高血压伴发脑微出血的分布特点及其危险因素  

Cerebral Microbleeds Associated with Hypertension: the Distribution and Related Risk Factors

作　　者：杨栋梁[1] 刘红艳[1] 赖碧玉[1] 卢俊英[1] 彭旭红[1] 

机构地区：[1]清远市人民医院CT磁共振科,广东清远511500

出　　处：《中国医学影像学杂志》2016年第1期32-35,共4页Chinese Journal of Medical Imaging

基　　金：清远市科技局科研项目(2012B011204023)

摘　　要：目的探讨高血压伴发脑微出血（CMB）的分布特点,并评估其相关危险因素,降低远期大面积脑出血风险。资料与方法连续收集行头颅MRI检查的心血管内科及神经内科住院患者共160例,其中高血压110例,非高血压50例,行T2＊加权血管成像序列（SWAN）扫描,观察CMB的数量及位置,分析高血压伴发CMB的分布特点及其与患者年龄、性别、高血压病程、高血压级别、吸烟、血糖、血脂、血小板、血红蛋白之间的相关性。结果高血压组110例患者共检出CMB 472个,其中大脑深部212个（44.9%）,皮层及皮层下区149个（31.6%）,幕下区111个（23.5%）,CMB分布较高的区域分别为丘脑（98个,20.8%）、基底节（78个,16.5%）、颞叶（64个,13.6%）及脑干（62个,13.1%）。单因素分析提示CMB组高血压、糖尿病患者比率明显高于无CMB组、患者平均年龄高于无CMB组（P〈0.05）,多因素分析提示年龄、高血压为CMB的独立危险因素。高血压组CMB概率分别在≥45岁组及〈45岁组差异有统计学意义（P〈0.05）,在高血压病程〈5年组、5~9年组、≥10年组差异有统计学意义（P〈0.05）,在高血压1级与2、3级间差异有统计学意义（P〈0.05）。高血压组CMB数量与患者病程相关（P〈0.05）,与年龄、高血压级别无关（P〉0.05）。结论高血压、年龄是CMB的独立危险因素,对于≥45岁、高血压病程≥5年、高血压2、3级的患者应引起临床重视,必要时行MRI扫描排查有无CMB,减少远期脑出血的风险。Purpose To detect the distribution of cerebral microbleeds （CMB） in patients with hypertension and evaluate its related risk fhctors in order to reduce long-term risk of cerebral hemorrhage in large areas. Materials and Methods A consecutive 110 patients of hypertension and 50 patients of non-hypertension in the departments of cardiovascular medicine and neurology were enrolled. All the patients underwent T2 star weighted angiography （SWAN） sequence scan of head. The location and quantity of CMB and other related information of patients were recorded, The distribution of CMB in patients with hypertension and correlation between CMB and age, sex, level of hypertension, duration of time, hemoglobin, platelets, smoking, diabetes, hyperlipidemia were also analyzed. Results A total of 472 CMB were detected in the hypertension group, of which 212 CMB （44.9%） were tbund in deep brain, 149 （31.6%） were in cortical and subcortical region, 1 11 （23.5%） under the tentorium. The highest distribution of CMB was in thalamus （98, 20.8%）, followed by basal ganglia （78, 16.5%）, temporal lobe （64, 13.6%） and brainstem （62, 13.1%）. The univariate analysis showed that CMB group had significantly higher rate of hypertension and diabetes than that without CMB and the average age in CMB group was also higher （P〈0.05）. The results of multivariate analysis showed that age and hypertension were independent risk factors for CMB. In hypertension group, there was statistically significant difference in the incidence of CMB between patients aged 45 and older and those aged under 45 （P〈0.05）; the differences were significant between the patients with hypertension duration time less than 5 years, those with hypertension duration time 5 to 10 years and those over 10 years （P〈0.05）： the differences also existed between the patients with hypertension at class l and those patients with hypertension at class ll and 111 （P〈0.05）. The quantity of CMB in patients with hypertension was correl

关 键 词：高血压 脑出血 磁共振成像 磁敏感加权成像 年龄因素 

分 类 号：R743[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]