高血压合并腔隙性脑梗死风险因素分析
|
摘要
目的探讨高血压合并腔隙性脑梗死患者临床患病特点及其相关危险因素。方法随机选取2012年2月-2015年2月就诊于新疆维吾尔自治区人民医院米东医院内一科的高血压病患者作为调查对象,测定所有研究对象胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)和空腹血糖(fasting blood glucos,FBG)等生化指标。检测患者同型半胱氨酸(Hcy)水平,以血Hcy浓度≥15μmol/L为高同型半胱氨酸血症。对颈动脉内膜厚度(IMT)进行超声检测。结果高血压不合并腔隙性脑梗死与高血压合并腔隙性脑梗死比较,左、右颈总动脉内中膜的厚度、Hcy、吸烟、饮酒及糖尿病之间差异有统计学意义(P <0.05)。将高血压合并脑梗死的危险因素进行二分类logistic回归分析,在多因素分析中,高血压患者合并糖尿病(OR=4.988,95%CI=1.966～12.655)、吸烟(OR=3.629,95%CI=1.186～11.100)、高龄(OR=1.127,95%CI=1.073～1.183)、高TC(OR=0.453,95%CI=0.216～0.952)是腔隙性脑梗死的危险因素,差异有统计学意义(P<0.05)。结论合并有糖尿病、吸烟、年龄是高血压合并脑梗死的独立危险因素。在腔隙性脑梗死的防控过程中,应根据患者的具体情况,给予积极的个性化的干预措施。
Objective To investigate the clinical characteristics and related risk factors of patients with hypertension complicated with lacuna infarction.Methods A total of patients with hypertension hospitalized in the Department of Internal Medicine of the Midong Branch of the People′s Hospital of Xinjiang Uyghur Autonomous Region from February 2012 to February 2015 were selected in this study.All subjects′cholesterol (TC) and triglyceride (TG) were determined,high density lipoprotein-cholesterol (HDL-C),low density lipoprotein-cholesterol (LDL-C)and fasting blood glucos (FBG) and other biochemical indicators were tested.At the same time,the patient's homocysteine (Hcy) level was measured,and the blood Hcy concentration ≥15 umol/L was diagnosed for hyperhomocysteinemia.Carotid intima-media thickness (IMT) was measured using ultrasound testing.Results There was no significant difference of the thickness of the medial membrane between the left and right common carotid arteries,Hcy,smoking,alcohol consumption and diabetes in hypertension coupled with lacunar infarction group and hypertension not coupled with lacunar infarction group.Risk factors for hypertension and cerebral infarction were analyzed by two-way logistic regression.In multivariate analysis,hypertensive patients with diabetes (OR =4.988,95%CI=1.966-12.655),smoking (OR =3.629,95%CI=1.186-11.100),advanced age (OR =1.127,95%CI =1.073-1.183),high CH (OR =0.453,95%CI =0.216-0.952) are risk factors for lacunar infarction,the difference is statistically significant (P <0.05).Conclusion Patients with diabetes,smoking,and age are independent risk factors for hypertension and cerebral infarction.In the prevention and control of lacunar infarction,positive and individualized interventions should be given according to the specific conditions of patients.
Objective To investigate the clinical characteristics and related risk factors of patients with hypertension complicated with lacuna infarction.Methods A total of patients with hypertension hospitalized in the Department of Internal Medicine of the Midong Branch of the People′s Hospital of Xinjiang Uyghur Autonomous Region from February 2012 to February 2015 were selected in this study.All subjects′cholesterol (TC) and triglyceride (TG) were determined,high density lipoprotein-cholesterol (HDL-C),low density lipoprotein-cholesterol (LDL-C)and fasting blood glucos (FBG) and other biochemical indicators were tested.At the same time,the patient's homocysteine (Hcy) level was measured,and the blood Hcy concentration ≥15 umol/L was diagnosed for hyperhomocysteinemia.Carotid intima-media thickness (IMT) was measured using ultrasound testing.Results There was no significant difference of the thickness of the medial membrane between the left and right common carotid arteries,Hcy,smoking,alcohol consumption and diabetes in hypertension coupled with lacunar infarction group and hypertension not coupled with lacunar infarction group.Risk factors for hypertension and cerebral infarction were analyzed by two-way logistic regression.In multivariate analysis,hypertensive patients with diabetes (OR =4.988,95%CI=1.966-12.655),smoking (OR =3.629,95%CI=1.186-11.100),advanced age (OR =1.127,95%CI =1.073-1.183),high CH (OR =0.453,95%CI =0.216-0.952) are risk factors for lacunar infarction,the difference is statistically significant (P <0.05).Conclusion Patients with diabetes,smoking,and age are independent risk factors for hypertension and cerebral infarction.In the prevention and control of lacunar infarction,positive and individualized interventions should be given according to the specific conditions of patients.
引文
[1]石义永,余宏,林传鸿,等.腔隙性脑梗死预后与缺血性脑血管疾病危险因素的相关研究[J].临床荟萃,2013,1(28):65-66.
[2]孙丽明,李丹,张敏,等.发病次数对老年脑梗死患者记忆障碍的影响[J].中国老年学杂志,2013,33(14):3433-3435.
[3]王姝.血清尿酸、超敏C-反应蛋白与腔隙性脑梗死患者颈动脉粥样硬化程度的相关分析[J].中国现代神经疾病杂志,2013,13(1):66-70.
[4]AUTENRIETH C S,EVENSON K R,YATSUYA H,et al.Association between physical activity and risk of stroke subtypes:the atherosclerosis risk in communities study[J].Neuroepidemiology,2013,40(2):109-116.
[5]周瑞芹,马晨旭,王亚蕊.经颅多普勒超声对腔隙性梗死的诊断价值[J].中国实用神经疾病杂志,2014(16):72-73.
[6]王菁哲.原发性高血压患者颈动脉形态学及血流动力学与急性缺血性脑卒中相关研究[D].江苏大学,2016.
[7]杨嵩,储照虎.急性脑梗死溶栓治疗的现状与进展[J].医学信息,2016,29(6):39-40.
[8]姜虹.生活方式与社区老年人慢性病的相关性及健康教育对患者生活方式的影响[J].中国初级卫生保健,2017,31(8):39-40.
[9]畅琦.天津市社区居民慢性疾病综合干预项目实施效果研究[D].天津医科大学,2013.
[10]杨姗姗,何耀.吸烟与心脑血管疾病系列研究报告[J].心脑血管病防治,2017,17(5):329-331.
[11]利扎·居马,太来提·阿吉,娜迪热·海比夫.新疆某医院2008-2009年270例脑梗死危险因素分析[J].新疆医科大学学报,2011,34(10):1142-1146.
[12]纪文洋,蔡美卿.高血压伴腔隙性脑梗死患者血清同型半胱氨酸水平和颈动脉硬化的关系.中国老年保健医学[J],2012,10(4):48-50.
[13]王玉兰,朱国燕,曹建新.腔隙性脑梗死与颈动脉粥样硬化的关系[J].临床神经外科杂,2012,9(4):238-239.
[2]孙丽明,李丹,张敏,等.发病次数对老年脑梗死患者记忆障碍的影响[J].中国老年学杂志,2013,33(14):3433-3435.
[3]王姝.血清尿酸、超敏C-反应蛋白与腔隙性脑梗死患者颈动脉粥样硬化程度的相关分析[J].中国现代神经疾病杂志,2013,13(1):66-70.
[4]AUTENRIETH C S,EVENSON K R,YATSUYA H,et al.Association between physical activity and risk of stroke subtypes:the atherosclerosis risk in communities study[J].Neuroepidemiology,2013,40(2):109-116.
[5]周瑞芹,马晨旭,王亚蕊.经颅多普勒超声对腔隙性梗死的诊断价值[J].中国实用神经疾病杂志,2014(16):72-73.
[6]王菁哲.原发性高血压患者颈动脉形态学及血流动力学与急性缺血性脑卒中相关研究[D].江苏大学,2016.
[7]杨嵩,储照虎.急性脑梗死溶栓治疗的现状与进展[J].医学信息,2016,29(6):39-40.
[8]姜虹.生活方式与社区老年人慢性病的相关性及健康教育对患者生活方式的影响[J].中国初级卫生保健,2017,31(8):39-40.
[9]畅琦.天津市社区居民慢性疾病综合干预项目实施效果研究[D].天津医科大学,2013.
[10]杨姗姗,何耀.吸烟与心脑血管疾病系列研究报告[J].心脑血管病防治,2017,17(5):329-331.
[11]利扎·居马,太来提·阿吉,娜迪热·海比夫.新疆某医院2008-2009年270例脑梗死危险因素分析[J].新疆医科大学学报,2011,34(10):1142-1146.
[12]纪文洋,蔡美卿.高血压伴腔隙性脑梗死患者血清同型半胱氨酸水平和颈动脉硬化的关系.中国老年保健医学[J],2012,10(4):48-50.
[13]王玉兰,朱国燕,曹建新.腔隙性脑梗死与颈动脉粥样硬化的关系[J].临床神经外科杂,2012,9(4):238-239.