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醫(yī)學(xué)論文范文:動脈硬化性腦梗死復(fù)發(fā)的危險(xiǎn)因素分析
【摘要】 目的：探討腦梗死復(fù)發(fā)的危險(xiǎn)因素。方法 ：隨訪觀察769例腦梗死患者，比較有復(fù)發(fā)的腦梗死患者和無復(fù)發(fā)的腦梗死患者首次卒中時的危險(xiǎn)因素、血同型半胱氨酸（Hcy)、可溶性黏附分子（SICAM-1)、細(xì)胞因子水平、頸動脈粥樣硬化的嚴(yán)重程度、狹窄程度及斑塊類型、首次卒中后危險(xiǎn)因素控制情況。結(jié)果 ：769例腦梗死患者在隨訪期有156例（占20.3%)復(fù)發(fā)，出院后正規(guī)服阿斯匹林的患者復(fù)發(fā)率低于未正規(guī)服阿斯匹林的患者（P <0.05)；首次卒中后戒煙者及血壓、血糖、血膽固醇控制在正常范圍的患者復(fù)發(fā)率低于控制不好的患者；多變量Logistic回歸分析表明，年齡、血清白蛋白/球蛋白比例、血糖、纖溶酶原活性、Hcy、sICAM-1、IL-6水平及頸動脈粥樣硬化的嚴(yán)重程度、狹窄程度、斑塊類型以及首次卒中后是否戒煙，血壓、血糖和血膽固醇是否控制在正常水平，出院后是否正規(guī)服用阿斯匹林是腦梗死復(fù)發(fā)密切相關(guān)的危險(xiǎn)因素。結(jié)論 ：與腦梗死復(fù)發(fā)相關(guān)的危險(xiǎn)因素多，首次卒中后戒煙、控制好血壓、血糖和血膽固醇以及出院后正規(guī)服用阿斯匹林在降低腦梗死復(fù)發(fā)中起重要作用。
【關(guān)鍵詞】 腦梗死；預(yù)后；頸動脈粥樣硬化；細(xì)胞因子；同型半胱氨酸
Analysis of risk factors for recurrence of atherosclerotic cerebral infarction CHI Wan-zhang，YI Xing-yang，CHI Li-fen，PAN Ji-bao，ZHANG Shun-kai. Department of Neurology，Rui’an People’s Hospital，Wenzhou，325200
Abstract: Objective: To explore the risk factors for recurrence of cerebral infarction. Methods: 769 patients with cerebral infarction were following-up observed. The risk factor of stroke， the levels of blood homocysteine (Hcy)， soluble intercellular adhesion molecule， cytokine， the grade of carotid atherosclerosis， stenosis， and types of plaque and the situation of controlling the first post-stroke risk factors were compared between patients with recurrent cerebral infarction and non recurrent cerebral infarction of the firstr stroke. Results:Of 769 patients with cerebral infarction， 156 patients (20.3%) relapsed during follow-up periods. The incidence of recurrence was lower in patients of regular use of aspirin than those of no regular use after discharge （P <0.05)， The incidence of recurrence was lower in patients of giving up smoking and controlling normal of blood glucose， blood pressure，blood cholesterol than those of continuing smoking and poor control after stroke. The multivariable logistic regression analysis showed that the age， blood glucose， the A/G ratio， and the levels of HCY， sICAM-1， IL-6， plasminogen， the grade of carotid atherosclerosis， stenosis， and types of plaque，and whether or not to give up smoking， whether or not to control normal blood glucose，blood pressure， blood cholesterol， whether or not to regular use of aspirin after first stroke were closely related to cerebral infarction recurrence risk factors. Conclusion:There are many risk factors related to cerebral infarction recurrence. To give up smoking， control blood pressure， blood glucose and blood cholesterol， as well as regular use of aspirin after the first stroke play important roles. in the reduction of recurrence of cerebral infarction
Key words: cerebral infarction；prognosis；atherosclerosis；cytokine；homocysteine
腦梗死復(fù)發(fā)率高，復(fù)發(fā)的腦梗死患者預(yù)后不良。腦梗死復(fù)發(fā)的研究國內(nèi)外雖較多，但多為回顧性的或病側(cè)對照研究，前瞻性研究國內(nèi)較少。本研究對腦梗死復(fù)發(fā)的危險(xiǎn)因素進(jìn)行多因素分析，并探討其可能的機(jī)制醫(yī).學(xué).全.在.線gydjdsj.org.cn。
1 資料和方法
1.1 研究對象 腦梗死組：為2000年8月至2005年12月在我院住院首次發(fā)病的腦梗死患者。腦梗死的診斷符合第四屆全國腦血管病會議修訂的標(biāo)準(zhǔn)，全部病例均經(jīng)頭顱CT或MRI掃描證實(shí)，根據(jù)臨床及影像學(xué)將腦梗死分成動脈粥樣硬化性血栓性腦梗死和腔隙性腦梗死。排除標(biāo)準(zhǔn)：①年齡≥80歲；②心源性或其他原因的腦栓塞；③不能分類的腦梗死；④出血性腦血管病或瘤卒中；⑤伴嚴(yán)重的心、肝、腎疾�。虎薏辉竻⑴c該研究的患者；⑦短暫性腦缺血發(fā)作（TIA)患者。符合上述診斷標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)的腦梗死患者共791例，其中22例因外地定居等原因失訪，因此共769例納入分析。男432例，女337例，年齡45～79歲，平均（69.8±21.2)歲。出院后正規(guī)服阿斯匹林677例（100 mg，每日1次)，其中在此基礎(chǔ)上服辛伐他汀者有320例，未正規(guī)服阿斯匹林92例。健康對照組：為60名健康體檢者，年齡44～78歲，平均（67.7±21.3)歲。
