脑梗死伴脑微出血的危险因素分析

Clinical Observation on the Risk Factors of Cerebral Infarction Complicated by Cerebral Microbleeds

目的探讨脑梗死伴脑微出血的特点及危险因素。方法选择2010年6月至2012年12月沧州市人民医院神经内科收治的急性脑梗死患者285例为研究对象,并根据有无脑微出血分为脑微出血组和无脑微出血组,比较两组患者一般资料,并对危险因素进行Logistic多因素回归分析。结果两组患者在性别、吸烟史、饮酒史、糖尿病史,血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇以及尿素氮水平异常等方面比较,差异无统计学意义(P>0.05);脑微出血组患者的年龄>70岁、有高血压史、有脑白质病、服用阿司匹林史、血清高密度脂蛋白胆固醇(HDL-C)水平<1.0 mmol/L、纤维蛋白原>3.8 g/L的比例显著高于无脑微出血组(P<0.05),存在颈动脉粥样斑块及心房颤动的比例显著低于无脑微出血组(P<0.05)。Logistic多因素回归分析显示,年龄、高血压、纤维蛋白原、脑白质病、HDL-C是脑微出血的危险因素。结论当脑梗死患者高龄、存在高血压史、脑白质病、低HDL-C及高纤维蛋白原等中一项或多项时,应高度警惕脑微出血,应及时进行磁共振梯度回波序列扫描确诊,利于制订个体化治疗方案以降低脑出血的风险。

Objective To investigate the characteristics and risk factors of cerebral infarction complicated by cerebral microbleeds（ CMB）. Methods A total of 285 patients with acute cerebral infarction treated in Department of-Neurology,Cangzhou People＇s Hospital from Jun. 2010 to Dec. 2012 were selected as research objects,and divided into CMB group and non-CMB group according to the presence or absence of CMB. The clinical data of the two groups were compared and the risk factors of cerebral infarction complicated by CMB were analyzed by Logistic multivariate regression analysis. Results Concerning the patients＇ gender,smoking history,drinking history,diabetes history,serum levels of total cholesterol,triglyceride,low density lipoprotein cholesterol,and urea nitrogen,there were no statistically significant differences between the two groups（ P〉0. 05）; the ratios of patients older than 70 years,and who had history of hypertension,leukoencephalopathy,having aspirin,or serum level of high density lipoprotein cholesterol（ HDL-C） 1. 0 mmol/L,fibrinogen level 3. 8 g/L in CMB group were significantly higher than those in non-CMB group（ P〈0. 05）,the ratios of patients who had carotid atheromatous plaque or atrial fibrillation in non-CMB group were significantly lower than those in non-CMB group（ P〈0. 05）. Results of Logistic multivariate analysis showed that age,hypertension,fibrinogen,leukoencephalopathy,HDL-C were the risk factors of cerebral microbleeds. Conclusion When patients with cerebral infarction has one or several risk factors such as advanced age,hypertension history,leukoencephalopathy history,low serum level of HDL-C or fibrinogen at the same time,it is necessary to alert the presence of CMB,magnetic resonance gradient echo sequence scanning should be conducted to diagnose,in order to establish individualized treatment plan to low the risk of cerebral hemorrhage.