急性脑出血后不同部位脑微出血患者临床特征及神经功能结局研究

Study on the clinical characteristics and outcome of nerve function in patients with acute intracerebral microhemorrhage in different areas

目的:探讨急性脑出血后,是否存在脑微出血(cerebral microbleed,CMB)及不同部位CMB患者的临床及影像学特征,以及预后和相关因素。方法:回顾性连续纳入2017年1月至2018年12月在神经内科住院治疗的急性脑出血患者,并完善头部MRI检查(包含SWI序列)。收集患者人口学资料、临床特征和影像学特征等资料,随访发病后3个月时神经功能结局。将影响脑出血预后的因素作为自变量,3个月时不良神经功能结局作为应变量进行Logistic回归分析。结果:总共纳入156例急性脑出血患者。CMB组与无CMB组患者相比,更年老、男性比例更低、入院时空腹血糖更高、血肿体积更大(P<0.05)。根据CMB的位置,分为脑叶CMB组、深部或幕下CMB组和混合型CMB组。三组之间,年龄、糖尿病史、吸烟史、饮酒史、血肿位置存在一定差异。有无CMB及不同部位CMB患者的三个月时不良神经功能结局未见明显统计学差异。发病年龄(OR=1.12;95%CI为1.06-1.31)、GCS评分(OR=0.34;95%CI为0.22-0.54)、血肿体积(OR=1.05;95%CI为1.03-1.09)、发生侧脑室出血(OR=1.21;95%CI为1.14-1.44)、混合性CMB(OR=1.21;95%CI为1.09-1.33)等因素与脑出血3个月时不良神经功能独立相关。结论:在急性脑出血后,有无CMB及不同部位CMB患者其临床特征、影像学特征存在一定的差异,但两组的预后无明显差异;混合型CMB患者预后较差并且为脑出血患者预后不良的独立危险因素。

Objective:To investigate the clinical and imaging features of cerebral microbleeds(CMB)and different regions of CMB after intracerebral hemorrhage(ICH),and its prognosis and influencing factors.Methods:Patients with ICH admitted to neurology department from January 2017 to December 2018 were consecutively and retrospectively included,who completed MRI examination(including SWI sequence).Demographic data,clinical and radiologic features,as well as functional outcome at 3 months after onset were collected and analyzed.The Logistic regression was used to determine related factors associated with poor clinical outcome.Results:A total of 156 patients with ICH were included.Compared with patients without CMB,patients with CMB were older,with lower proportion of male,higher blood glucose,and larger hematoma volume(P<0.05).According to regions of CMB,it was divided into three groups:lobar CMB group,deep or infratentorial CMB group,and mixed CMB group.Between the three groups,age,proportion of diabetes history,smoking history,drinking history,and the location of hematoma were significant different.However,there was no significant difference of poor clinical outcome between CMB group and without CMB group and different regions of CMB.Age of onset(OR=1.12;95%CI,1.06-1.31),GCS score(OR=0.34;95%CI,0.22-0.54),hematoma volume(OR=1.05;95%CI,1.03-1.09),presence of intraventricular hemorrhage(OR=1.21;95%CI,1.14-1.44)and mixed CMB(OR=1.21;95%CI,1.09-1.33)were independently associated with 3-month poor clinical outcome.Conclusion:After ICH,the clinical and imaging characteristics of patients with or without CMB and those with different sites of CMB are different to some extent.Patients with mixed CMB was an independent risk factors for poor prognosis of patients with ICH at 3-month.