脑微出血与脑梗死的相关性研究

Relationship between cerebral microbleeds and ischemic stroke

目的探讨脑梗死患者脑微出血(cerebral microbleeds,CMB)与血清同型半胱氨酸的相关性,进而寻找复发脑梗死的危险因素及生物标记。方法回顾性分析脑梗死患者540例,其中首发脑梗死患者188例(首发脑梗死组),复发脑梗死患者352例(复发脑梗死组)。依据影像学资料分为CMB患者146例(CMB组),非CMB患者394例(非CMB组)。比较人口统计学资料、血管危险因素以及血清学指标与CMB、复发脑梗死的相关性,并对脑梗死进行不同年龄区分析。结果 CMB组高血压、收缩压、同型半胱氨酸明显高于非CMB组,TC明显低于非CMB组,差异有统计学意义(P<0.05,P<0.01)。与复发脑梗死组比较,首发脑梗死组年龄明显降低,吸烟、收缩压、舒张压、糖化血红蛋白、TC、LDL明显升高,差异有统计学意义(P<0.05,P<0.01)。多因素分析显示,高血压、同型半胱氨酸为CMB的独立危险因素(OR=1.852,95%CI:1.134~3.026,P=0.014;OR=1.012,95%CI:1.001~1.023,P=0.037)。TC为CMB的保护因素(OR=0.827,95%CI:0.732~0.935,P=0.002)。年龄45~65岁患者差异最大,且更易出现首发脑梗死。结论 CMB可通过控制血压和血清同型半胱氨酸水平、调整TC等治疗达到预防的作用;同时可降低复发脑梗死,特别是控制高血压和糖尿病。

Objective To study the relationship between cerebral microbleeds （CMB） and serum homocysteine level in ischemic stroke （IS） patients in order to find the risk factors and biomarkers for recurrent IS. Methods Five hundred and forty IS patients were divided into first-ever IS group （n= 188） and recurrent IS group （n=352） or into CMB group （n= 146） and CMB-free group （n=394） according to their imaging data. Relationship of demographic data,vascular risk factors and serological parameters with CMB and recurrent IS was analyzed. The age to develop IS was also analyzed. Results The incidence of hypertension, SBP and serum homocysteine level were significantly higher while the serum TC level was significantly lower in CMB group than in CMB-free group （P〈0.05,P〈0.01）. The age was significantly younger while the prevalence of smoking, SBP, DBP, serum levels of HbAIc, TC and LDL were significantly higher in first-ever IS group than in recurrent IS group （P〈0.05,P〈0.01）. Multivariate logistic regression analysis showed that hypertension and serum homocysteine level were the independent risk factors for CMB while TC was the protective factor for CMB （OR = 1. 852,95%CI. 1. 13± 3. 026, P= 0. 014;OR= 1. 012,95%CI： 1. 001- 1. 023,P=0. 037;OR= 0. 827,95%CI.0. 732-0. 935,P= 0. 002）. First-ever IS was easy to occur in 45-65 years old patients. Conclusion CMB can prevent IS by regulating hypertension and serum levels of homocysteine and TC,and reduce the incidence of recurrent IS,especially that of hypertension and diabetes mellitus.