原发性脑出血血肿远隔部位DWI高信号病灶与胰岛素抵抗相关性研究

Study on the correlation betueen high signal lesions on DWI and insulin resistance in the distant part of primary cerebral hemorrhage hematoma

目的探讨原发性脑出血患者弥散加权成像出现高信号病灶的危险因素。方法回顾性分析2021年1月至2022年9月九江市第一人民医院收治的病程2周内的132例原发性脑出血患者的临床资料。根据是否发生血肿远隔部位高信号病灶(R-DWILs)将其分为A组(发生R-DWILs)以及B组(未发生R-DWILs)。比较两组患者人口学特征指标、血液学指标水平。采用多因素logistic回归分析明确原发性脑出血R-DWILs的影响因素。结果A组患者的年龄高于B组,差异有统计学意义(P<0.05)。两组患者的性别、糖尿病、高血压、心房颤动、吸烟、饮酒、发病至入院时间、血肿体积比较,差异无统计学意义(P>0.05)。A组患者的空腹血糖(FPG)、胰岛素抵抗指数(HOMA-IR)、中性粒细胞与淋巴细胞计数比值(NLR)高于B组,差异有统计学意义(P<0.05)。两组患者的白细胞计数、红细胞沉降率比较,差异无统计学意义(P>0.05)。多因素logistic回归分析显示,高龄、高FPG、高HOMA-IR以及高NLR均是原发性脑出血R-DWILs的独立危险因素(OR=1.492、2.173、1.686、1.736,95%CI:1.045~1.896、1.356~3.682、1.145~4.371、1.166~3.501,P=0.001、<0.001、<0.001、<0.001)。结论胰岛素抵抗增加了原发性脑出血患者R-DWILs发生的风险。

Objective To investigate the risk factors of high signal lesions in diffusion weighted imaging in patients with primary cerebral hemorrhage.Methods The clinical data of 132 patients with primary cerebral hemorrhage admitted to Jiujiang NO.1 People's Hospital from January 2021 to September 2022 were retrospectively analyzed.The patients were divided into group A(with R-DWILs)and group B(without R-DWILs)according to whether remote-diffusion weighted imaging(R-DWILs)occurred at the distant site of hematoma.The levels of demographic characteristics and hematology indexes were compared between the two groups.Multivariate logistic regression analysis was used to determine the influencing factors of R-DWILs in primary cerebral hemorrhage.Results The age of patients in group A was higher than that in group B,and the difference was statistically significant(P<0.05).There were no significant differences in gender,diabetes,hypertension,atrial fibrillation,smoking,drinking,time from onset to admission,and hematoma volume between the two groups(P>0.05).The fasting blood-glucose(FPG),homeostasis model assessment-insulin resistance(HOMA-IR)and neutrophil-lymphocyte ratio(NLR)in group A were higher than those in group B,and the differences were statistically significant(P<0.05).There were no significant differences in white blood cell count and erythrocyte sedimentation rate between the two groups(P>0.05).Multivariate logistic regression analysis showed that elder age,high FPG,high HOMA-IR and high NLR were all inde pendent risk factors for R-DWILs in primary cerebral hemorrhage(OR=1.492,2.173,1.686,1.736,95%CI:1.045-1.896,1.356-3.682,1.145-4.371,1.166-3.501,P=0.001,<0.001,<0.001,<0.001).Conclusion Insulin resistance increases the risk of R-DWILs in patients with primary cerebral hemorrhage.