脑微出血影响因素及其对出血性脑卒中的影响分析

Influencing Factors of Cerebral Microbleeds and Its Influence on Hemorrhagic Stroke

背景近年来脑卒中发病率逐渐增加,寻找脑卒中发病的因素是临床研究重点,脑微出血可使心血管疾病的发生率增加,虽然脑微出血和出血性脑卒中发病的危险因素重叠,但脑微出血是否与出血性脑卒中的发生存在相关性仍不明确,且两者发病关系的相关报道较少,仍需进一步探究。目的探讨脑微出血的影响因素,并探究脑微出血对出血性脑卒中的影响。方法选取2013年9月—2016年12月于常州市武进中医医院进行颅脑CT和MRI检查的体检者520例,根据是否发生脑微出血分为脑微出血组(n=119)和无脑微出血组(n=401),随访时间3~7年,根据是否发生出血性脑卒中分为出血性脑卒中组(n=77)和无出血性脑卒中组(n=443)。收集所有患者的性别、年龄、体质指数、吸烟史、饮酒史、规律体育锻炼情况和高脂血症、高血压、偏头痛、心血管疾病病史及同型半胱氨酸、血脂指标、空腹血糖、糖化血红蛋白水平。采用多因素Logistic回归模型分析脑微出血和出血性脑卒中的影响因素。结果多因素Logistic回归分析结果显示,年龄〔OR=3.206,95%CI(1.602,6.416)〕、规律体育锻炼〔OR=0.283,95%CI(0.116,0.687)〕、高血压病史〔OR=7.478,95%CI(3.090,18.101)〕、心血管疾病病史〔OR=3.421,95%CI(1.660,7.051)〕、同型半胱氨酸水平〔OR=5.948,95%CI(2.960,11.950)〕是脑微出血的独立影响因素(P<0.05);年龄〔OR=3.476,95%CI(1.803,6.703)〕、规律体育锻炼〔OR=0.294,95%CI(0.121,0.711)〕、高血压病史〔OR=2.892,95%CI(1.417,5.903)〕、同型半胱氨酸水平〔OR=2.596,95%CI(1.349,4.996)〕、脑微出血〔OR=4.071,95%CI(1.823,9.094)〕是出血性脑卒中的独立影响因素(P<0.05)。结论年龄≥55岁、无规律体育锻炼、高血压病史、心血管疾病病史、同型半胱氨酸水平升高为脑微出血的危险因素,同时脑微出血会增加出血性脑卒中的发生风险。

Background In recent years,the incidence of stroke has gradually increased.It is the focus of clinical research to find the factors of stroke.Cerebral microbleeds can increase the incidence of cardiovascular disease.Although the risk factors of cerebral microbleeds and hemorrhagic stroke overlap,whether the correlation between cerebral microbleeds and hemorrhagic stroke is still unclear,and there are few reports about the relationship between cerebral microbleeds and hemorrhagic stroke,which need to be further explored.Objective To explore the influencing factors of cerebral microbleeds,and to explore the influence of cerebral microbleeds on hemorrhagic stroke.Methods A total of 520 physical examinations were screened in Changzhou Wujin TCM Hospital for CT and MRI examination of the brain,they were divided into cerebral microbleeds group(n=119)and non cerebral microbleeds group(n=401)according to whether occurrence of cerebral microbleeds.The follow-up time was 3-7 years,and the patients were divided into hemorrhagic stroke group(n=77)and non hemorrhagic stroke group(n=443)according to whether occurrence of hemorrhagic stroke.The gender,age,body mass index,smoking history,drinking history,regular physical exercise,history of hyperlipidemia,hypertension,migraine,and cardiovascular disease,levels of homocysteine,blood lipid,fasting blood glucose and glycosylated hemoglobin of all patients were collected,and multivariate Logistic regression analysis was used to analyze the influencing factors of cerebral microbleeds and hemorrhagic stroke.Results Multivariate Logistic regression analysis showed that age〔OR=3.206,95%CI(1.602,6.416)〕,regular physical exercise〔OR=0.283,95%CI(0.116,0.687)〕,hypertension history〔OR=7.478,95%CI(3.090,18.101)〕,cardiovascular disease history〔OR=3.421,95%CI(1.660,7.051)〕,homocysteine level〔OR=5.948,95%CI(2.960,11.950)〕were influencing factors of cerebral microbleeds(P<0.05);age〔OR=3.476,95%CI(1.803,6.703)〕,regular physical exercise〔OR=0.294,95%CI(0.121,0.711)〕,hypertension history〔OR=2.892,95%CI(1.417,5.903)〕,homocysteine level〔OR=2.596,95%CI(1.349,4.996)〕,cerebral microbleeds〔OR=4.071,95%CI(1.823,9.094)〕were influencing factors of hemorrhagic stroke(P<0.05).Conclusion Age≥55 years old,regular physical exercise,history of hypertension and cardiovascular disease and homocysteine level increased are risk factors for cerebral microbleeds,and cerebral microbleeds can increase the risk of hemorrhagic stroke.