正常血压急性大动脉粥样硬化性脑梗死患者脑微出血的危险因素分析

Analysis of risk factors for cerebral microbleeds in patients with acute ischemic stroke of large-artery atherosclerosis

目的探讨急性大动脉粥样硬化性脑梗死患者发生脑微出血的危险因素。方法收集2013年7月至2015年1月南京医科大学附属南京医院神经内科住院的TOAST分型为大动脉粥样硬化性的急性脑梗死患者112例患者。根据头颅MRI磁敏感加权成像（SWI）,分为有CMBs组（56例）和无CMB组（56例）。收集两组患者病史、一般临床资料、血生化结果及头颅MRI,对两组资料进行单因素和多因素分析。结果单因素分析结果显示,两组患者脑室周围高信号、深部白质高信号Fazekas’s分级的构成比的差异有统计学意义（P〈0.05）;无CMBs组与CMBs组患者的年龄（61.620±11.479 vs.70.620±11.185）、UA（278.920±69.512 vs.353.460±111.206）、Cr（71.360±19.797 vs.90.450±44.989）、Hcy（12.587±2.664 vs.21.715±10.437）比较,差异有统计学意义（P〈0.05）。多因素分析结果显示：年龄（OR=0.963,95%CI：0.905~1.025,P〈0.05）、Hcy（OR=1.487,95%CI：1.219~1.813,P〈0.05）是CMBs的独立危险因素。结论年龄、Hcy是急性大动脉粥样硬化性脑梗死患者发生脑微出血的独立危险因素。

Objective To investigate the risk factors of cerebral microbleeds （CMBs） in patients with acute isch- emic stroke of large-artery atherosclerosis. Methods One hundred twelve patients with acute ischemic stroke of large-ar- tery atherosclerosis admitted from July 2013 to January 2014 in Nanjing First Hospital affiliated to Nanjing Medical Uni- versity were enrolled. According to the results of MRI magnetic sensitive weighted imaging, the patients were divided into CMBs group or non-CMBs group. The history, general clinical data, serum biochemical results and MRI in both groups were enrolled. All the data were analyzed by the univariate and multivariate analysis. Results The results of univariate analysis showed that there were significant differences in age （61.620±11.479 vs. 70.620±11.185）, serum uric acid （UA） level （278.920±69.512 vs. 353.460±111.206）, serum creatinine （Cr） level （71.360±19.797 vs. 90.450±44.989）, serum homocysteine （Hcy） level （12.587±2.664 vs. 21.715±10.437） between the two groups （P〈0.05）. There were significant differences in constituent ratio of Fazekas＇ s grade of periventricular hyperintensities and deep white matter hyperintensities between the two groups （P〈0.05）. The results of multivariate analysis showed that age （OR=0.963, 95% CI： 0.905-1.025, P〈0.05） and serum Hcy level （OR=1.487, 95% CI： 1.219~1.813, P〈0.05） were the independent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis. Conclusions Age and serum Hcy level are the inde- pendent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis.