缺血性脑血管病患者脑微出血的危险因素分析

摘要

Objective To investigate the risk factors of cerebral microbleeds ( CMB) in patients with ischemic cere-brovascular disease, and to provide clinical basis for the prevention and treatment of stroke.Methods The clinical data of 135 patients with ischemic cerebrovascular disease, including the age, sex, body mass index ( BMI) , height, blood pres-sure, blood glucose, blood lipid, smoking history, drinking history, heart disease and other clinical data, were collected. Meanwhile, the susceptibility-weighted imaging (SWI) was used to detect the CMB, silent lacunar infarction and leukodys-trophy.We compared the clinical characteristics of patients with or without CMB, different parts of CMB and different se-verity of CMB.Logistic regression was used to analyze the risk factors of CMB.Results During 135 patients, 55 cases of patients had CMB, and 80 cases had no CMB.There were 35 cases of deep/infratentorial CMB and 20 cases of lobar CMB in CMB patients.According to the severity, CMB was divided into three levels, level 1 CMB was found in 22 cases, level 2 in 26 case and level 3 in 4 cases.The age, BMI, systolic blood pressure level, the scale of white matter lesion and pro-portion of hypertension, history of stroke and lacunar infarction in deep/infratentorial CMB group were significantly higher than that of non-CMB group ( all P<0.05) .The BMI, proportion of hypertension and lacunar infarction in deep/infraten-torial CMB group were higher than lobar CMB group (all P<0.05).The age and the scale of white matter lesion in lobar CMB group were significantly higher than non-CMB group (all P <0.05).The proportion of hypertension, history of stroke, lacunar infarction and white matter lesion of patients with level 3 and level 2 CMB were significantly higher than those of patients with level 1 CMB (all P<0.05).Multivariate Logistic regression analysis showed that the age, hyperten-sion, history of stroke, asymptomatic lacunar infarction and the white matter lesion were the independent risk factors for CMB (OR=7.536, 0.432, 0.470, 0.413 and 2.158, all P<0.05).Conclusion The patients who have advanced age, hypertension, lacunar infarction, white matter lesion and history of stroke are prone to CMB, and thus, we should pay attention to the possibility of recurrence of stroke.%目的：探讨缺血性脑血管病患者脑微出血（ CMB）发生的危险因素，为脑卒中的预防及治疗提供临床依据。方法收集缺血性脑血管病135例患者的年龄、性别、体质量、身高、血压、血糖、血脂、有无吸烟史、饮酒史、心脏病史等临床资料，以及磁共振磁敏感加权成像检测CMB、无症状腔隙性脑梗死、脑白质病变情况，比较有无CMB、不同部位CMB及不同严重程度CMB患者的临床特点，采用Logistic回归对CMB的危险因素进行分析。结果135例患者中，发生CMB 55例，无CMB 80例；CMB出现在深部幕下35例、脑叶20例，其严重程度分为1级25例、2级26例、3级4例。深部幕下CMB患者年龄、BMI、收缩压水平、脑白质病变评分以及出现高血压、既往卒中史、无症状腔隙性脑梗死比例高于非CMB患者（P均＜0．05），BMI及出现高血压、无症状腔隙性脑梗死比例高于脑叶CMB患者（P均＜0．05），脑叶CMB患者年龄、脑白质疏松评分明显高于非CMB患者（P均＜0．05）。 CMB 2级、3级患者出现高血压、既往卒中史、无症状腔隙性脑梗死比例以及脑白质疏松评分明显高于CMB 1级患者（ P均＜0．05）。 Logistic多元回归分析显示高龄、高血压、既往卒中史、无症状腔隙性脑梗死及脑白质病变（ OR分别为7．536、0．432、0．470、0．413、2．158，P均＜0．05）是CMB发生的独立危险因素。结论高龄、高血压、有腔隙性脑梗死、脑白质病变以及既往有卒中史患者易发生CMB，应注意再发脑卒中的可能。