急性脑梗死患者脑微出血影响因素分析

Analysis of influencing factors of cerebral microhemorrhage in patients with acute cerebral infarction

目的探讨脑微出血(CMB)可能的影响因素及其机制。方法选择铜陵市人民医院神经内科2011年1月至2014年2月收治的74例急性脑梗死患者,进行常规序列(T1WI、T2WI、FLAIR)、DWI及T2-GRE扫描,对CMB进行分区、计数、分级。根据有无CMB,分为CMB组(36例)与无CMB组(38例)。回顾性分析两组患者年龄、吸烟饮酒史、血糖、血压、低密度脂蛋白、同型半胱氨酸水平等情况。结果 CMB组高血压、腔隙性脑梗死患者比例高于无CMB组,差异有统计学意义(χ2=11. 013,P=0. 010;χ2=6. 121,P=0. 012)。两组患者血浆生化检查结果进行比较,除了UA,Cr之外,差异无统计学意义(P> 0. 05); logistic回归分析显示,高血压(OR=4. 66,95%CI:1. 22~17. 64,P=0. 010)、腔隙性脑梗死(OR=4. 321,95%CI:1. 19~16. 75,P=0. 012)是CMB的危险因素。结论 CMB与高血压、腔隙性脑梗死密切相关,其中高血压为CMB最重要的可控危险因素,腔隙性脑梗死与CMB可能具有类似的发病机制。

Objective To explore the possible influencing factors and mechanism of cerebral microhemorrhage. Methods Seventy - four cases of patients with acute cerebral infarction admitted to this hospital between Jan 2011 and Feb 2011 were selected and re-ceived regular sequence（TjWI, T2WI, FLAIR） , DWI and T2 - GRE scanning, then cerebral microbleed（ CMB） was partitioned, counted and graded. According to the presence or absence of CMB, the patients were divided into CMB group（36 cases） and non - CMB group（38 cases）. The age, smoking and drinking history, blood glucose, blood pressure, LDL and homocysteine levels were analyzed retrospectively. Results The proportion of patients with hypertension and lacunar cerebral infarction in CMB group was signiflcandy higher than that in non - CMB group, showing a statistically significant difference^2 =11. 013 , P = 0. 0 1 0 ; / = 6 . 121, P = 0. 012 ） . Plasma biochemical examination results of the two groups showed no statistically significant difference（P 〉 0.05） , inaddition to the UA、 Cr. Logistic regression analysis showed that high blood pressure（ = 4. 66, 95% Cl 1. 22 ~ 17. 64, P = 0. 010） , lacunar cerebral infarction（ OR = 4. 321,95% Cl： 1.19 ~ 16.75, P= 0.012） were risk factors for CMB. Conclusion CMB is closely related to hypertension and lacunar cerebral in-farction, among which hypertension is the most important controllable risk factor of CMB. Lacunar cerebral infarction and the incidence of CMB may have similar mechanisms.