急性脑梗死患者脑微出血相关因素分析

Influencing factors for cerebral microbleeds in patients with acute ischemic stroke

目的比较有无合并脑微出血（CMB）两组急性脑梗死患者危险因素和临床生化有无区别，探讨急性脑梗死合并CMB的可能原因。方法选择南京卒中登记系统中自2008年6月至2009年3月所有急性脑梗死并进行MRIGE-T2WI检查的68例患者，并检测纤维蛋白原、尿酸等生化指标，比较有无合并CMB组相关危险因素及生化指标是否存在差异，并进行多因素回归分析。结果68例患者中，合并有CMB29例，共109处CMB。其中患者年龄、高血压病史、纤维蛋白原含量、尿酸两组间比较差异有统计学意义。多因素回归分析显示，年龄（OR=1．14，95％CI1．042～1．247；P=0．04）、高血压病史（OR=0．084，95％CI0．017～0．403；P=0．02）以及纤维蛋白原含量（OR=1．009，95％CI1．002—1．017；P=0．019）与CMB相关。结论急性脑梗死患者合并有CMB比率较高，CMB与患者年龄、高血压病史、纤维蛋白原含量相关。纤维蛋白原增高与CBM的机制有待进一步研究。

Objective To investigate the relationship between cerebral microbleeds （CMB）, cardiovascular risk factors, and plasma fibrinogen in patients with acute ischemic stroke. Methods Sixty- eight patients with acute ischemic stroke from June 2008 to March 2009 were enroued prospectively. All patients received cranial magnetic resonance imaging at the first week, and T2^＊ -weighted gradient echo MRI sequence was performed to detect CMB. Plasma fibrinogen, uric acid levels and other biochemical parameters were measured on the next day of admission. All data were selected from Nanjing Stroke Registry Program. Results Among a total 68 patients, 29 （43%） patients had 109 lesions of cerebral microbleeds on gradient-echo MRI. Age, hypertension, fibrinogen and uric acid were significantly associated with the presence of CMB （P = 0. 004 , 0. 024, 0. 020, 0. 027 respectively）. Through a logistic regression analysis, age, hypertension and plasma fibrinogen were significantly associated with the presence of cerebral microbleeds [ （ P = 0.02, OR = 1.10,95% CI 1.02 to 1.19 ; P = 0. 003, OR = 9. 35,95% CI2. 17 to 40. 23 ; P = 0. 019, OR = 1.01,95% CI1. 00 to 1.02]. Conclusion There is a high prevalence of CMB in patients with acute ischemic stroke. And it has a strong relationship with high plasma fibrinogen.