老年缺血性脑血管病患者脑微出血与颈动脉内膜中层厚度的相关性

Relationship between cerebral microbleeds and carotid intima-media thickness in elderly ischemic cerebrovascular disease patients

目的研究老年缺血性脑血管病患者脑微出血(CMB)与颈动脉内膜中层厚度(IMT)的相关性。方法回顾性收集2019年12月~2021年1月国家康复辅具研究中心附属康复医院门诊就诊的老年缺血性脑血管病患者157例,经头颅MRI及颈动脉彩色超声检查。根据磁敏感加权成像分为CMB组78例,非CMB组79例。记录2组IMT及CMB数量、分布,所有患者根据CMB数目分为0~3级。根据CMB分布分为深部-幕下、脑叶及混合。Pearson相关性分析CMB与颈动脉IMT的关系。结果 2组年龄、性别、高血压、脑白质评分比较,差异有统计学意义(P<0.05,P<0.01)。CMB组共检出401个病灶,混合285个(71.1%),脑叶65个(16.2%),深部-幕下51个(12.7%);CMB分布:深部-幕下31例(39.7%),脑叶26例(33.3%),混合21例(26.9%)。CMB组颈动脉IMT正常、增厚、斑块分别为5例(6.4%)、16例(20.5%)、57例(73.1%),随颈动脉粥样硬化程度增加,CMB发生率逐步提高,差异有统计学意义(χ^(2)=19.790,P=0.000)。CMB组1、2、3级患者颈动脉IMT斑块检出率比较,差异有统计学意义(χ^(2)=32.446,P=0.000)。Pearson相关性分析显示,去除年龄因素,颈动脉IMT分级与CMB数目、CMB分级呈正相关(r=0.176,P=0.028;r=0.323,P=0.000)。结论老年缺血性脑血管病患者CMB与颈动脉粥样硬化密切相关,颈动脉IMT可预测CMB发生。

Objective To study the relationship between cerebral microbleeds(CMB) and carotid intima-media thickness(IMT) in elderly ischemic cerebrovascular disease(ICD) patients.MethodsOne hundred and fifty-seven elderly ICD patients who underwent head and neck MRI and carotid color ultrasonography in our hospital from December 2019 to January 2021 were divided into CMB group(n=78) and CMB-free group(n=79).Their carotid IMT,number and distribution of CMB were recorded.The number of CMB was graded into 0-3.The CBM were divided into deep subtentorial group, lobar group, and mixed group.The relationship between CMB and carotid IMT was analyzed by pearson correlation analysis.Results Significant difference was detected in age, gender, incidence of hypertension, and white matter score between the two groups(P<0.05,P<0.01).A total of 401 lesions were detected in CMB group, including 285 mixed lesions(71.1%),65 lobar lesions(16.2%) and 51 deep subtentorial lesions(12.7%).Of the 78 CBM,31(39.7%) were distributed in deep subtentoria, 26(33.3%) in cerebral lobe, and 21(26.9%) in mixed regions.Normal carotid IMT,thickened carotid IMT and plaques were detected in 5 patients(6.4%),16 patients(20.5%) and 57 patients(73.1%) respectively.The incidence of CMB increased gradually with the increasing severity of carotid atherosclerosis(χ^(2)=19.790,P=0.000).The detection rate of carotid IMT plaques was significantly different in CMB group(χ^(2)=32.446,P=0.000).Pearson correlation analysis showed that carotid IMT was positively related with the number and grade of CMB after adjustment of age(r=0.176,P=0.028;r=0.323,P=0.000).Conclusion CMB are closely related with carotid atherosclerosis in elderly ICD patients and carotid IMT can predict CMB.