非致残性缺血性脑血管事件患者脑微出血的危险因素

Risk factors for cerebral micro bleeds in patients with non-disabling ischemic cerebrovascular events

目的探讨非致残性缺血性脑血管事件(non-disabling ischemic cerebrovascular events,NICE)患者伴脑微出血(cerebral microbleeds,CMBs)的危险因素。方法纳入2017年1月至2018年9月在昆明医科大学第二附属医院神经内科住院治疗的NICE患者,收集相关临床资料并完善头颅MRI检查,应用磁敏感加权成像检测CMBs。比较CMBs组与非CMBs组人口统计学和临床资料,应用多变量logistic回归分析确定CMBs的独立危险因素,应用多元线性回归分析确定CMBs数量的独立影响因素。结果共纳入159例患者,CMBs组73例(45.9%),非CMBs组86例(54.1%)。CMBs组高血压、糖尿病、既往卒中或短暂性脑缺血发作(transient ischemic attack,TIA)史、颈动脉粥样硬化、NICE分型(TIA、轻型卒中)和发病前使用药物的患者构成比以及舒张压和脑白质Fazekas评分与非CMBs组均差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,舒张压较高(优势比1.047,95%可信区间1.016~1.079;P=0.002)和Fazekas评分较高(优势比1.825,95%可信区间1.465~2.273;P<0.001)是CMBs的独立危险因素。多元线性回归分析显示,脑白质Fazekas评分与CMBs数量呈独立正相关联系(r=0.273,P<0.001)。结论在NICE患者中,CMBs与舒张压水平较高和脑白质Fazekas评分较高相关,其中脑白质Fazekas评分与CMB严重程度呈正相关。

Objective To investigate the risk factors for cerebral microbleeds(CMBs)in patients with non-disabling ischemic cerebrovascular events(NICE).Methods From January 2017 to September 2018,patients with NICE admitted to the Department of Neurology,the Second Affiliated Hospital of Kunming Medical University were enrolled.The relevant clinical data were collected and the cranial MRI examinations were completed.CMBs were detected by susceptibility-weighted imaging.The demographic and clinical data of the CMBs group and non-CMBs group were compared.Multivariate logistic regression analysis was used to determine the independent risk factors for CMBs.Multivariate linear regression analysis was used to determine the independent influencing factors of the number of CMBs.Results A total of 159 patients were enrolled,including 73(45.9%)in the CMBs group and 86(54.1%)in the non-CMBs group.There were significant differences in hypertension,diabetes mellitus,past stroke or transient ischemic attack(TIA)history,carotid atherosclerosis,NICE classification(TIA,mild stroke)and the proportion of patients taking drugs before onset,as well as diastolic blood pressure and white matter Fazekas score between the CMBs group and the non-CMBs group(all P<0.05).Multivariate logistic regression analysis showed higher diastolic blood pressure(odds ratio 1.047,95%confidence interval 1.016-1.079;P=0.002)and higher Fazekas score(odds ratio 1.825,95%confidence interval 1.465-2.273;P<0.001)were the independent risk factors for CMBs.Multiple linear regression analysis showed that there was an independent positive correlation between the white matter Fazekas score and the number of CMBs(r=0.273,P<0.001).Conclusion In patients with NICE,CMBs were associated with higher diastolic blood pressure level and higher white matter Fazekas score,and the white matter Fazekas score was positively correlated with the severity of CMBs.