Objective To investigate the risk factors for cerebral microbleed (CMB) in patients with stroke attributable to small artery occlusion (SAO).Methods The patients with acute small-artery occlusive stroke who completed susceptibility-weighted imaging (SWI) examination were enrolled.They were divided into either a positive group or a negative group according to whether they had CMBs or not.The general clinical data,biochemical parameters,and imaging data were compared between the two groups.Multivariate logistic regression analysis was used to identify the independent risk factors for CMBs.Spearman correlation analysis was used to identify the correlations of CMBs with the severity of old lacunar infarcts and leukoaraiosis.Results A total of 109 patients with small-artery occlusive stroke were enrolled,47 (43.1％)were in the CMB positive group and 62 (56.9％) were in the CMB negative group.The age (65.15 ±12.91 years vs.62.32 ± 11.61 years; t =0.770,P =0.037),proportion of hypertension (66.0％ vs.32.3％ ;x2 =16.598,P ＜ 0.001),thrombin time (14.62 ± 2.25 s vs.16.49 ± 4.68 s; t =2.400,P =0.041),partial thromboplastin time (34.98 ± 5.20 s vs.33.47 ± 7.00 s; t =1.532,P =0.010),international normalized ratio (0.94± 0.27vs.0.91± 0.10; t=-0.886,P=0.016),triglyceride (1.16±0.51 mmol/L vs.1.76 ± 1.36 mmol/L; t =2.699,P =0.005],low-density lipoprotein cholesterol (2.49 ±0.72 mmol/L vs.2.64 ± 1.37 mmol/L; t =0.641,P=0.046),as well as the grades of old lacunar infarction (x2 =34.961,P＜0.001) and leukoaraiosis (x2 =35.161,P＜0.001) in the CMB positive group had significant differences with those in the CMB negative group.Multivariate logistic regression analysis showed that hypertension (odds ratio [OR] 6.368,95％ confidence interval [CI] 2.279-17.799; P ＜0.001),old lacunar infarction (OR 3.876,95％ CI 1.080-13.912; P =0.038),and leukoaraiosis (OR 16.797,95％ CI 1.433-196.960; P =0.025) were the independent risk factors for CMBs in patients with acute small-artery occlusive stroke,while triglyceride ≥ 1.52 mmol/L was an independent protective factor for it (OR 0.270,95％ CI 0.074-0.983; P =0.047).Spearman correlation analysis showed that CMB grade and lacunar infarction grade (r =0.520,P ＜ 0.001) and leukoaraiosis severity (r =0.553,P ＜ 0.001)showed a significant positive correlation.Conclusions Hypertension,old lacunar infarction,and leukoaraiosis are the independent risk factors for CMBs in patients with acute small-artery occlusive stroke,and triglyceride ≥ 1.52 mmol/L is its independent protective factor.%目的 探讨急性小动脉闭塞性卒中(small artery occlusion,SAO)患者脑微出血(cerebral microbleed,CMB)的危险因素.方法 纳入完成磁敏感加权成像(susceptibility-weighted imaging,SWI)检查的SAO患者,根据有无CMB分为阳性组和阴性组,比较两组间一般临床资料、生化指标以及影像学资料,采用多变量logistic回归分析确定CMB的独立危险因素,采用Spearman相关分析确定CMB与陈旧性腔隙性梗死和脑白质疏松严重程度的相关性.结果 共纳入109例SAO患者,CMB阳性组47例(43.1％),阴性组62例(56.9％).CMB阳性组年龄[(65.15±12.91)岁对(62.32 ±11.61)岁;t=0.770,P=0.037]、高血压患者构成比(66.0％对32.3％;x2=16.598,P＜0.001)、凝血酶时间[(14.62 ±2.25)s对(16.49 ±4.68)s;=2.400,P=0.041]、部分凝血酶原时间[(34.98 ±5.20)s对(33.47 ±7.00)s;t=1.532,P=0.010]、国际标准化比率(0.94±0.27对0.91±0.10;t=-0.886,P=0.016)、三酰甘油[(1.16±0.51) mmol/L对(1.76±1.36) mmol/L;t=2.699,P=0.005]、低密度脂蛋白胆固醇[(2.49 ±0.72) mmol/L对(2.64±1.37) mmol/L;t=0.641,P=0.046]以及陈旧性腔隙性梗死(x2 =34.961,P＜0.001)和脑白质疏松(x2 =35.161,P＜0.001)分级与CMB阴性组存在显著性差异.多变量logistic回归分析显示,高血压[优势比(odds ratio,OR)6.368,95％可信区间(confidence interval,CI)2.279 ～ 17.799;P＜0.001]、陈旧性腔隙性梗死(OR3.876,95％ CI 1.080 ～ 13.912;P=0.038)和脑白质疏松(OR 16.797,95％ CI 1.433～196.960;P=0.025)是急性SAO患者CMB的独立危险因素,而三酰甘油≥1.52mmol/L是其独立保护因素(OR 0.270,95％ CI 0.074 ～0.983;P =0.047).Spearman相关性分析显示,CMB分级与腔隙性梗死分级(r=0.520,P＜0.001)和脑白质疏松严重程度(r=0.553,P＜0.001)呈显著正相关.结论 高血压、陈旧性腔隙性梗死和脑白质疏松是急性SAO患者CMB的独立危险因素,而三酰甘油≥1.52 mmol/L是其独立保护因素.
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