心房颤动患者脑微出血的分布和相关危险因素分析

Distribution of cerebral microbleeds in patients with atrial fibrillation and related risk factors

目的了解心房颤动患者脑微出血(CMBs)的比例和分布,分析房颤脑微出血患者的相关危险因素。方法选取2015年1月～2017年6月在我院住院且行头颅磁敏感加权成像检查的132例房颤患者。对所有患者采集一般临床资料,并对CMBs的数量和分布进行分析;采用Logistic回归分析房颤患者的相关危险因素。结果本研究中38例房颤患者(28.9%)合并有CMBs,其中9例患者(23.7%)CMBs病灶数为1个,17例患者(44.7%)病灶数为2～4个,12例患者(31.6%)病灶数≥5个。房颤CMBs患者总病灶数为183个,其中102个病灶(55.7%)位于脑叶,57个病灶(31.2%)位于深部,24个病灶(13.1%)位于幕下。回归分析提示年龄(OR=1.102,P=0.001,95%CI1.044～1.163)和抗凝治疗(OR=3.006,P=0.033,95%CI 1.091～8.281)是房颤患者CMBs的独立危险因素。结论房颤患者脑微出血病灶主要位于脑叶,对于年龄大且需要抗凝的房颤患者,建议行头颅磁敏感加权成像监测脑微出血。

Objective To understand the proportion and distribution of brain microbleeds(CMBs) in patients with atrial fibrillation, and to analyze the related risk factors of patients with atrial fibrillation. Methods A total of 132 patients with atrial fibrillation who were hospitalized in our hospital and underwent head-to-head magnetic sensitive weighted imaging examination from January 2015 to June 2017 were enrolled. General clinical data were collected from all patients, and the number and distribution of CMBs were analyzed. Logistic regression was used to analyze the risk factors associated with AF patients. Results In this study, 38 patients with atrial fibrillation(28.9%) had CMBs, 9 cases of whom(23.7%) had 1 CMBs, and 17 cases(44.7%) had 2-4 lesions, 12 patients(31.6%) had ≥5 lesions. The total number of lesions in patients with atrial fibrillation and CMBs was 183, of which 102 lesions(55.7%) were located in the brain lobe, 57 lesions(31.2%) were located deep, and 24 lesions(13.1%) were located under the curtain. Regression analysis suggested that age(OR=1.102, P=0.001, 95% CI 1.044-1.163)and anticoagulant therapy (OR=3.006, P=0.033, 95%CI 1.091-8.281) were independent risk factors for CMBs in patients with atrial fibrillation. Conclusion The brain microbleeds in patients with atrial fibrillation are mainly located in the cerebral lobe. For patients with atrial fibrillation who need anticoagulation, it is recommended to monitor brain mcrobleeds by magnetic sensitive imaging.