应用SWAN序列检测初诊为脑小血管病的患者脑微出血的危险因素分析

Risk factors analysis of cerebral microbleeds detected by SWAN sequence in patients with suspected cerebral small vessel disease

目的对初诊为脑小血管病的患者,应用磁敏感成像(SWAN序列)检测其脑微出血(CMBs)灶,结合临床相关指标及常规MR影像学指标分析患者CMBs的危险因素。方法对2017年至2018年期间初诊为脑小血管病的患者行常规颅脑MR及SWAN序列扫描,以患者的性别、年龄、血压、空腹血糖值、总胆固醇值、低密度脂蛋白值、高密度脂蛋白值及影像学指标(腔隙性脑梗死、脑白质疏松)作为因子,应用多元有序Logistic回归辨别CMBs分级的危险因素。结果共289例,男152例,女137例,平均年龄66.5岁±10.7岁,CMBs共检出100例,阳性率34.6%;其中男性阳性率(42.1%,64/152)高于女性(26.2%,36/137)。经年龄校正后,多元有序Logistic回归分析结果显示,男性(OR=2.118,95%CI:1.18-3.802,P=0.009)、腔隙性脑梗塞(P=0.10,其中多发腔隙性脑梗塞OR=10.26,95%CI:1.18-3.802,P=0.003)、脑白质疏松(P<0.001,脑白质疏松3级OR=10.743,95%CI:3.944-29.261;P<0.001;2级OR=2.971,95%CI:1.13-7.81,P=0.027)、及舒张压升高(P=0.46,其中舒张压3级OR=8.29,95%CI:3.944-29.261,P=0.005)是CMBs分级的危险因素。结论男性、高血压(舒张压升高)、腔隙性脑梗死、脑白质疏松是初诊为脑小血管病的患者CMBs的危险因素,提示在临床工作中,对这类患者CMBs的防控主要通过控制患者的血压水平。

Objective To investigate the risk factors of cerebral microbleeds(CMBs)detected by SWAN sequence in suspected cerebral small vessel disease(CSVD)patients.Methods Suspected CSVD patients were studied during in-patient time from 2017 to2018,all patients underwent common MR and SWAN sequence studies.Patients’gender,age,blood pressure,fasting blood glucose lever,total cholesterol,low density lipoprotein,high density lipoprotein and common MR imaging makers(lacunar infarction,leukoaraiosis)were used as candidated risk factors,multivariate ordinal Logistic regression was used to find the risk factors of CMBs grading in patients with suspected CSVD.Results 289 patients were finally studied.Male 152,female 137;averaged age was 66.5±10.7 years;100(34.6%)patients with CMBs were detected,and the prevalence of CMBs was higher in male(42.1%,64/152)than in female(26.2%,36/137).Multivariate ordinal logistic regression analysis adjusted by age revealed that male(OR=2.118,95%CI:1.18-3.802,p=0.009),lacunar infarction(P=0.10,multi lacunar infarction,OR=10.26,95%CI:1.18-3.802,P=0.003),leukoaraiosis(P<0.001,grade 3,OR=10.743,95%CI:3.944-29.261;P<0.001;grade 2,OR=2.971,95%CI:1.13-7.81,P=0.027),increased diastolic pressure(P=0.46,grade 3,OR=8.29,95%CI:3.944-29.261,P=0.005)were the risk factors of the degree of severity CMBs in patients with suspected CSVD.Conclusions CMBs in patients with suspected CSVD are significantly associated with male,hypertension(increased diastolic pressure),lacunar infarction and leukoaraiosis.This suggested that the preventing and controlling CMBs in patients with suspected CSVD may be mainly through controlling patients’blood pressure in clinical practice.