影响脑微出血严重程度的危险因素分析

Analysis of the risk factors for affecting the severity of cerebral microbleeds

目的探讨影响脑微出血严重程度的危险因素。方法连续纳入2011年8月—2013年3月在北京军区总医院经头部磁共振磁敏感加权成像(SWI)证实有脑微出血(CMBs)的患者200例,根据SWI上CMBs的病灶数将其分为轻度(1～5个)组111例,中度(6～15个)组86例,重度(≥15个)组30例。分析影响CMBs严重程度的危险因素。结果①单因素分析结果显示,3组患者性别、年龄、糖尿病、心房颤动、高血压、颈动脉粥样硬化、凝血功能异常及抗血小板聚集治疗差异无统计学意义(P>0.05)。微出血的程度随腔隙性脑梗死灶数量、脑白质疏松程度的增加而增加,脑出血率也随着CMBs程度的加重而增加,3组患者差异有统计学意义(P<0.05)。中、重度组合并后与轻度组比较,差异仍有统计学意义(P<0.05)。②Spearman相关分析显示,CMBs程度与腔隙性脑梗死灶数量(r=0.392,P<0.01)及脑白质疏松程度(r=0.362,P<0.01)呈正相关。③将中重度组合并后进行多因素Logistic回归分析显示,腔隙性脑梗死灶数量(OR=4.259,95%CI:3.064～5.620,P=0.001)、脑白质疏松程度(OR=3.250,95%CI:2.351～4.665,P=0.003)是影响CMBs程度的独立危险因素。CMBs程度与脑出血呈正相关(OR=1.813,95%CI:1.788～2.581,P=0.029)。结论脑白质疏松程度、腔隙性脑梗死数目及脑出血与CMBs的严重程度密切相关。

Objective To investigate the risk factors for affecting the severity of cerebral microbleeds （CMBs）. Methods A total of 200 consecutive patients with CMBs confirmed by magnetic resonance imaging （MRI） susceptibity weighted imaging （SWI） at General Hospital of Beijing Military Com- mand from August 2011 to March 2013 were enrolled. According to the number of CMBs on SWI, they were divided into three groups： a mild group （ 1 to 5 CMBs;n = 111 ） , a moderate group （6 to15 CMBs ; n = 86 ） , and a severe group （ t〉 15 CMBs ; n = 30 ）. The risk factors for affecting the severity of CMBs were analyzed. Results ①Univariate analysis showed that there were no significant differences in gender, age, diabetes, history of atrial fibrillation, hypertension, carotid atherosclerosis, coagulopathy, and antiplatelet aggregation therapy among the three groups （ P 〉 0.05 ）. The severity of CMBs increased with the number of lacunar infarction and severity of leukoaraiosis, and the cerebral hemorrhage rate also increased with severity of CMBs. There were statistically significant among the 3 groups （ P 〈 0.05 ）. Com- pared with the mild group after combining the moderate and severe groups, there were still statistically sig- nificant （ P 〈 0.05 ）. ②Spearman correlation analysis showed that the severity of CMBs was positively cor- related with the number of lacunar infarction （ r = 0. 392 ; P 〈 0.01 ） and the severity of leukoaraiosis （ r = 0. 362;P 〈 0.01 ）. ③After combining the moderate and severe groups, multivariate logistic regressionanalysis showed the number of lacunar infarction （ OR = 4. 259, 95 % CI： 3. 064 to 5. 620 ; P = 0.001 ）, se- verity of leukoaraiosis （ OR = 3. 250, 95% CI： 2. 351 to 4. 665, P = 0. 003） were the independent risk fac- tors for affecting the severity of CMBs. The severity of CMBs was positively correlated with cerebral hemor- rhage （ OR = 1. 813, 95% CI： 1. 788 to 2. 581 ;P = 0. 029）. Conclusion The severity of leukoaraiosis, the number of lacunar infarction and cerebral hemorrhage are closely associated with the severity of CMBs.