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目的研究缺血性脑卒中患者脑微出血的临床、影像学及血清生物学的危险因素,以及不同部位微出血与危险因素之间的关系。方法回顾性分析纳入153例缺血性脑卒中患者,应用磁敏感成像(susceptibility weighted imaging,SWI)技术检测脑微出血,计数并记录其部位。颅脑MRI的脑白质病变的严重程度采用Fazekas评分进行评估。应用Logistic回归分析法研究缺血性脑卒中合并脑微出血的危险因素,并研究危险因素与不同部位脑微出血数量的关系。结果 59例(38.6%)患者存在CMBs。皮层-皮层下CMBs出现率为34.0%,深部CMBs为24.8%,幕下CMBs为27.5%。多因素Logistic回归显示,男性、高血压病及中重度深部脑白质病变是伴有CMBs的有显著统计学意义的相关因素(P<0.05)。校正年龄及性别后,偏相关分析显示,高血压病仅与深部CMBs的数量仍然显著相关(r=0.174,P=0.032)。中重度深部脑白质病变与皮层-皮层下CMBs及深部CMBs数量存在显著相关(r=0.285,P<0.001,r=0.258,P=0.001)。结论男性、高血压病及中重度深部白质病变为脑微出血的危险因素;高血压病主要与与脑深部微出血的数量相关,而中重度深部脑白质病变与脑皮层-皮层下及深部微出血数量相关。
Objective To study the clinical, imaging and serum biological risk factors of cerebral micro-hemorrhage in patients with ischemic stroke and the relationship between micro-hemorrhage and risk factors in different areas. Methods A retrospective analysis of 153 patients with ischemic stroke was performed. Susceptibility weighted imaging (SWI) was used to detect micro-hemorrhage in the brain, and the sites were counted and recorded. The severity of white matter lesions in brain MRI was assessed using Fazekas score. Logistic regression analysis was used to study the risk factors associated with cerebral microbleeds in ischemic stroke and the relationship between risk factors and the number of cerebral microbleeds in different sites. Results CMBs were found in 59 patients (38.6%). Cortical-subcortical CMBs were 34.0%, deep CMBs 24.8%, and infratentorial CMBs 27.5%. Multivariate Logistic regression showed that men, hypertension and moderate-severe deep white matter lesions were the significant statistic related factors associated with CMBs (P <0.05). After adjusting for age and gender, partial correlation analysis showed that the prevalence of hypertension was still significantly correlated with the number of deep CMBs (r = 0.174, P = 0.032). There was a significant correlation between moderate and severe deep white matter lesions and the numbers of subcortical CMBs and deep CMBs (r = 0.285, P <0.001, r = 0.258, P = 0.001). Conclusions Male, hypertensive and moderate to severe deep white matter disease are the risk factors for cerebral microbleeding. Hypertension is mainly related to the amount of micro-hemorrhage in the deep brain. However, moderate to severe deep white matter lesions are associated with cerebral cortex-subcortical and deep micro- The number of bleeding related.