动脉粥样硬化性脑梗死患者颅内外动脉狭窄及载脂蛋白A1、B的相关性分析.pdf

- 1 - 目 录 中文摘要·····················································································03 英文摘要·····················································································04 中英文对照··················································································06 引 言·····················································································07 研究对象与方法 ···········································································09 结 果·····················································································12 讨 论·····················································································18 结 论·····················································································22 参考文献·····················································································23 致 谢·····················································································27 综 述·····················································································28 - 2 - 动脉粥样硬化性脑梗死患者颅内外动脉狭窄 与载脂蛋白A1、B 的相关性分析 摘 要 目的：探讨福建汉族动脉粥样硬化性脑梗死患者颅内外动脉狭窄的分布及其与载 脂蛋白A1 、B 的关系。 方法：回顾性分析2009 年12 月至2012 年10 月于福建医科大学附属第一医院神 经内科住院的动脉粥样硬化性脑梗死患者，经头颈部 CTA 或MRA 分为单纯颅 内动脉狭窄（ICAS ）组，颅内合并颅外动脉狭窄（COMS ）组，单纯颅外动脉 狭窄组（ECAS ）组，无脑动脉狭窄（NCAS ）组。收集患者的临床资料、实验 室检查及影像学资料。采用多因素Logistic 回归分析颅内外动脉狭窄与载脂蛋白 （apoA1 ）、载脂蛋白（apoB ）的相关性，ROC 曲线计算其判断颅内外动脉狭窄 的界值。 结果：共入选412 人，ICAS 组有137 （33.3% ）人，COMS 组有74 （18.0%）人， ECAS 组有44 （10.7%）人，NCAS 组有157 （38.1% ）人。颅内外动脉狭窄最好 发的部位分别为：大脑中动脉（43.8% ），颈内动脉颅外段（30.7% ）。与 NCAS 组相比，apoB 在3 个狭窄组中均升高（P 均0.001 ），apoA1 在ICAS 组、COMS 组中降低（P 分别为0.021 及0.032 ）。ApoB 在颅外动脉狭窄率大于50%组中明 显升高（P=0.030 ），apoA1 在颅内动脉狭窄率大于 50%组中明显降低(P0.001), 秩相关分析提示 apoA1 与颅内动脉狭窄程度呈负相关(r:0.468