主动脉夹层院内死亡相关危险因素分析

目的分析主动脉夹层(AD)患者院内死亡的相关危险因素。方法回顾性分析厦门市心脏中心2002年1月至2011年10月确诊急性AD患者175例的临床资料,其中男性129例,女性46例,平均年龄(56.8±12.1)岁。按住院期间是否死亡进行分组,分为存活组(n=141)及死亡组(n=34),分析年龄、性别、既往病史、血压水平、症状、并发症及实验室指标与死亡的相关性,并用Logistic回归分析危险因素与病死率的关系。结果与存活组比较,死亡组D-二聚体水平升高,意识障碍和心包填塞比例增加,手术或支架治疗比例减少,差异有统计学意义(P均0.05)。Logistic回归分析结果表明,D-二聚体水平升高(OR=1.325,95%CI:1.436~1.973,P=0.004)、伴意识障碍(OR=2.481,95%CI:1.302~3.203,P=0.003)、心包填塞(OR=7.726,95%CI:1.762~34.003,P=0.008)为AD患者住院死亡的独立危险因素,手术或介入治疗(OR=0.101,95%CI:1.762~34.003,P=0.044)为保护因素。结论 AD患者中D-二聚体明显升高,并发意识障碍、心包填塞者病死率高,临床上应予高度重视,依据病情采取手术或介入治疗有利于降低AD患者的病死率。     

Logistic回归分析食管静脉曲张破裂出血的危险因素*

目的 探讨与肝硬化食管静脉曲张破裂出血（EVB）相关的危险因素,寻找一种有效预测EVB发生的无创检测指标。方法 回顾性分析168例肝硬化患者的临床资料,其中出血85例,非出血83例,对可能影响EVB发生的临床指标进行分析,将有显著性差异的因素进行单因素Logistic回归分析,然后对两组中有统计学意义的因素进行多因素非条件Logistic回归分析。结果 两组患者性别、年龄、病因分布差异均无统计学意义（P＞0.05）;出血患者门静脉直径（DPV）、脾静脉直径（DSV）和脾脏指数（SI）分别为（1.48±0.28） cm、（1.08±0.19） cm和（72.54±16.69）cm2,显著高于非出血组[分别为（1.34±0.29） cm、（1.18±0.25） cm和（66.98±19.21） cm2,P＜0.05];出血患者血Na+和血小板/脾长径比值分别为（139.45±3.41） mmol/L和（5.05±2.07）×109/L?cm-1,显著低于非出血组[分别为（140.66±4.41） mmol/L和（8.99±4.36）×109/L?cm-1,P＜0.05];出血组Child-Pugh分级与非出血组比较,差异有统计学意义（P＜0.05）;单因素Logistic回归分析显示两组间DPV、DSV、血小板计数与脾脏长径比值和Child-Pugh分级差异均有统计学意义（OR值分别为6.832、7.283、0.655、2.129,P＜0.05）,多因素非条件Logistic回归分析显示血小板计数与脾脏长径比值（OR=0.685,P=0.000）是肝硬化患者发生EVB的独立危险因素。结论 血小板计数与脾脏长径比值可作为肝硬化患者发生EVB的无创预测指标。     

脂肪肝危险因素Logistic回归分析

目的调查、分析我市城镇成年人群脂肪肝的患病率、发展趋势，同时试对脂肪肝危险因素进行Logistic回归分析，以进一步探求防治措施。方法通过询问病史、生活史及既往史，测量身高、体重、血压，检测血脂、血尿酸、血糖、胰岛素、肝功能、华支睾吸虫抗体、肝脏B超等，收集2003-2005年连续3年来在我科健康普查的11956名成人的临床资料，进行临床医学统计处理和分析。结果我市城镇成年人群脂肪肝患病率呈逐年上升趋势（由14．11％→16．33％→20．76％），其中以20～39岁患病率上升较明显，患病率随年龄增长而上升，脂肪肝患者中肝功能异常率为28．5％，饮酒、肥胖、高甘油三酯血症、高胆固醇血症、糖尿病或糖耐量异常、高尿酸血症、高血压、华支睾吸虫病均为脂肪肝的危险因素，其中脂肪肝各危险因素按危险风险大小顺序排列如下：饮酒〉肥胖〉高甘油三酯血症〉高胆固醇血症〉糖尿病或糖耐量异常〉高尿酸血症〉高血压〉华支睾吸虫病。结论中山市城镇成年人群近3年来脂肪肝患病率呈上升趋势，并随着年龄增长而上升，有呈年轻化的趋势，而且与华支睾吸虫病发病呈相关性。     

冠心病危险因素的Logistic回归分析

目的分析冠心病(CHD)与其常见危险因素之间的关系,为CHD的预防提供临床依据。方法通过病例对照研究设计,对病例组103例和对照组80例进行Logistic回归分析,探讨CHD的危险因素。结果 Logistic回归显示年龄、动物脂肪摄入、吸烟史、冠心病家族史、高血压病史及总胆固醇是冠心病的相对危险度增加的独立危险因素。结论改变不良生活方式、积极对高危人群进行体检及干预有助于早期防治冠心病。     

进展性脑卒中相关危险因素的临床分析

进展性脑卒中[1](stroke in progression,SIP)是指脑卒中发病后6～48 h内病情进展或阶梯式加重.目前对于急性脑梗死患者血压的处理尚存在争议,资料显示,伴有高血压病史的脑卒中患者发生SIP的几率显著增加,尤其是病程长,血压控制不理想,收缩压低、脉压差小的患者发生SIP的危险性更大.     

非酒精性脂肪性肝病发病相关危险因素分析

目的分析体检人群非酒精性脂肪性肝病（NAFLD）发生的危险因素。方法2016年1月~2017年1月对在河南省省直第二医院进行健康体检的人群采用Logistic回归分析与NAFLD发生的危险因素。结果在1421名体检人群中,检出NAFLD 245例（17.2%）,男性NAFLD发病率为23.9%,明显高于女性的8.5%（P<0.05）;单因素分析显示NAFLD患者性别、血清总胆固醇、甘油三酯、低密度脂蛋白、空腹血糖、谷丙转氨酶、γ-谷氨酰转肽酶、体质指数水平、伴有高血压、冠心病、高尿酸血症、糖尿病和吸烟的比例显著高于非NAFLD人群;在校正混杂因素后,经Logistic多因素回归分析显示,血清TG 、TC、ALT、GGT和BMI水平高、伴有糖尿病和高血压为NAFLD发生的独立危险因素。结论肥胖、高血压、糖尿病和高脂血症为NAFLD发病的危险因素,减轻体质量,维持正常血脂和血糖水平是防治NAFLD的关键措施。     

老年人消化性溃疡出血的相关危险因素分析

目的 对老年人消化性溃疡出血的危险因素进行分析,为预防和治疗提供理论依据.方法 采用回顾性分析研究方法,以2001年1月至2006年1月在首都医科大学宣武医院消化科住院治疗消化性溃疡病合并上消化道出血患者414例为观察对象,按照年龄分为老年组(≥60岁)183例和非老年组(＜60岁)231例,对两组患者并存疾病、出血原因等进行比较分析.结果 老年组并存慢性疾病的检出率高于非老年组,老年组同时患有2种或2种以上的疾病者126例(68.9%),非老年组仅23例(10.0%).老年组消化性溃疡出血的诱因多与服用心、脑血管和骨关节病药物有关,而非老年组以劳累、精神压力和饮食为主;老年组幽门螺旋杆菌的感染率为35.0%,非老年组为58.0%.结论 合理使用抗凝、止痛等药物对防治老年人消化溃疡、降低病死率和改善预后具有重要意义.

Abstract：

Objective To explore the risk factors for peptic ulcer bleeding in elderly patients.Methods The 414 patients with upper gastrointestinal ulcer bleeding in Xuanwu Hospital from January 2001 to January 2006 were enrolled.The patients were divided into elderly group (≥ 60years,n= 183 ) and non-elderly group ( ＜ 60 years,n= 231 ).The coexisting diseases and hemorrhage causes were compared and analyzed.Results The detection rate of coexisting diseases was significantly higher in elderly group than in non-elderly group (68.9% vs.10.0% ).The hemorrhage causes included the taking of drugs for cardiovascular and cerebrovascular diseases or osteoarthropathy in elderly group.And the fatigue,stress and dietary upset were the main causes in non-elderly group.Helicobacter pylori infection rate was 35.0% in the elderly and 58.0% in young patients.Conclusions It is very important to promote rational use of anticoagulant drugs and analgesic agents in elderly patients for managing peptic ulcer complication.     

脑出血继续出血危险因素分析

目的探讨脑出血继续出血的危险因素及其预防。方法对116例脑出血病例分为继续出血组和非继续出血组,并且进行回顾性对比分析。结果继续出血组的收缩压、舒张压均高于非继续出血组,两组差异显著(P0.01,P0.05).继续出血组发生丘脑出血及破入脑室的比例明显高于非再出血组(P0.05);脑出血继续出血组的血肿体积明显大于非继续出血组(P0.01);继续出血组早期使用甘露醇的比例明显高于非继续出血组(P0.01)。结论血压升高是脑出血继续出血的危险因素之一,丘脑出血的患者容易发生继续出血,脑出血破入脑室容易继续出血,脑出血量大的患者容易发生继续出血,发病早期使用甘露醇的患者易发生继续出血。     

老年人消化性溃疡出血的相关危险因素分析

Objective To explore the risk factors for peptic ulcer bleeding in elderly patients.Methods The 414 patients with upper gastrointestinal ulcer bleeding in Xuanwu Hospital from January 2001 to January 2006 were enrolled.The patients were divided into elderly group (≥ 60years,n= 183 ) and non-elderly group ( ＜ 60 years,n= 231 ).The coexisting diseases and hemorrhage causes were compared and analyzed.Results The detection rate of coexisting diseases was significantly higher in elderly group than in non-elderly group (68.9% vs.10.0% ).The hemorrhage causes included the taking of drugs for cardiovascular and cerebrovascular diseases or osteoarthropathy in elderly group.And the fatigue,stress and dietary upset were the main causes in non-elderly group.Helicobacter pylori infection rate was 35.0% in the elderly and 58.0% in young patients.Conclusions It is very important to promote rational use of anticoagulant drugs and analgesic agents in elderly patients for managing peptic ulcer complication.     

脑干出血患者的预后相关危险因素分析

在自发性出血性脑卒中中,脑干出血的病情最重,病死率最高。1997年1月至2003年6月,我院神经内科、神经外科、急诊科、ICU收住42例脑干出血患者。现对其临床资料进行回顾性分析,并探讨影响脑干出血预后的相关危险因素。     

三七皂苷治疗基底节脑出血的脑血流动力学研究

目的探讨三七皂苷治疗基底节出血的脑血流动力学变化。方法35例基底节出血病人早期全部给予三七皂苷治疗。应用经颅多普勒(TCD)超声技术探测双侧大脑中动脉(MCA),观察平均血流速度(Vm)及脉动指数(PI)。结果中等量出血组(出血量15mL～25mL)患侧MCA的Vm值低于健侧(P<0.05);大量出血组(出血量>25mL)患侧MCA的PI高于健侧,Vm值低于健侧(P<0.01)。中等量出血组治疗后30d患侧Vm与治疗前比较有所升高,患侧PI值与治疗前比较有所下降。大量出血组治疗后14d及30d患侧MCA的PI与治疗前比较均有所下降(P<0.01),Vm值与治疗前比较均有所升高(P<0.01)。结论基底节区脑出血超过15mL者脑血流动力学存在非对称现象。采用大剂量三七皂苷早期治疗基底节脑出血,可改善出血侧脑血流动力学,是有效而安全的。     

Analysis on Risk Factors for Recurrent Hemorrhage after Surgery for Hypertensive Cerebral Hemorrhage

Objectives To analyze the risk factors for recurrent hemorrhage after craniotomy for hypertensive cerebral hemorrhage （HCH）. Methods Clinical data from 162 HCH patients who underwent surgery were retrospectively analyzed for the correlation between recurrent hemorrhage and gender, age, duration of hypertension, history of diabetes mellitus and hypercholesterolemia, site and volume of hemorrhage and post-surgical systolic and diastolic pressure. Results Post-surgical recurrent hemorrhage was found in 24 patients. With multi-variate regression analysis, history of diabetes, long-term hypertension and higher post-surgical systolic pressure were proved positively correlated to the incidence of recurrent hemorrhage after craniotomy for hypertensive cerebral hemorrhage （ P 〈 0.05 ）. Conclusions Risk factors for recurrent hemorrhage after craniotomy for hypertensive cerebral hemorrhage are history of diabetes, long-term hypertension and higher post-surgical systolic pressure. Patients with diabetes and hypertension are at higher risk for cerebral hemorrhage or post-surgical recurrent hemorrhage. Effective control on blood pressure after surgery can reduce the incidence of recurrent hemorrhage after surgery for hypertensive cerebral hemorrhage. （ S Chin J Cardiol 2009 ; 10 （4） ： 204 -207）     

双侧基底节区高血压脑出血治疗的探讨

目的探讨双侧基底节区高血压脑出血的预后及其个体化治疗方案。方法分析总结2001年10月至2005年12月收治的9例双侧基底节区高血压脑出血病例的临床资料。结果9例入院时脑出血意识分级均为四级,哥拉斯格昏迷指数(GCS)评分9分以下;术后日常生活能力(ADL)分级法评定:Ⅲ级(生活部分自理)3例,Ⅳ级(卧床但有意识)2例,Ⅴ级(植物生存)2例;术后2个月死于再出血1例,另1例术后3个月自动出院。结论术前根据血肿部位和大小、患者神经功能缺失程度以及治疗方式和手术径路对术后神经功能恢复的影响来制定个体化的治疗方案,以尽可能地保全患者尚未缺失的神经功能作为选择治疗的主要考虑并对预后有重要的意义。     

普通人群脑出血危险因素的汇总分析

目的:探讨普通人群脑出血的危险因素.方法:通过西文生物医学期刊文献数据库(EMCC)、中国医院知识仓库(CHKD)、MEDLINE和中国生物医学文献数据库(CBMdisc)检索相关研究.检索词为脑出血、因素、病例对照研究或队列研究.结果:共有8篇文献符合纳入标准且有原始数据.因各研究包含的危险因素在计数和计量方面存在差异,无法合并所有数据.高血压、脑血管病家族史、高盐饮食、饮酒、糖尿病、舒张压增高、收缩压增高、吸烟、鼾症和体质指数(BMI)增高的加权均数差(95%可信区间)分别为5.71(4.00～6.79)、3.54(2.44～5.14)、2.58(1.94～3.43)、2.80(2.29～3.43)、2.78(1.83～4.23)、1.90(1.35～2.70)、17.76(16.60～18.92)、30.43(28.61～32.25)、5.42(5.15～5.70)、1.90(1.34～2.69)、6.88(4.61～10.26)和5.42(5.15～5.70).以上指标在病例组与对照组之间有显著差异(P均<0.000 01).结论:脑出血的危险因素包括高血压、脑血管病家族史、高盐饮食、吸烟、饮酒、鼾症、糖尿病、超重、舒张压增高、收缩压增高和BMI增高.     

Higher Mortality Due to Intracerebral Hemorrhage in Dialysis Patients: A Comparison with the General Population in Japan

Cerebrovascular diseases, including intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage, remain prevalent causes of morbidity and mortality among dialysis patients. Their mortality rate for cerebrovascular diseases is roughly three times higher than that in the general population. However, whether mortality rates for all subtypes of cerebrovascular diseases are equally higher has not been evaluated. The aim of this study was to determine the mortality rate for each stroke subtype, comparing dialysis patients and the general population in Japan. We used mortality data reported by the Japanese Society for Dialysis Therapy and national Vital Statistics data between 2008 and 2009. We calculated standardized mortality ratios and compared the mortality rates for stroke subtypes including intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage. During the 2‐year study period, 51 994 and 933 deaths from intracerebral hemorrhage, 79 124 and 511 deaths from cerebral infarction, and 24 957 and 147 deaths from subarachnoid hemorrhage were recorded per 252 million person‐years and per 546 474 dialysis patient‐years, respectively. Standardized mortality ratios among dialysis patients relative to the general population were 3.8 (95% confidence interval, 3.6–4.1), 1.3 (1.2–1.4), and 1.3 (1.1–1.6) for intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage, respectively. Intracerebral hemorrhage was the highest cause of mortality in the dialysis population, although cerebral infarction was the highest in the general population. Relative to the general population in Japan, Japanese dialysis patients had higher mortality rates, especially for intracerebral hemorrhage.     

高血压脑出血手术治疗的临床研究

目的探讨高血压脑出血手术治疗的效果。方法回顾性分析208例高血压脑出血手术治疗患者的资料,其中行开颅血肿清除术加去骨瓣减压术35例,直切口小骨窗开颅血肿清除术36例,微创血肿引流术137例。观察比较三组患者手术疗效并与入院时GCS评分,出血量,手术时机的关系。结果患者入院时GCS评分越高预后越好,血肿量较小者预后较好,患者在6h内及6~24h内手术较24h后手术预后好。三组术式患者近期疗效指标(术后2周GOS评分)和远期疗效(术后3月ADL评分)无显著性差异。结论GCS评分可用于判断HICH的严重程度和估计预后,超早期或早期手术能降低病死率,提高手术疗效,不同的血肿量决定了患者的不同预后,不同的手术方法对预后无显著性差异。     

Risk Factors for Early Intracerebral Hemorrhage after Intravenous Thrombolysis with Alteplase

Aim: Intracerebral hemorrhage (ICH) is one of the most severe complications of thrombolysis. Symptomatic ICHs are associated with adverse outcomes. It has been reported that symptomatic ICHs most commonly occur within the first few hours after the initiation of intravenous thrombolysis. Our aim here was to determine the risk factors for early ICH (within 12 h) after thrombolysis.Methods: We analyzed patients with acute ischemic stroke who received intravenous alteplase at two hospitals affiliated to Wenzhou Medical University between March 2008 and November 2017. The ICH diagnosis time was defined as the time from the intravenous administration of alteplase to the first detection of hemorrhage on computed tomography. Demographic data, medical history, clinical features, and laboratory examination results were collected. Univariate analysis followed by multivariable logistic regression analysis was performed to determine the predictors of early ICH (within 12 h) after thrombolysis.Results: Among 197 patients, early ICH (within 12 h) after thrombolysis occurred in 13 patients (6.6%). In the univariate analysis, patients with early ICHs were significantly correlated with prior stroke (P = 0.04). After adjusting for potential confounders in the multivariate analysis, prior stroke (odds ratio [OR]: 5.752, 95% confidence interval [CI]: 1.487–22.248; P = 0.011) and atrial fibrillation (OR: 5.428, 95% CI: 1.427–20.640; P = 0.013) were associated with early ICH.Conclusions: Prior stroke and atrial fibrillation are independent risk factors for early ICHs (within 12 h) after intravenous thrombolysis with alteplase.     

活血通腑汤对大鼠脑出血后脑水肿的治疗作用

目的　研究活血通腑汤对脑出血后脑水肿的治疗作用。方法　利用大鼠自体血注入大脑一侧的尾状核建立脑出血实验动物模型,随机分组。观察药物对大鼠的神经功能缺损症状、脑血肿周围组织脑水含量以及钠离子含量的影响。结果　活血通腑汤能改善脑出血大鼠的神经功能评分,降低脑血肿周围脑组织的钠水含量,与对照组比较有显著差异P <0 . 0 1。结论　活血通腑汤对大鼠脑出血后脑水肿具有明显的治疗作用,为临床应用提供实验理论依据。     

维甲酸对脑出血大鼠LINGO-1表达的影响

目的观察脑出血后LINGO-1表达的变化,探讨维甲酸对脑出血后LINGO-1表达的影响。方法将72只SD大鼠随机分为假手术组、模型组和维甲酸治疗组,选取造模后1d、3d、7d和14d为观察点。制备脑出血模型,Longa评分法评价神经功能缺损程度,RT-PCR法检测LINGO-1 m RNA的表达,Western blot法检测LINGO-1蛋白的表达。结果模型组Longa评分7d最高,14d出现下降;LONG-1 m RNA 3d表达最高,7~14d出现下降;LONG-1蛋白7d到高峰,14d出现下降。维甲酸治疗组在14d Longa评分较模型组下降(P0.05);在7d和14d LINGO-1m RNA表达较模型组下降(P0.05);在14d LINGO-1蛋白表达较模型组下降(P0.05)。结论脑出血后LINGO-1表达明显上调,呈先上升后下降的变化规律。维甲酸可以降低LINGO-1 m RNA和蛋白的表达及神经功能评分。     

高血压患者合并抑郁的危险因素分析

目的 通过对高血压合并抑郁患者群体指标的分析,探讨高血压患者合并抑郁的危险因素。方法 选取高血压合并抑郁患者和单纯高血压患者各110例,收集并比较两组患者的一般资料及各血清因子水平。筛选单因素分析有统计学意义的变量进行多因素Logistic回归分析。结果 单因素分析显示,高血压合并抑郁患者的皮质醇(Cor)和肾素前体(Rep)水平显著升高,血红素加氧酶1(HO-1)水平显著降低,差异有统计学意义(P＜0.05),两组间其他指标差异无统计学意义。对单因素分析筛选出的上述3个变量采用非条件多因素Logistic回归分析发现,HO-1水平降低(OR=0.012,95%CI:0.001~0.251,P＜0.01)和Rep水平升高(OR=5.979,95%CI:3.054~11.706,P＜0.001)是高血压患者合并抑郁的重要危险因素。结论 HO-1水平下降和Rep水平升高是高血压患者合并抑郁的重要危险因素。