老年性短暂性脑缺血发作患者中脑微出血发生与分布的相关危险因素分析

摘要

Objective: To investigate the relevant risk factors for analyzing the occurrence and distribution of cerebral microbleeds(CMB) in old patients with transient ischemic attack(TIA). Materials and Methods:One hundred and eighty-two old patients with TIA diagnosed by physician were collected from September 2013 to July 2015 in our hospital, whose clinical data and MRI data were analyzed by two neurologists and two radiologists respectively. Clinical data included age, gender, clinical symptoms, diagnosis, confounding diseases, IADL score and biochemical test results(such as triglyceride(TG)and high-density lipoprotein(HDL)). MRI data contained the location and distribution of CMB, the degree of lacunar infarction(LI), periventricularhighsignal(PVH) and deep white matter hyperintensities(DWMH). Then the relative risk factors were analysis for the occurrence and distribution of CMB in old patients with TIA. Results:In comparison with CMB(-)group, there were higher age, LI amount, PVH and DWMH grading and lower HDL in CMB(+) group, which had statistical significance(P<0.05), but IADL score was not statistical signiifcance(P>0.05) in both groups. For the distribution of CMB, there were higher LI and DWMH in diffuse type than cerebral lobe and deep structure type, which had statistical significance(P<0.05). but HDL level was not statistical signiifcance(P>0.05) among three type groups. The relative risk factors were serious PVH and high TG for cerebral lobe type(OR=7.01)and deep structure type(OR=6.80)respectively, and were serious DWMH and LI amount for diffuse type(OR=9.4;OR=7.88). Conclusion:The occurrence and distribution of CMB in old patients with TIA are related to age, LI amount, TG, PVH and DWMH grading, which are helpful to the diagnosis and treatment for CMB patients.%目的探讨脑微出血(cerebral microbleed，CMB)在老年性短暂性脑缺血发作(transient ischeamic attack，TIA)患者中的发生及分布，初步明确其可能的危险因素。材料与方法收集我院2013年9月至2015年7月期间临床诊断为短暂性缺血发作老年患者共182名，分别对其患者的临床资料和磁共振成像(magnetic resonance imaging，MRI)资料进行登记评估。临床资料包括患者年龄、性别、临床症状、诊断及其合并症、工具性日常活动能力评分(IADL评分)、血液生化检查；MRI资料评估包括CMB是否存在，腔隙性脑梗死(lacunar infarction，LI)，脑室旁高信号(periventricularhighsignal，PVH)、深部脑白质高信号(deep white matter hyperintensities，DWMH)的程度和分布；然后通过统计学来分析CMB发生与分布的相关危险因素。结果与CMB(-)相比，CMB(+)组TIA患者既往缺血性中风史阳性者所占比例更高，其高密度脂蛋白(high density lipoprotein，HDL)水平低、而平均年龄、LI数目、PVH及DWMH分级高，具有统计学意义(P＜0.05)；两组之间的 IADL评分无统计学意义(P＞0.05)；根据CMB(+)分布：CMB弥漫型组中LI及DWMH明显高于脑叶组及深部结构组，具有统计学意义(P＜0.05)，但3组之间的HDL水平无显著差异(P＞0.05)；脑叶型CMB发生相关危险因素为严重PVH(OR=7.01)；深部结构CMB发生相关的危险因素为高甘油三酯(triglyceride，TG)(OR=6.80)；而与弥漫型CMB发生相关危险因素为LI数目及DWMH(OR=9.4；OR=7.88)。结论 CMB的发生与分布与老年性缺血性脑血管病患者的年龄、LI数目、PVH及DWMH分级及TG有关，有助于CMB的诊断和治疗。