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

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1、分类号：R746.1学校代码：10392学科专业代码：105104学号：1210306045福建医科大学硕士研究生毕业论文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AssociationofapolipoproteinA1、Bwithstenosisofintracranialandextracranialarteriesinpatientswithatheroscleroticcerebralinfarction学位类型：临床医学硕士所在学院：第一临床医学院研究生：李弥弥学科、专业：神经病学导师：王柠教授研

2、究起止日期：2012年9月至2013年4月答辩日期：2013年6月6日二○一三年六月-1-目录中文摘要·····················································································03英文摘要·····················································································04中英文对照····································

3、··············································06引言·····················································································07研究对象与方法···········································································09结果···············································

4、······································12讨论·····················································································18结论·····················································································22参考文献················································

5、·····································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

6、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4

7、12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(P<0.001),秩相关分析提示apoA1

8、与颅内动脉狭窄程度呈负相关(r:0.468,P<0.001)。多因素logistic回归示apoA1为颅内动脉狭窄的保护因素（当apoA1>1.28g/L,OR=0.39），apoB是颅内动脉狭窄及颅外动脉狭窄的独立危险