脑出血患者出血部位与病因构成的相关性研究  

Correlation study of bleeding sites and etiology in patients with intracerebral hemorrhage

作　　者：蒋小群[1] 郝子龙[1] 王秋筱[1] 董薇[1] 陶文丹[1] 吴思缈[1] 游潮[2] 刘鸣[1] 

机构地区：[1]四川大学华西医院神经内科,成都610041 [2]四川大学华西医院神经外科,成都610041

出　　处：《中国脑血管病杂志》2013年第5期259-263,共5页Chinese Journal of Cerebrovascular Diseases

基　　金："十二五"国家科技支撑计划项目(2011BAI08B05)

摘　　要：目的分析脑出血患者不同出血部位的病因构成,探讨两者的相关性。方法纳入2002年3月—2006年12月成都卒中登记库的脑出血患者831例。其中男540例(65.0%),女291例(35.0%),平均年龄(59±13)岁。根据出血部位分为深部、脑叶、脑干、小脑、脑室、多部位出血。根据病因将脑出血分为原发性和继发性脑出血,并进一步分析出血部位和病因的关系。采用Logistic回归分析出血部位与病因的相关性。结果①常见的出血部位依次是深部(63.2%)、脑叶(17.4%)、脑干(9.0%)、多部位(4.2%)、脑室(3.6%)及小脑出血(2.5%)。②出血病因以高血压最多见,占62.2%。③各部位出血均以原发性为主,与继发性比较,差异有统计学意义(χ2=26.549,P<0.01)。不同病因在各部位出血中所占的比例差异有统计学意义(χ2=618.256,P<0.01)。④多因素分析显示,深部出血与高血压呈正相关(OR=1.96,95%CI:1.33～2.88),与血管畸形呈负相关(即危险性较小,OR=0.23,95%CI:0.07～0.72);脑叶出血与高血压呈负相关(OR=0.29,95%CI:0.13～0.61),与动脉瘤呈正相关(OR=10.70,95%CI:2.35～48.66);小脑出血与血管畸形呈正相关(OR=17.84,95%CI:3.64～87.40);脑室出血与烟雾病呈正相关(OR=10.85,95%CI:2.14～55.11)。结论脑出血部位与病因有一定相关性。高血压是深部出血、动脉瘤是脑叶出血、血管畸形是小脑出血、烟雾病是脑室出血的重要病因。结合临床特点,根据出血部位推测病因有一定参考意义。Objective To analyze the etiology of the bleeding site in patients with intracerebral hemorrhage and to investigate the correlation between the hemorrhagic sites and etiology. Methods The patients with intracerebral hemorrhage in Chengdu Stroke Registry were included in the study from March 2002 to December 2006. A total of 831 patients with intracerebral hemorrhage were enrolled,540 patients （65.0%） were males and 291 （35.0%） were females. Their mean age was 59 ± 13 years old. The sites of bleeding were classified as deep, lobar, brain stem, eerebellar, ventricular, and multiple-sites according to the hemorrhagic sites. The intracerebral hemorrhage was divided into the primary and secondary hemorrhage according the etiology. The relationship between the hemorrhagic sites and etiology were further analyzed. The logistic regression was used to analyze the correlation between the hemorrhagic sites and its etiology. Results ①The order of the common hemorrhagic sites were as follows ： deep （63.2%）, lobar （ 17.4% ）, brain stem （9.0%）, muhiple-sites （4.2%）, ventricular （3.6%）, and cerebellar （2.5%） hemorrhage. ②The most common bleeding etiology was hypertension and it accounted for 62.2% （9.0%to 77.0% ）. ③The bleeding at all sites were mainly primary intracerebral hemorrhage. The differences were statistically significant as compared with secondary hemorrhage （X2 = 26. 549,P 〈 0.01 ）. There were significant differences in etiologies in all hemorrhagic sites （X2 = 618. 256 ,P 〈 0.01 ）. ④Multivariate analysis showed that the deep hemorrhage was positively correlated with hypertension （OR = 1.96, 95% C1 1.33 to 2.88） , and it was negatively correlated with vascular malformation （ OR =0.23, 95% CI 0. 07 to 0.72） ; lobar hemorrhage was negatively correlated with hypertension （ OR = 0. 29, 95% CI 0. 13 to 0. 61 ） , and it was positively correlated with aneurysms （ OR = 10.70, 95% CI 2.35 to 48.66） ; cerebellar hemorrhage was positively correlated with

关 键 词：脑出血 高血压 出血部位 病因 

分 类 号：R743.34[医药卫生—神经病学与精神病学]