出血性卒中后首次确诊高血压患者的脑小血管病影像特征分析

目的探讨出血性卒中后首次确诊高血压患者的脑小血管病(CSVD)影像特征。方法回顾性分析2016年8月至2021年10月51例出血性卒中就诊且首次确诊高血压患者的头颅MRI资料。记录腔隙性脑梗死(LI)、颅内微出血灶(CMBs)的数目与位置,脑白质疏松(LA)的Fazekas分级。采用Pearson分析CMBs数目与LI数目的相关性;Spearman分析CMBs数目与Fazekas分级的相关性;Kruskal-Wallis H检验各Fazekas分级的CMBs数目。结果40例LI共123个病灶,87.00%位于深部脑组织(基底节区、丘脑、半卵圆中心、脑干);39例LA,Fazekas 1级21例,2级9例,3级9例;39例存在CMBs,轻度(1~3个)17例,中度(4~10个)10例,重度(>10个)12例,位置分型I型27例(69.23%),II~V型12例(30.77%)。29例血肿周围可见CMBs,数量(2.38±1.69)个。CMBs数目与LI数目、Fazekas分级均存在正相关(r=0.25,P=0.001;r=0.702,P=0.001);各Fazekas分级CMBs数目不全相等(H=25.1,P=0.001),其中Fazekas 0级组明显少于2级、3级组(P=0.025;0.001)。结论出血性卒中后首次确诊高血压患者存在不同程度的CSVD,包括LI、LA和CMBs,可作为前期筛查高血压的重要依据。

Objective To explore the imaging features of cerebral small vascular disease(CSVD)in patients with hypertension diagnosed for the first time after admission to the hospital with hemorrhagic stroke.Methods The head MRI data of 51 patients with hypertension diagnosed for the first time after admission to the hospital with hemorrhagic stroke in Hangzhou Xiaoshan First People's Hospital from August 2016 to October 2021 were retrospectively analyzed.The number,location of lacunar cerebral infarction(LI),cerebral microbleeds(CMBs)and Fazekas classification of leukoaraiosis(LA)were recorded.The Pearson test was used to analyze the correlation between the number of CMBs and the number of LI.The Spearman test was used to analyze the correlation between the number of CMBs and the Fazekas classification.The Kruskal-Wallis H test was used to analyze the number of CMBs in each Fazekas classification.Results 40 cases had LI with 123 lesions,most of which were located in deep brain tissues(basal ganglia,thalamus,semioval center,brainstem)(107/123,87.00%).39 cases had LA,21 cases in Fazekas grade 1,9 cases in grade 2 and 9 cases in grade 3.39 cases had CMBs,17 cases of mild(1-3),10 cases of moderate(4-10),12 cases of severe(>10).27 cases(69.23%)with CMBs were in location type I.12 cases(30.77%)were in type II-V.CMBs were seen around the hematoma in 29 cases,with an average of 2.38±1.69.The number of CMBs was positively correlated with the number of LI and Fazekas classification(r=0.25,P=0.001;r=0.702,P=0.001).The number of CMBs in each Fazekas classification was not all equal(H=25.1,P=0.001),among which Fazekas grade 0 group was significantly less than grade 2 and grade 3 groups(P=0.025,0.001).Conclusion Patients with hypertension diagnosed for the first time after hemorrhagic stroke have different degrees of cerebral small vascular disease,including LI,LA and CMBs,can be used as an important basis for pre-screening of hypertension.