首发急性腔隙性脑梗死患者脑微出血与早期神经功能恶化的关联研究

Correlation study between cerebral microbleeds and early neurological deterioration in patients with firstonset acute lacunar stroke

目的急性腔隙性脑梗死患者早期神经功能恶化（early neurological deterioration,END）的影响预测指标目前尚不明确。文中拟探讨首发急性腔隙性脑梗死患者脑微出血病灶的位置、数量与END的联系。方法选取2009年3月至2012年5月发病24 h内收治于安徽省立医院神经内科的急性腔隙性脑梗死患者217例。所有患者完成磁共振磁敏感成像检查,探讨微出血病灶的位置、数量与END的联系。结果 END发生率占35.0%。其中检出脑微出血（cerebral microbleeds,CMBs）阳性患者33例,占43.4%。CMBs阳性组与阴性组之间END发生率差异无统计学意义（P=0.173）。在病灶数量分级的比较中,〉5个CMBs病灶的患者发生END的可能性显著增加（P=0.005）。Logistic回归结果显示,相对于CMBs阴性患者,CMBs病灶数目〉5个与END存在相关性（OR=3.14,95%CI：1.22-8.13）,≤5个CMBs病灶与END不存在统计学关联（OR=1.12,95%CI：0.53-2.37）。CMBs病灶位置与END发生无统计学关联（P〉0.05）。结论磁共振SWI成像中的CMBs病灶分布位置与早期神经功能波动无关,但5处以上的CMBs病灶可能是END的独立预测因素。

Objective The predictive indexes which affect early neurological deterioration（ END） of patients with acute lacunar stroke still remain unclear. The purpose of the article was to investigate the correlation between the location and numbers of cerebral microbleeds（ CMBs） and END in patients with first-onset lacunar stroke. Methods 217 patients with acute lacunar stroke hospitalized in Anhui Provincial Hospital within 24 hours after occurrence from Mar 2009 to May 2012 were prospectively enrolled. All patients underwent susceptibility-weighted imaging MRI right after admission,followed by the investigation on the relationship of the location and numbers of CMBs and END. Results END occurred in 76（ 35. 0%） patients. Among these patients,there were 33 positive cases with CMBs（ 43. 3%）. There were no significant difference in END incidence between positive group and negative group（ P =0. 173）. In the comparison of the numbers of CMBs foci,patients with more than 5 foci were more prone to END（ P = 0. 005）. Logistic regression analysis showed there was relation between CMBs foci numbers 〉5 and END（ OR = 3. 14,95% CI： 1. 22 - 8. 13）,and there was no relation between CMBs foci numbers≤5 and END（ OR =1. 12,95% CI： 0. 53 - 2. 37） as to CMBs negative patients. No significant relationship was found in CMBs location and END occurrence（ P〉 0. 05）. Conclusion The distribution of CMBs foci has nothing to do with early neurological fluctuation. However,more than 5 CMBs foci might be the independent prediction cause of END.