脑出血与脑白质病变的关系探讨

Relationship between cerebral hemorrhage and brain white matter lesions

目的探讨脑出血后患者是否白质病变更严重,出血的体积和部位是否影响白质进展。方法回顾性分析2012年1月～2017年11月南京医科大学附属江宁医院影像登记中心的脑出血患者2951例,其中90例有2次头颅MRI的脑出血患者被纳入最终研究(脑出血组,包括出血时头颅MRI和出血后头颅MRI)。选择90例年龄、性别相匹配且有2次头颅MRI的健康老年人作为对照组。脑出血组根据脑出血体积的四分位数间距将患者分为4组,第1组57例,出血体积0～25%;第2组17例,出血体积26%～50%;第3组10例,出血体积51%～75%;第4组6例,出血体积76%～100%。收集患者的一般临床资料、发病后12h内的头颅CT及2次头颅MRI资料。计算头颅CT出血量及2次头颅MRI上脑白质高信号(WMH)的体积以及WMH的年进展率。结果脑出血组WMH的年进展率显著高于对照组(33%vs 20%,P=0.01);多元线性回归分析显示,在调整其他危险因素后,脑出血、短暂性脑缺血发作或脑卒中与WMH的年进展率密切相关(β=-0.17,P=0.02;β=0.14,P=0.04);与第1组比较,第4组WMH的年进展率显著增高(76.2%vs 26.1%,P<0.05)。结论脑出血患者在出血后白质进展程度更明显,其进展率与出血量密切相关。

Objective To study whether the brain white matter lesions(WML)become severer after cerebral hemorrhage and whether the volume and sites of cerebral hemorrhage affect the progression of brain WML.Methods Out of the 2951 cerebral hemorrhage patients aged≥40 years who underwent brain CT imaging in our hospital,90 who underwent twice MRI served as a cerebral hemorrhage group and 90 age-and gender-matched healthy individuals who underwent twice MRI served as a control group.The patients were further divided into group A(n=57),group B(n=17),group C(n=10),and group D(n=6).Their clinical data and brain CT imaging parameters within 12 h after onset of cerebral hemorrhage were recorded.The volume of cerebral hemorrhage and the size of brain WML were measured,and the annual progression rate of brain WML was calculated.Results The annual progression rate of brain WML was significantly higher in cerebral hemorrhage group than in control group(33%vs 20%,P=0.01).Multivariate linear regression analysis showed that cerebral hemorrhage,TIA and cerebral stroke were closely related with the annual progression rate of WML after adjustment for other risk factors(β=-0.17,P=0.02;β=0.14,P=0.04).The annual progression rate of WML was significantly higher in group D than in group A(76.2%vs 26.1%,P<0.05).Conclusion Elevated progression rate of brain WML is closely related with the volume of cerebral hemorrhage in cerebral hemorrhage patients.