自发性脑出血患者出现远隔部位病灶的相关因素分析

Related factors for remote lesions in patients with spontaneous intracerebral hemorrhage

目的探讨脑出血患者出现远隔部位弥散受限病灶(R-DWILs)的相关因素。方法选择金华市中心医院神经内科自2018年1月至2019年12月收治的203例自发性脑出血患者进入研究,根据是否存在R-DWILs将患者分为阳性组(39例)及阴性组(164例),分析阳性组患者R-DWILs基本情况并比较2组患者临床资料及实验室检查结果;随后将P<0.1的项目纳入多因素Logistic回归分析,明确导致R-DWILs出现的独立影响因素。结果39例(19.2%)脑出血患者中共检测到55个R-DWILs,其中皮层-皮层下45个(81.8%),基底节区8个(14.5%),脑干1个(1.8%),小脑1个(1.8%)。病灶的直径为2~20 mm,呈圆形或椭圆形、片状、不规则形等。共计42个(76.4%)病灶在血肿的对侧半球,患者R-DWILs的数量为1~3个。阳性组患者收缩压、舒张压、白细胞计数(WBC)、中性粒细胞计数、中性粒细胞与淋巴细胞比值(NLR)、空腹血糖均较阴性组患者明显升高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,空腹血糖(OR=1.632,95%CI:1.213~2.072,P=0.015)、中性粒细胞计数(OR=1.037,95%CI:1.019~1.581,P=0.042)及NLR(OR=2.151,95%CI:1.397~2.733,P=0.003)是R-DWILs出现的独立影响因素。结论R-DWILs在脑出血患者中常见,以皮层-皮层下多见,且好发于血肿的对侧半球。空腹血糖、中性粒细胞计数及NLR偏高患者更易出现R-DWILs。

Objective To explore the relevant factors for remote diffusion-weighted imaging lesions(R-DWILs)in patients with spontaneous intracerebral hemorrhage.Methods Two hundred and three patients with spontaneous intracerebral hemorrhage,admitted to our hospital from January 2018 to December 2019,were enrolled.According to the presence of R-DWILs,these patients were divided into positive group(n=39)and negative group(n=164).The basic information of R-DWILs in the positive group was analyzed.The basic demographic and clinical data and laboratory examination results were collected and compared between the two groups.Subsequently,the items with P<0.1 were included in the multivariate Logistic regression analysis to identify the independent influencing factors for R-DWILs.Results A total of 55 R-DWILs were detected in 39 patients(19.2%)with spontaneous intracerebral hemorrhage,including 45 in the cortical and subcortical area(81.8%),8 in the basal ganglia area(14.5%),one in the brainstem area(1.8%),and one in the cerebellum area(1.8%).The diameter of these lesions ranged from 2-20 mm,which were round or oval,flaky,irregular and so on.Forty-two R-DWILs(76.4%)were in the contralateral hemisphere,and the number of R-DWILs was 1-3 in these patients.Systolic blood pressure,diastolic blood pressure,white blood cell count(WBC),neutrophil count,neutrophil to lymphocyte ratio(NLR),fasting blood glucose level in the positive group were significantly higher than those in the negative group(P<0.05).Logistic regression analysis showed that fasting blood glucose level(OR=1.632,95%CI:1.213-2.072,P=0.015),neutrophil count(OR=1.037,95%CI:1.019-1.581,P=0.042),and NLR(OR=2.151,95%CI:1.397-2.733,P=0.003)were independent influencing factors for R-DWILs.Conclusions R-DWILs are common in patients with spontaneous intracerebral hemorrhage,the lesions mainly occur in the cortical and subcortical area,and it is more common in the contralateral hemisphere.Patients with high fasting blood glucose,neutrophil count,and NLR are trended to have R-DWILs.