期发现、规范诊疗和改善预后提供更多的理论支持。方法:入组2023年7月至2024年1月在河北医科大学第二医院神经内科住院治疗和门诊复诊的患者,共计190例。采集患者的空腹血样,由河北医科大学第二医院检验科统一检测。采用匹兹堡睡眠质量指数量表对患者的睡眠情况进行评估,将总分≥7分作为分组标准,把所有入组患者分为睡眠障碍组和非睡眠障碍组。收集两组患者的临床资料,包括性别、年龄、文化程度、病程分期、卒中类型、卒中病灶解剖部位、既往史、个人史、神经缺损程度(使用NHISS评分量表进行评估)、日常活动能力(使用BI量表进行评估)、体重指数BMI及实验室检验结果。实验室检验结果包括:血清同型半胱氨酸、红细胞计数(RBC)、血红蛋白含量(HBG)、白细胞计数(WBC)、中性粒细胞百分比(NE%)、淋巴细胞百分比(LY%)、血小板计数(PLT)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、肌酐(CR)、尿酸(UA)、尿素(UREA)。统计学方面,分析两组之间上述临床资料的差异。对于单因素统计分析发现两组间差异有统计学意义的因素进行多因素Logistic回归分析。以P<0.05为差异有统计学意义,探索卒中相关睡眠障碍可能的影响因素。结果:1.卒中相关睡眠障碍的发生率为44.2%。2.单因素分析结果显示:睡眠障碍组与非睡眠障碍组患者在年龄、病程分期、卒中部位、高血压病史、糖尿病病史、心脏疾病病史、吸烟史、BMI、TG方面差异有统计学意义(P<0.05),而在性别、文化程度、卒中类型、脑卒中既往史、饮酒史、NIHSS评分、BI评分、同型半胱氨酸、RBC、HBG、WBC、NE%、LY%、PLT、TC、HDL、LDL、ALT、AST、CR、UA、UREA方面差异无统计学意义(P>0.05)。3.多因素Logistic回归分析结果显示卒中相关睡眠障碍与年龄(OR=1.060,95%CI=1.015-1.107)、皮质下白质卒中(OR=6.657,95%CI=2.137-20.734)、丘脑卒中(OR=8.437,95%CI=2.098-33.936)、糖尿病病史(OR=0.378,95%CI=0.163-0.875)及心脏疾病病史(OR=0.126,95%CI=0.042-0.375)关系密切(P<0.05)。结论:卒中相关睡眠障碍发生率较高,年龄、皮质下白质卒中、丘脑卒中、糖尿病病史、心脏疾病病史是其可能的影响因素。更多还原

【Abstract】 Objective: In stroke patients,there are changes in the structure and internal environment of the brain that control sleep and wakefulness.The timing and rhythm of sleep and wakefulness are also altered in stroke patients.A growing number of studies have found that stroke patients are more likely to suffer from sleep disorders than the general population.Sleep disorders negatively affect stroke patients in many ways,including reduced quality of recovery,increased blood glucose and blood pressure,prolonged recovery of neurological function,and even stroke recurrence.Thus,there is a causal relationship between stroke and sleep disorders.The aim of this study is to collect and analyze the clinical data of stroke patients to investigate the incidence of stroke-related sleep disorders and the risk factors that may affect them,so as to provide more theoretical support for the standardization of diagnosis and treatment,and the prevention of stroke-related sleep disorders.Methods: Stroke patients who were hospitalized in the Department of Neurology of the Second Hospital of Hebei Medical University and followed up in the Outpatient Clinic of the Department of Neurology and who met the enrollment criteria from July 2023 to January 2024 were included in the study group,a total of 190 cases.Patients’ fasting blood samples were collected and uniformly tested by the Laboratory Department of the Second Hospital of Hebei Medical University.The Pittsburgh Sleep Quality Index Scale was used to evaluate the patients’ sleep.The total PSQI score ≥7 was taken as the grouping criterion,and all enrolled patients were divided into the sleep disordered group and the non-sleep disordered group.Clinical data of patients in both groups were collected,including gender,age,education level,disease stage,anatomical site of stroke lesion,medical history,personal history,degree of neurological deficit(assessed by the NHISS rating scale),ability to perform activities of daily living(assessed by the BI scale),body mass index(BMI),and laboratory test results.Laboratory test results included:Serum homocysteine,red blood cell count(RBC),hemoglobin content(HBG),white blood cell count(WBC),neutrophil percentage(NE%),lymphocyte percentage(LY%),platelet count(PLT),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL),low-density lipoprotein cholesterol(LDL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine(CR),uric acid(UA),and urea(UREA).The differences in the above clinical data between the two groups were statistically analyzed.Multifactorial logistic regression analysis was performed for those factors for which one-way statistical analysis showed statistically significant differences between the two groups.P < 0.05 was used to represent statistical significance.In this way,factors that may affect strokerelated sleep disordered were explored.Results:1.The incidence of Stroke-related sleep disorders was 44.2 %.2.Single-Factor Logistic Regression analysis showed that there were significant differences in age,disease stage,stroke site,hypertension history,diabetes history,heart disease history,smoking history,BMI and TG between the sleep disorder group and the non-sleep disorder group(P < 0.05).3.Multi-Factor Logistic Regression analysis results.Age(OR =1.060,95 % CI = 1.015-1.107),subcortical white matter stroke(OR =6.657,95 % CI = 2.137-20.734),thalamic stroke(OR = 8.437,95 % CI =2.098-33.936),history of diabetes(OR = 0.378,95 % CI = 0.163-0.875)and history of heart disease(OR = 0.126,95 % CI = 0.042-0.375)were the influencing factors of stroke-related sleep disorders(P < 0.05).Conclusion: The incidence of stroke-related sleep disorders was 44.2 %.Age,the location of stroke in the subcortical white matter and thalamic,history of diabetes,and history of heart disease are possible influencing factors.更多还原