MRI磁敏感加权成像在高血压伴脑微出血的临床应用及潜在危险因素分析  

Clinical Application and Potential Risk Factors of Susceptibility Weighted MRI in Hypertensive Patients with Cerebral Microbleeds

作　　者：贾济波 朱全新[1] 杨文广[1] 王禹[1] 王庆荣[1] 王勋[1] JIA Ji-bo;ZHU Quan-xin;YANG Wen-guang;WANG Yu;WANG Qing-rong;WANG Xun(Department of Radiology,the Third People's Hospital of Kunshan,Kunshan,Jiangsu,215316,China)

机构地区：[1]江苏省昆山市第三人民医院放射科,江苏昆山215316

出　　处：《中国血液流变学杂志》2021年第2期260-264,共5页Chinese Journal of Hemorheology

摘　　要：目的探讨高血压患者脑内微出血(CMB)的好发部位分布特点,并评估其潜在危险因素,指导临床早期干预,降低远期大量脑出血风险。方法收集2017年—2021年心血管内科及神经内科高血压住院患者28例,无高血压患者10例,所有患者均行常规头颅MRI平扫(包括TIWI、T2WI及FLAIR序列)+磁敏感加权成像(SWI)检查,观察CMB在脑内的位置及数目,分析高血压患者CMB在脑内的分布特点及其与患者年龄、性别、吸烟、饮酒、高血压病程及分级、糖尿病、冠心病、抗凝、同型半胱氨酸、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、总胆固醇、载脂蛋白A、载脂蛋白B的相关性。结果高血压患者28例共检出CMB 133个,其中大脑深部62个(46.6%),皮层及皮层下区51个(38.3%),幕下20个(15.1%),CMB主要分布在丘脑(32个,24.1%)、基底节(27个,20.3%)、颞叶(20个,15.1%)。单因素分析示CMB组高血压患者比例及同型半胱氨酸、低密度脂蛋白胆固醇水平均高于无CMB组,多因素回归分析示同型半胱氨酸、低密度脂蛋白胆固醇为CMB的独立危险因素。高血压组CMB在年龄≥45岁组及<45岁组差异有统计学意义(P<0.05)。结论同型半胱氨酸、低密度脂蛋白胆固醇是CMB的独立危险因素,对于年龄≥45岁,同型半胱氨酸、低密度脂蛋白胆固醇水平增高的高血压患者应引起临床重视,必要时行SWI检查筛查有无CMB,制定个体化治疗方案,降低远期大量脑出血的风险。Objective To investigate the distribution of predilection sites of intracerebral microbleeds(CMB)in hypertensive patients,and to evaluate its potential risk factors,so as to guide early clinical intervention and reduce the risk of long-term massive cerebral hemorrhage.Methods 28 hospitalized patients with hypertension and 10 patients without hypertension in geriatric department and neurology department of the Third People's Hospital of Kunshan were collected from 2017 to 2021.All patients underwent MRI scan and susceptibility weighted imaging(SWI).The number and location of CMB were observed.The distribution characteristics of CMB in patients with hypertension and its correlation with age,gender,smoking,drinking,course and grade of hypertension,diabetes mellitus,coronary heart disease,anticoagulation,homocysteine,low density lipoprotein cholesterol,high density lipoprotein cholesterol,triglyceride,total-cholesterol,apolipoprotein A,and apolipoprotein B were analyzed.Results A total of 33 CMB were detected in 28 patients with hypertension,including 62(46.6%)in deep brain,51(38.3%)in cortex and subcortical area,and 20(15.1%)in infratentorial area.The areas with higher CMB distribution were thalamus(32,24.1%),basal ganglia(27,20.3%)and temporal lobe(20,15.1%).Univariate analysis showed that the ratio of hypertensive patients,homocysteine number and low density lipoprotein cholesterol level in CMB group were higher than those in non CMB group.Multivariate analysis showed that homocysteine and low density lipoprotein cholesterol were independent risk factors for CMB.The CMB probability of hypertension group was significantly different between≥45 years old group and<45 years old group(P<0.05).Conclusion Homocysteine and low-density lipoprotein cholesterol are independent risk factors of CMB.Clinical attention should be paid to the patients over 45 years old with high levels of homocysteine and low-density lipoprotein cholesterol.SWI examination should be performed when necessary to screen for CMB,and individualized t

关 键 词：高血压 脑微出血 磁敏感加权成像 同型半胱氨酸 低密度脂蛋白胆固醇 

分 类 号：R445.2[医药卫生—影像医学与核医学]