Objective To investigate the risk factors and neuroimaging of cerebral microbleeds(CMBs) in patients with lacunar in-farction and find the associations between these risk factors and the location and numbers of CMBs.Methods Consecutive 127 patients with lacunar infarction who were in department of neurology of General Hospital of Guangzhou Military Command of PLA from March 2015 to Sep-tember 2017 were prospectively recruited. All of the patients underwent MRI-susceptibility weighted imaging(SWI). The location and num-bers of CMBs were recorded. The severity of WMLs was assessed by using the Fazekas scale. The patients were divided into CMBs(42 ca-ses) and non-CMBs groups(85 cases),and the clinical data including general conditions,biochemical indicators and imaging features were compared between the two groups. The independent risk factors of CMB were analyzed in multivariable logistic regression. The relationships between these risk factors and the location and numbers of CMBs were also analyzed. Results CMBs were found in 42/127 patients (33.1%). The frequency of cortical-subcortical,deep and infratentorial CMBs were 39.0%,43.3% and 18.0%,respectively. Compared with non-CMBs group,the age (t=2.472,P=0.017), history of hypertension (χ2=20.96,P<0.001), systolic pressure (t=4.539,P<0.001), high density lipoprotein cholesterol(HLD) (t=-2.939,P=0.004),number of lacunar infarction(t=4.074,P<0.001),moder-ate-to-severe deep white matter hyperintensities (DWMH)(t=28.608,P<0.001) and periventricular hyperintensities (PVH) (t=16.935, P<0.001) in the patients with CMBs had statistical difference.Logistic regression analysis showed that the age,history of hypertension,high systolic pressure and moderate-to-severe DWMH were the independent risk factors for presence of CMBs.Adjusted with age and sex, partial correlation showed that history of hypertension only correlated with the numbers of deep CMBs significantly (r=0.731,P=0.025). Moder-ate-to-severe of DWMH significantly correlated with the numbers of cortical-subcortical and deep CMBs(r=0.281,P<0.001,r=0.364,P=0.001,respectively).Conclusions Age, history of hypertension, high systolic pressure and moderate-to-severe DWMH are independent risk factors of CMBs in patients with lacunar infarction. History of hypertension correlates with deep CMBs,while moderate-to-severe DWMH correlates with cortical-subcortical and deep CMBs.%目的 探讨腔隙性脑梗死患者合并脑微出血(CMBs)的危险因素及其影像学特征及不同部位微出血与危险因素之间的关系.方法 采用前瞻性研究方法,连续收集腔隙性脑梗死患者127例,应用磁敏感加权成像(SWI)技术检测CMBs,计数并记录其部位.脑白质病变的严重程度采用Fazekas评分进行评估.根据有无CMBs将患者分为CMBs组(42例)和无CMBs组(85例),比较2组间基本临床资料、生化指标及影像学特点是否存在差异,并采用多因素逐步Logistic回归模型分析CMBs发生的独立危险因素,并研究危险因素与不同部位CMBs数量的关系.结果 42例(33.1%)患者存在CMBs.皮层-皮层下CMBs发生率为38.6%,深部为43.4%,幕下为18.0%.CMBs组和无CMBs组年龄(t=2.472,P=0.017)、高血压史(χ2=20.96,P<0.001)、入院时收缩压(t=4.539,P<0.001)、高密度脂蛋白胆固醇(t=-2.939,P=0.004)、腔隙性脑梗死数目(t=4.074,P<0.001)、中重度深部脑白质疏松(χ2=28.608,P<0.001)及中重度脑室旁白质疏松(χ2=16.935,P<0.001)比较差异具有统计学意义.Logistic回归分析显示:年龄、高血压史、入院时收缩压及中重度深部脑白质疏松是腔隙性脑梗死患者发生CMBs的独立危险因素.校正年龄及性别后,偏相关分析显示,高血压史仅与深部CMBs的数量显著相关(r=0.731,P=0.025);中重度深部脑白质疏松与皮层-皮层下及深部CMBs数量存在显著相关(r=0.281;P=0.001,r=0.364,P=0.001).结论 腔隙性脑梗死患者CMBs发生与年龄、高血压史、入院时收缩压及脑白质疏松程度有关.高血压史主要与脑深部CMBs的数量相关,而中重度深部脑白质疏松与脑皮层-皮层下及深部CMBs数量相关.
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