【作者】 胡丹；

【导师】 姜亚军；

【作者基本信息】 南京中医药大学 ， 中西医结合临床， 2011， 硕士

【摘要】 目的：通过研究缺血性中风/TIA患者的病情,找出相应的可用于预测缺血性脑血管病和其他心血管事件复发的工具。方法：对147例急性缺血性脑血管病患者进行数字减影血管造影(DSA)、Essen卒中危险评分(ESRS)和中风中医辨证的评价。纳入经血管造影证实存在脑动脉狭窄的病例,并随访一年。记录患者存活、复发中风和其他心血管事件的情况,用SPSS17.0分析血管造影、Essen评分和中医证型的特点。结果：1.在为期1年的随访中,21例发生了血管事件,其中17人复发缺血性中风,3人发生缺血性心血管事件,1人死于反复缺血性中风。缺血性中风复发率20.39%,心血管病复发率2.91%,总血管事件复发率23.30%。2.血管事件与脑血管狭窄的关系2.1.分布和血管事件单纯颅内动脉狭窄组复发率20.69%,单纯颅外动脉狭窄组复发率7.50%,颅内外动脉均狭窄组复发率32.35%,三组间有统计学差异(P<0.05)。经两两比较,颅内外动脉均狭窄组的复发率明显高于单纯颅外狭窄(P<0.01)。颅内外动脉均狭窄的患者更易继发脑血管事件。2.2.病变血管数量和血管事件多支血管狭窄组的复发率为29.63%,明显高于单支血管狭窄组的8.16%,两者差异有显著统计学意义(P<0.01)。2.3.狭窄程度和血管事件中度以上狭窄或闭塞组复发率23.38%,轻度狭窄组复发率7.69%。与预期相反,两组无统计学差异(P>0.05)。3.血管事件与ESRS的关系将103例患者分为2组,ESRS≥3分的高危组70人,ESRS<3分的中危组33人。高危组复发率为25.71%,高于低危组的6.06%,差异有统计学意义(P<0.05)。4.血管事件与年龄的关系老年组复发率为26.98%,略高于中青年组的10.00%,差异有统计学意义(P<0.05)。老年人血管事件复发的危险较大。5.血管事件与中医差异的关系全部病例分为痰热腑实、气虚血瘀、阴虚风动、风痰阻络和肝阳暴亢五个证型,其复发率分别为6.67%、17.24%、71.43%、19.57%和0%。痰热腑实、气虚血瘀和阴虚风动证之间复发率有差别(P<0.05),而阴虚风动证的复发率高于其余两个证型(P<0.0125)。阴虚风动证患者复发较为常见。结论：1.存在脑动脉狭窄的缺血性脑血管病患者,更易复发致死性或非致死性心脑血管事件。对这些病人进行二级预防是必要的。2.联合ESRS、DSA和中医辨证来预测缺血性脑血管病和其他心血管事件的复发风险,具有一定临床意义和实用价值。更多还原

【Abstract】 Objective:To find out the predictive methods for the recurrence of ischemic cerebral vascular disease(CVD), and other cardiovascular events within the patients with acute ischemic stroke/TIA.Methods:147 patients with acute ischemic cerebrovascular disease were given the following evualutions, including cerebral digital substrating angiography (DSA), Essen stroke risk score(ESRS) and TCM differention of stroke syndrome. Only those patients with cerebral stenosis confirmed by DSA, were selected and followed-up one year.The survial and stroke recurrence as well as cardiovascular events were investigated and analysed with clinical data such as the characteristics of DSA, ESRS and TCM syndrome by SPSS 17.0.Results:1.There were 21 patients had vasuclur events during one-year follow-up, which inclued 17 patients had recurrence of ichemic stroke,3 had ischmic cardiovacular events,1 died of recurrent ischemic stroke.The rate of ischemic stroke recurrence was 20.39%, recurrent rate of cardiovascular disease was 2.91%, totally 23.30%.2. The Relationship Between The Vascular Events And Cerebral Vascular Stenosis2.1.Location And Vascular EventsThe recurrent rate was 20.69%in who only had intracranial artery stenosis,7.50%in who only had extracranial artry stenosis,32.35%in those had both intracranial and extracranial artery stenosis. There was a significant difference in the three groups(P< 0.05). Pairwisely comparisoning, the recurrence rate in both intracranial and extracranial artery stenosis group was significant higher than that of the extracranial artry stenosis group (P<0.01),which suggesting that patients had both intracranial and extracranial artery stenosis are more likely to suffer from secondary cerebral vascular events.2.2.Number Of Abnormal Blood Vessels And Vascular EventsThe recurrence rate of vascurlar events in multi-vessel stenosis group was 29.63%, significantly higher than 8.16% that in one-vessel stenosis group(P<0.01).2.3.Degree Of Stenosis And Vascular EventsThe recurrence rate of vascular events was 23.38% in moderate-above degree stenosis and occlusion group,7.69% in mild stenosis group, unspectively, there was no significant difference between the two groups(P>0.05). 3.The Relationship Between The Vascular Events And ESRS103 patients were devided into two group,70 cases with high-risk group with ESRS≥3 and 33 cases with medium-risk group with ESRS<3. Recurrence rate in high-risk group was significantly higher than that in medium-risk group,25.71% vs 6.06%(P<0.05).4.The Relationship Between The Vascular Events And AgeThe aged group had a slight higher recurrence rate of vascular events(26.98%) than the middle-youth age patients(10.00%), indicating that Aged patients are at high risk of recurrence (P<0.05).5.The Relationship Between The Vascular Events And TCM DifferentionAll cases were divided into five groups:phlegm-heat and sthenia of fu-organ group, qi deficiency and blood stasis group and Yin-deficiency and wind generating group, wind-phlegm and blood stasis group, sudden excess of liver-yang group.Recurrence rate of five syndromes were 6.67%,17.24%,71.43%,19.57% and 0%, respectively. There were differences in first three syndromes(P<0.05), and Yin-deficiency and wind generating group had a higher recurrence rate than others(P<0.0125). Thus, recurrence is common in the patients with Yin-deficiency and wind generating syndrome.Conclusion:1.Fatal or non-fatal cardiovascular and cerebrovascular recurrence were higher in the ischemic cerebrovascular patients with artery stenosis It suggests that the secondary prevention for such patients is necessary.2.It has clinical significance and practical value to predict the recurrence of CVD and other cardiovascular disease events by using the combination of DSA, ESRS and TCM differention.更多还原