脑微出血与脑白质高信号及服用阿司匹林相关性分析

A clinical study of the association between white matter hyperintensity,aspirin therapy and cerebral microbleeds

目的探讨脑微出血与脑白质高信号和服用阿司匹林的关联性,并筛查脑微出血相关危险因素。方法纳入2016年6月至2021年2月首都医科大学附属北京朝阳医院收治的2654例缺血性脑血管病患者,记录入院时收缩压和舒张压、是否服用阿司匹林和服药时间,以及入院24 h内测定血清高密度脂蛋白胆固醇、低密度脂蛋白胆固醇(LDL-C)和血浆糖化血红蛋白(Hb A1c)、同型半胱氨酸(Hcy)、纤维蛋白原、D-二聚体;头部MRI评估脑白质高信号严重程度(Fazekas评分)并计数脑微出血灶数目[脑微出血解剖评分量表(MARS)]。单因素和多因素逐步法Logistic回归分析筛查脑微出血及其严重程度相关危险因素。结果2654例患者根据Fazekas评分分为对照组(1315例)、轻度脑白质高信号组(461例)、中度脑白质高信号组(440例)和重度脑白质高信号组(438例),各组年龄(H=353.837,P=0.000),合并高血压(χ^(2)=79.818,P=0.000)、冠心病(χ^(2)=56.768,P=0.000)和糖尿病(χ^(2)=8.936,P=0.030)比例,入院时收缩压(H=47.979,P=0.000),服用阿司匹林比例(χ^(2)=161.576,P=0.000)和服药时间(H=4.766,P=0.000),血清LDL-C(H=16.533,P=0.002),血浆Hb A1c(H=22.127,P=0.000)和Hcy(H=83.558,P=0.002),脑微出血比例(χ^(2)=642.054,P=0.000)差异有统计学意义。Logistic回归分析显示,入院时舒张压高(OR=1.017,95%CI:1.007~1.026,P=0.001;OR=1.020,95%CI:1.011~1.029,P=0.000)和Fazekas评分高(OR=1.673,95%CI:1.590~1.761,P=0.000;OR=1.754,95%CI:1.669~1.844,P=0.000)是存在脑微出血及其严重程度的危险因素,血清LDL-C是存在脑微出血及其严重程度的保护因素(OR=0.856,95%CI:0.765~0.957,P=0.006;OR=0.860,95%CI:0.774~0.956,P=0.005);而服用阿司匹林和服药时间与存在脑微出血及其严重程度无明显关联性。结论脑白质高信号严重程度(Fazekas评分)是存在脑微出血及其严重程度的危险因素。

Objective To investigate the association between white matter hyperintensity(WMH),aspirin therapy and cerebral microbleeds(CMBs),and to screen risk factors for CMBs and severity of CMBs.Methods Total 2654 patients with ischemic cerebrovascular disease were admitted to Department of Neurology in Beijing Chao-Yang Hospital,Capital Medical University from June 2016 to February 2021.Systolic blood pressure(SBP),diastolic blood pressure(DBP),aspirin therapy,time of aspirin therapy,highdensity lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)of the serum,glycated hemoglobin(HbA1 c),homocysteine(Hcy),fibrinogen(FIB)and D-dimer of plasma were collected within 24 h of admission.MRI was used to evaluate the severity of WMH by Fazekas score and identify the number of CMBs by Microbleed Anatomical Rating Scale(MARS).Univariate and multivariate stepwise Logistic regression analyses were used to screen the related risk factors for CMBs and its severity.Results Total 2654 patients were divided into control group(n=1315),mild(n=461),moderate(n=440)and severe(n=438)WMH groups by Fazekas score.There was statistically significant difference in age(H=353.837,P=0.000),history of hypertension(χ^(2)=79.818,P=0.000),coronary heart disease(χ^(2)=56.768,P=0.000)and diabetes(χ^(2)=8.936,P=0.030),SBP at admission(H=47.979,P=0.000),aspirin therapy(χ^(2)=161.576,P=0.000),time of aspirin therapy(H=4.166,P=0.000),serum LDL-C(H=16.533,P=0.002),plasma HbAlc(H=22.127,P=0.000)and Hey(H=83.558,P=0.002),proportion of CMBs(χ^(2)=642.054,P=0.000)among groups.Logistic regression analysis showed that DBP at admission(OR=1.017,95%CI:1.007-1.026,P=0.001;OR=1.020,95%CI:1.011-1.029,P=0.000)and Fazekas score(OR=1.673,95%CI:1.590-1.761,P=0.000;OR=1.754,95%CI:1.669-1.844,P=0.000)were risk factors for CMBs and its severity.Serum LDL-Cwas a protective factor for CMBs and its severity(OR=0.856,95%CI:0.765-0.957,P=0.006;OR=0.860,95%CI:0.774-0.956,P=0.005).Aspirin therapy and time of aspirin therapy were not significantly correlated with CMBs and its severity.Conclusions Severity of WMH(Fazekas score)was a risk factor for CMBs and its severity.