不同脑血管病患者脑微出血的患病率及其危险因素分析

The prevalence and related risk factors of cerebral microbleeds among different cerebral vascular diseases.

目的研究不同脑血管病患者脑微出血的患病率及危险因素,并探究其临床意义。方法连续入组急性脑血管病患者393例及对照组146名,常规行核磁共振T2梯度回波加权扫描,并登记所有患者的基线资料,分析不同类型脑血管病患者脑微出血的患病率,采用Logistic回归分析探索脑微出血的危险因素。结果脑出血、脑梗死、TIA及脑白质病患者脑微出血的患病率分别为84.0%、45.98%、25.0%及63.13%,对照组为13.70%;多变量Logistic回归分析显示脑微出血的相关危险因素为无症状腔隙性脑梗死(OR=2.350,95%CI 1.426～3.874,P=0.001)、高血压病(OR=2.146,95%CI 1.224～3.761,P=0.008)、脑白质病(OR=5.133,95%CI 3.121～8.442,P=0.000)、脑梗死(OR=2.206,95%CI 1.175～4.143,P=0.014)、脑出血(OR=17.751,95%CI 4.781～65.902,P=0.000)及高胆固醇(OR=1.645,95%CI 1.123～2.410,P=0.011),低密度脂蛋白为保护性因素(OR=0.516,95%CI 0.336～0.794,P=0.003)。结论脑出血、脑梗死及脑白质病患者脑微出血的患病率较高,脑微出血的危险因素为无症状性腔隙性脑梗死、高血压病、脑梗死、脑出血、脑白质病及高胆固醇,低密度脂蛋白为保护性因素。

Objective To study the prevalence and related risk factors of cerebral microbleeds among different cerebral vascular diseases,and investigate the clinical significance of cerebral microbleeds.Methods Consecutive 393 in-patients with acute cerebral vascular diseases and 146 control cases underwent gradient echo-T2＊ weighted imaging.The prevalence of microbleeds among different strokes and related risk factors were analyzed.Results The prevalence of cerebral microbleeds in cerebral hemorrhage,cerebral infarction,transient ischemic attack,leukoencephalopathy and the control was 84.0%,45.98%,25.0%,63.13% and 13.70%,respectively.The binary logistic regression analysis showed that risk factors of cerebral microbleeds,in a descending order,were silent old lacunar infarct（OR=2.350,95%CI 1.426～3.874,P=0.001）,hypertension（OR=2.146,95%CI 1.224～3.761,P=0.008）,leukoencephalopathy（OR=5.133,95%CI3.121～8.442,P=0.000）,infarction（OR=2.206,95%CI 1.175～4.143,P=0.014）,hemorrhage（OR=17.751,95%CI 4.781～65.902,P=0.000）and hypercholesterolemia（OR=1.645,95% CI 1.123～2.410,P=0.011）.The protective factor was low density lipoprotein（OR=0.516,95%CI 0.336～0.794,P=0.003）.Conclusions The prevalence of cerebral microbleeds is higher in hemorrhage,infarction and leukoencephalopathy and related risk factors of cerebral microbleeds are silent old lacunar infarct,hypertension,infarction,hemorrhage,hypercholesterolemia and leukoencephapathy.Low density lipoprotein is the protective factor.