急性缺血性卒中患者脑微出血相关因素分析

Related Factors of Cerebral Microbleeds in Patients with Acute Ischemic Stroke

目的探讨急性缺血性卒中患者合并脑微出血(cerebral microbleeds,CMB)的情况及其相关因素。方法本研究采用单中心、前瞻性研究方法,连续收集2011年1月～2012年6月于北京市第六医院神经内科住院的急性缺血性卒中患者302例,根据有无CMB将患者分为有CMB组(83例)和无CMB组(219例),比较两组间一般临床资料、生化指标及影像学特点是否存在差异,并采用多因素逐步Logistic回归模型分析CMB发生的独立危险因素。结果 302例患者中,合并有CMB者83例(27.5%),其中年龄(t=3.67,P<0.001)、高血压(χ2=4.76,P=0.03)、卒中史(χ2=5.46,P=0.02)、纤维蛋白原(t=2.33,P=0.02)、腔隙性脑梗死数目(Z=-5.04,P<0.001)以及脑白质疏松程度评分(Z=-7.88,P<0.001)两组间比较差异具有显著性。Logistic回归分析显示,纤维蛋白原[比值比(oddsratio,OR)1.469,95%可信区间(confidenceinterval,CI)1.366～1.602;P=0.037]、腔隙性脑梗死数目(OR1.636,95%CI1.200～2.231;P=0.002)以及脑白质疏松程度评分(OR1.700,95%CI1.502～1.980;P<0.001)是急性缺血性卒中患者CMB发生的独立危险因素。结论 CMB的发生与纤维蛋白原含量、腔隙性脑梗死数目以及脑白质疏松程度相关。

Objective To investigate the prevalence and related factors of cerebral microbleeds （CMB） in patients with acute ischemic stroke. Methods Three hundred and two patients with acute ischemic stroke including all the etiological typings who were hospitalized in Department of Neurology of Beijing No.6 Hospital from January 2011 to June 2012 were successionally recruited. According to whether there were CMB, the patients were divided into two groups, CMB group （83 cases） and non-CMB group （219 cases）. Then compare the difference of clinical data including general conditions, biochemical indicators and imaging features between the two groups. The independent risk factors of CMB were analyzed with the Logistic multivariable regression. Results Among a total of 302 patients, 83 （27.5%） patients had lesions of cerebral microbleeds. Compared with non-CMB group, the age （t=3.67, P〈0.001）, hypertension （2,2=4.76, P=0.03）, history of stroke （X^2=5.46, P=0.02）, fibrinogen （t=-2.33, P=-0.02）, number of lacunar infarction （LI） （Z=-5.04, P〈0.001） and severity of leukoaraiosis （LA） （Z= -7.88, P〈0.001） in the patients with CMB had statistical difference. Logistic regression analysis showed that fibrinogen （OR 1.469, 95%C1 1.366-1.602; P=0.037）, number of LI （OR 1.636,95%CI 1.200-2.231; P=0.002） and severity of LA （OR 1.700, 95%CI 1.502M.980; P〈0.001） were the independent risk factors for presence of CMB.Conclusion CMB had relationships with fibrinogen, number of LI and severity of LA.