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无症状性脑梗死的临床诊治现况_20279

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无症状性脑梗死的临床诊治现况_20279无症状性脑梗死的临床诊治现况_20279 ÎÞÖ?×?ÐÔÄÔ??ËÀµÄÁÙ??ÕïÖÎÏÖ?ö [?êÇ?:À?Ô?] ×?Õß?ºÍõÓñÇÙ ÁõÔ?РÃÏÐÂÁá ÎÞÖ?×?ÐÔÄÔ??ËÀ??silent cerebral infarction??SCI????Òà?Æ??Ö?ÐÔÄÔ??ËÀ??ÊÇÖ?ÁÙ??ÉÏÎÞÃ?È?µÄÄÔ×äÖÐ??Ê??øÓ?ÏñÑ??ì?éÈ?ÓÐ??ËÀ??Ôî?òÓÐÓëÄÔ×äÖÐ??Ê?ÎÞ?صÄ??ËÀÔî??Õï?Ï SCI Ö?ÒªÒÀ?? CT?...
无症状性脑梗死的临床诊治现况_20279
无症状性脑梗死的临床诊治现况_20279 ÎÞÖ?×?ÐÔÄÔ??ËÀµÄÁÙ??ÕïÖÎÏÖ?ö [?êÇ?:À?Ô?] ×?Õß?ºÍõÓñÇÙ ÁõÔ?РÃÏÐÂÁá ÎÞÖ?×?ÐÔÄÔ??ËÀ??silent cerebral infarction??SCI????Òà?Æ??Ö?ÐÔÄÔ??ËÀ??ÊÇÖ?ÁÙ??ÉÏÎÞÃ?È?µÄÄÔ×äÖÐ??Ê??øÓ?ÏñÑ??ì?éÈ?ÓÐ??ËÀ??Ôî?òÓÐÓëÄÔ×äÖÐ??Ê?ÎÞ?صÄ??ËÀÔî??Õï?Ï SCI Ö?ÒªÒÀ?? CT??MRI ?ì?é[1]??ÀÏÄêÈË?à?û??Èç??ÔçÆÚ?ÉÔ?SCI ???ÉÑÝ?äΪÓÐÖ?×?µÄÄÔ??ËÀ?ò??Õ?ÖÁѪ?ÜÐÔ?Õ?ô(vascular dementia??VD)[2]???ÙÐÔÑÓËèÂé?Ô??ÖÎÁÆÖ?ÒªÊÇÕë?ÔÎ?ÏÕÒòËØ???ØÖÆѪÑ????µµÍѪÌÇ??ѪÖ?ºÍѪҺð??í?È???â?ýѪҺµÄ?ßÄý×?Ì????Ó?ø?øÒ????ÀÖ??àÔîÐÔÄÔ??ËÀËùÖµÄ?ÙÐÔÑÓËèÐÔÂé?Ô×?Ì???ÆäËû????Ö?????ƪ×ÛÊöÖ?ÔÚÒýÆð?ã?óÑ?ÕßµÄÖØÊÓ??ÒÔ?ã?ü?øÒ???ÑÐ???? 1???????úÖÆ 1.1ѪÁ???Á?Ñ??Ä?ä SCIÓëÊÕËõÑ?µÄË?Æ?ÓÐÃÜÇÐ?Øϵ??ÑÐ???á?ûÏÔÊ???ÔÚ?ßѪÑ???ÕßÖÐ??ÄÇÐ?ÓÐÃ?ÏÔ?ͺóµÍѪÑ?µÄ??Õß??ÔÚÉñ?,ϵÍ??öÏÖÖ?×?Ö?Ç??ÍÒÑ??ÏÖÎÞÖ?×?ÐÔÄÔËðº???Õâ˵Ã?SCI?ÉÄÜÓëѪÑ?????ÒýÆðµÄÄÔÄÚµÍ?àÁ?ÓÐ?Ø[3]???øѪÐ??åÔÚÄÔ??Âö???ä??Î?µÄ?Û??ÒÔ???îÐÔÎïÖÊÊÍ?ÅÔöÇ?ÊÇÄÔ??ËÀÐÎ?ɵÄ?Ø?ü[4]?? 1.2Î?Ë?Èû ÓÐÑ?ÕßÍ??ý?,Â,?àÆÕÀÕÉ?Ãè(TCD)?ÔSCIÕß?øÐÐË?×Ó?à?â????ÏÖÒÔ?ßÇ??È?ÌÔÝÐźÅ(HITS)Ϊ?ú?íµÄ?óÄÔË?×Ó?Ç??ÆÕ?é??Ìá?öÎ?Ë?×ÓºÍÄÔÎ?Ë?Èû?ÅÄî[5]?? 1.3ÌÇ?úÐ?Òì?? ÁÙ???Û?ìÓë??ÎïʵÑéÑÐ??Ö?Ã???ѪÌÇÔö?ßË?Æ?Óë??ËÀÃæ?ý??ÄÔË?Ö×??Éñ?,??ÄÜÈ?Ëð?Ì?ÈÒ?ÖÂSCI??Õß?à?ûÌÇÄÍÁ??õÍË??ÌÇË?Æ??????Ï?óµÄÏÖÏó[6]?? 2??Î?ÏÕÒòËØ 2.1Ò??ãÒòËØ ?üÀ?ÄêÁä??ÎüÑÌ??Òû?Æ??Éú?îÏ??ß??ÐÔ?ð????ËØ?ä????ÒÅ??ÒòËØÓë?ùÒò?àÌ?ÐÔ??ÆäÖÐ?É?ÉÔ?µÄΪÎüÑÌ??Òû?Æ??Éú?îÏ??ß?? 2.2?ßÎ?ÒòËØ 2.2.1?ßѪÑ? ?ݵ??é?ßѪÑ??ÐÆ??ÙËðÉËÍ?Ê?ÓÐÐÄÉöËðº?µÄ??ÕßÖÐ??58%ÓÐSCI??SCI??ÈÏΪÊÇÇ??üÆÚ?ßѪÑ??ÐÆ??ÙËðÉ˵ÄÒ?ÖÖ?îÍâ???ÀÁ?µÄÔ?Õ×ÐÔ?êÖ?[7]??ÎÞÂÛµ?Ç?ѪÑ?×??öÈçºÎ??Ã?ÓÐÄÔ??Èû?òTIAÊ???Õß??Êý×Ö??ÊÓÍøÄ??ÉÏñÄÜÖ?ʵ?ßѪÑ?ÊÓÍøÄ????ä?çÏÕÔö?Ó[8]??ÇÒ??ÆÚ?ßѪÑ?Ê?µÃÉî??Ö?Ð???ÂöÎ?Ѫ?ÜÍøÄÔ?à×?Á?Òì??[9]??Ѫ?ÜÍ?Í?ÐÔÔö?ß????Âö?ÚÖ?ÖÊÍ?Ã?ÐÔ?ä??Ð???Âö???ãºÍµ?Á??ã??ÄÚÄ?ÏÂ?ºÔ,ºÍÍ?Ã?ÖÊÌæ?ú??ÒýÆð??Âö?ÜÇ??ÕÈûÐÎ?ÉÇ?Ï?ÐÔ??ËÀÔî?? 2.2.2??ÂöÖàÑùÓ??? ?üÄêµÄÑÐ??×ÊÁÏ[10-11]ÏÔÊ?????ÂöÖàÑùÓ???ÊÇÒ?ÖÖÂýÐÔÑ×Ö??ý?Ì??ÔÚÑ×Ö??ý?ÌÖÐ×î?ß?êÖ?ÐÔµÄÒò×Óhs-CRP????ÈÏΪÊÇ??ÂöÖàÑùÓ?????Éú????Õ?ÖÐ???ßÃô?ÐÐÔµÄ?ì?âÖ??ê?????ÉÔ??âÄÔѪ?Ü??????ÕßµÄÎ?ÏÕÐÔºÍÅÐ?ÏÖÐ?ç??ÕßµÄÔ?ºó?? 2.2.3È?ѪÐÔÐÄÔà?? ÓÐÈ?ѪÐÔÐÄÔà??µÄ??ÕßSCIµÄ????ÂʺÜ?ß????ÓÐ??µÀ×óÐÄÊÒ?ʺñ?äÐÎÓëÄêÁä??ÊÕËõÑ?Ò?Æð??ÈÏΪÊÇ?É?ÀÁ?ÐÔÔ???ÎÞÖ?×?ÐÔÄÔËðº?µÄÒòËØ[12]?? 2.2.4ÌÇÄò?????ßÖ?ѪÖ? ÒòÌÇÄò????Õß??ÂöÖàÑùÓ??????ÊÅÖ???ßѪÑ???ѪÖ?Òì??µÈµÄ??ÉúÂÊ?ù?ßÓÚÏàÓ?µÄ?ÇÌÇÄò????ÕßȺ??ÓÐÑÐ??ÏÔÊ???ÂýÐÔ?ßѪÌÇ?ÔÄÔѪ?ܵÄ??ÐÔ×?ÓÃ??Óë???îµòÍöÏà?ص??×Òýµ?µÄÉñ?,Ï??ûËðÉË??µòÍöµÈÃÜÇÐÏà?Ø[13]?? 2.2.5?ßÍ?ÐÍ?ëë×??ËáѪÖ? ?ßÍ?ÐÍ?ëë×??Ëá(Hcy)ÊÇÒ?ÖÖº?Áò???ùËá???ßÓÐÖ??ÓÒýÆðѪ?ÜÄÚÆ?Ëðº????Ù?øÑõ??LDLÐÎ?É??ѪÐ??å?Û??µÈ×?ÓÃ?ø?Ù????ÂöÖàÑùÓ???µÄ??Éú??ÊÇÒýÆðÐÄÄÔѪ?Ü??Á?ÊÂ?þµÄ?ÀÁ?Î?ÏÕÒò[14]??SCI??ÕßѪÇåHcyË?Æ?Óë????ÂöÓ???µÄ?Ì?ÈÓÐ?Ø[15]?? 3??ÁÙ??ÀàÐÍ?????û??Î? Ä?Ç?Í??? SCI?ÖΪ3ÖÖÀàÐÍ[16]?º?ÙÇ?Ï?ÐÔ??ËÀÐÍÆäÌصãÊÇ???ä??Î?Éî????ÔîÖ?????15mm?????ä?àÀÛ??ÄÚÄÒ???ùµ×?Ú???ÅÉä?Ú??ÇðÄÔºÍÄÔ?ɵÈ[17]???Ú?ÇÇ?Ï?Æ?ÖÊ?òÆ?ÖÊÏÂ??ËÀÐÍ??Í??????ä?Ï?ó????ÓÉÓÚÐÄ???ü???ò?ó??ÂöµÄË?ÍÑÂäÒý?????ä?àÀÛ??ÓÒ?ëÇò?????ÇÓÅÊÆ?ëÇòµÄ?î????Ò????ÃÇøµÄ???ä??ÓÐÌåÏàÕÏ?,?òÊÓ?õÈ?Ê?µÈ????ÎÞÖ?Ëß???Û?ÖË?Áë??ËÀÐÍ????Ôî?àÎ?ÓÚ MCA Æ?ÖÊÖ?ºÍÉî??Ö?Ö??ä?? 4??Õï?Ï SCIÒò??Ôî?ÏÐ?????Î??ÏÉî?ò??Ôî?à??ÉúÔÚ?óÄÔ??Çø??Ö?×?ÇáÎ?Ò×??ºöÂÔ???òÕß?öÏÖÒ?Ð??ÇÌØÒìÐÔÖ?×???ÈçÍ?ÔÎ??Í?Í????ñÐÄ??Ò??ýÐÔÖ?Ìå??Á???ÂéÄ???ÓïÑÔº?ºý?????ò?öÏÖÒ?Ð??Ç??Î?ÌåÕ?µÄÖ?×???ÈçÆ?Ã???ÏóÏÞÃ???ÌåÏñÕÏ?,µÈ????ÕâÐ???????ÒýÆð??ÕßµÄÖØÊÓ?ø??ÄÜ??Ê??ÍÕï??Ò?Ò×??Ò?Ê?ºöÊÓ?øµ?ÖÂÁÙ??Õï?ÏÂʵÍ?òÎóÕï??Â?Õï[18]??MRIÊǵ??ñÕï?ÏSCI?ÏÃô?еÄ????????Ôî?ÉÏñÒ??ã?íÏÖΪT1?ÓÈ?µÍÐźÅ??T2?ÓÈ??ßÐźÅ?? 5??ÁÙ??ÒâÒå 5.1 SCIÊÇÈ?ѪÐÔÄÔѪ?Ü??µÄ?íÏÖ?òÁÙ??ÄÔ×äÖеÄÇ??üÆÚ SCI??ÈËËäÎÞÁÙ??Ö?×???µ?Ѫ?Ü???äÒ?ÔÚ?øÐÐ??ÄÔѪÁ??ÉÄܵÍÏÂ?? SCI??Éí?ÍÊÇÈ?ѪÐÔÄÔѪ?Ü??µÄ?íÏÖÐÎÊ??òÁÙ??ÄÔ×äÖеÄÇ??üÆÚ,?????à??µÄSCI?É??Õ?Ϊ?àÔîÐÔµÄ??ËÀ??×îÖÕÑÝ?äΪѪ?ÜÐÔ?Õ?ô?òÑÓËèÂé?Ô×?Ì?[19]?? 5.2 SCIÓëÈÏÖª??ÄܺÍ??Éñ?î????ÄÜÈ?ËðÃÜÇÐÏà?Ø PriceµÈ[20]?ÉÓÃÊý×Ö?ûºÅÌæ??ÊÔÑé???ÄÁ??òÒ×ÖÇÄÜ×?Ì??ì?éºÍÇÃÖ?ÊÔÑé?ì?éÀÏÄêÈËÈÏÖªºÍ??ÉñÔË????ÄÜ????ÏÖSCIÕßµÍÓÚ?ÇSCIÕß?? 6??ÖÎÁÆ SCIµÄÖÎÁÆÖ?ҪΪÔ??ÀÐÔÖÎÁÆ???Ä?äÉú?îÏ??ß???ÄÉÆѪҺ?ßÄý×?Ì????ØÖÆѪÑ???ѪÌǵÈ???Ý??µÀ??ÔçÆÚ?øÐÐ?ý??ÖÎÁÆ???ÉÒÔÌá?ßÄÔ??ËÀµÄÖÎÓúÂÊ???õÉÙÖÂ?Ð[21-22]???ÊÒË???ËÊ?µÄÖÎÁÆÈÏΪÊÇÄÔ×äÖÐ?ªÊ?ÖÎÁƵÄ×î?ÑÊ?ÆÚ?? 7???áÊøÓï?? ×ÛÉÏËùÊö??SCI???ÇÎÞÈκÎÁÙ??Ö?×????øÊÇÒò??Í??öÌå?úÉúÏàÓ?µÄ?òÇá?òÖØÁÙ??Ö?×?????Éú?ý?ÌÂþ????ÓÉ??ÆÚµÄѪÁ???Á?Ñ??Ä?ä??Î?Ë?Èû??ѪÌÇËùÖÂ??Æä????ÂÊÓëÄêÁä?ÊÕýÏà?Ø???ý?ËÖ?Íâ??ÓëÑÌ?ÆÊȺÃ??Éú?îÏ??ßµÈÏà?Ø??µ?ÖÂSCI??ÉúºÍ??Õ?µÄÖ?Òª?ßÎ?ÒòËØΪѪÑ???ѪÌÇ??ѪÖ????Ê?ØÖƺÃѪÑ???ѪÌÇ??ѪÖ??É×èÖ?SCIµÄ?øÒ?????Õ????Ó?øÓÐÐ??µµÍÖÂËÀÖÂ?ÐÂÊ??ÓÉÓÚSCIµÄÕï?ÏÖ?ÒªÒÀÀµMRI??ÁÙ??Ö?×???µäÐÍ????Ò?Éú????ÕߺöÊÓ??µ?ÆäÁÙ??ÒâÒåÖØ?ó??ÖØÊÓÐû??ºÍ?ÌÓýSCIµÄÎ?º?ÓÈΪÖØÒª?? ?Î ?? ÎÄ Ï× [1]ÁõËØÈØ,?ßÑÞÇí,ÍõÃôÎÞ.Ö?×?ÄÔ??ËÀÏà?ØÒòËصÄÑÐ??[J].Ò?Ñ?×ÛÊö,2006,12(20):1 254-1 256. 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