脑微出血与急性缺血性卒中的临床关系分析

Relationship between cerebral microbleeds and acute ischemic stroke

目的 探讨急性缺血性卒中（AIS）患者脑微出血（CMBs）的危险因素,并进一步探讨CMBs与脑卒中病灶面积和部位的相关性。方法 收集2014-1-2015-12在作者医院神经内科住院的AIS患者226例,据是否存在CMBs分为CMBs组（111例）和无CMBs组（115例）。收集研究对象临床资料,采用头颅MRI对其CMBs、脑白质病变（WML）、陈旧腔隙性脑梗死（LI）、AIS病灶面积和部位进行评价,并采用Logistic回归、t检验、χ^2检验等分析影响AIS患者发生CMBs的危险因素。结果多因素Logistic回归分析显示年龄（OR=1.063,95%CI：1.025～1.104,P〈0.01）、高血压史（OR=3.488,95%CI：1.113～10.927,P〈0.05）、WML（OR=1.282,95%CI：1.155～1.423,P〈0.01）及陈旧LI（OR=5.815,95%CI：1.539～21.973,P〈0.01）是AIS合并CMBs的独立危险因素;CMBs分级与WML分级（r=0.354,P〈0.01）、陈旧LI分级（r=0.394,P〈0.01）均呈正相关;不同脑卒中病灶面积患者间CMBs检出率比较有统计学差异（χ^2=7.878,P〈0.05）,其中新发LI患者更易检出CMBs（χ^2=6.084,P=0.009〈0.017）,且CMBs越严重,这种差异越明显（z=-2.832,P=0.005〈0.017）。结论 年龄、高血压史、WML及陈旧LI是AIS合并CMBs的独立危险因素,且CMBs严重程度随WML、陈旧LI的严重程度增加而增高。AIS患者CMBs检出率与梗死灶面积有关,在新发LI中更易被发现。

Objective To investigate the risk factors of cerebral microbleeds （CMBs） in patients with acute ischemic stroke （AIS） ,and explore the relationship between CMBs and the infarction lesion area and location. Methods A total of 226 consecutive inpatients with AIS from our department between January 2014 to December 2015 were chosen in our study. Based on the occurrence of CMBs ,the patients were divided into two groups （111 patients with CMBs;115 patients without CMBs ） . The demographic and clinical data were collected. MR imagings were performed in all the patients. CMBs were evaluated according to their locations. The number of old lacunar infarcts （LI） ,the severity of white matter lesions （WML） and the infarction lesion area and location were also recorded. Multivariate logistic regression analysis ,t test and χ^2 test were adopted to analyze the risk factors of CMBs in AIS patients. Results Multivariate logistic regression analysis showed that the age （OR=1.063 ,95% CI：1.025‐1.104 ;P〈0.01） ,hypertension （OR=3.488 ,95% CI：1.113‐10.927 , P〈0.05） ,WML （OR= 1.282 ,95% CI：1.155‐1.423 ;P〈 0.01） and old LI （OR= 5.815 ,95% CI：1.539‐21.973 ,P〈0.01） were the independent risk factors for CMBs in patients with AIS. The Spearman’ s rank correlation analysis suggested that the grade of CMBs was positively correlated with the grade of WML （r=0.354 ,P〈0.01） as well as the grade of old LI （r=0.394 , _ P〈0.01） . Kruskal‐Wallis H test showed that the occurrence of CMBs had significant differences （χ^2 =7.878 ,P〈0.05） in patients with different lesion area , especially in the patients with new LI （χ^2 =6.084 ,P=0.009〈0.017） . The higher grade CMBs were ,the more obviously difference was （z= -2.832 , P=0.005〈0.017） . Conclusions The age ,hypertension ,WML and old LI were the independent risk factors for CMBs in patients with AIS. The severity of CMBs increases with the increase of the number of LI or the severity of WML. CMBs in patients with AIS are more likely to occur in the subgroup of new LI.