不伴高血压病的动脉硬化性脑梗死患者脑微出血的危险因素分析  

Analysis of Risk Factors for Cerebral Microbleeds in Atherosclerotic Stroke Patients Without Hypertension

作　　者：桂千 冯红选[1] 卢艳丽[2] 王媚瑕 侯晓夏 程庆璋[1] 吴冠会[1] GUI Qian;FENG Hongxuan;LU Yanli(Department of Neurology and Radiology,Suzhou Municipal Hospital,Jiangsu 215002,China)

机构地区：[1]南京医科大学附属苏州医院(苏州市立医院)神经内科,215002 [2]南京医科大学附属苏州医院(苏州市立医院)影像科,215002

出　　处：《医学研究杂志》2022年第12期106-110,共5页Journal of Medical Research

基　　金：南京医科大学科技发展基金资助项目(NMUB2018227)。

摘　　要：目的探讨不伴高血压病的动脉硬化性脑梗死患者发生脑微出血(cerebral microbleeds,CMB)的危险因素。方法选取2018年5月~2020年7月在苏州市立医院神经内科住院的101例动脉硬化性脑梗死患者,血压水平均正常,收集患者基本资料。依据头颅MRI磁敏感加权成像(susceptibility-weighted imaging,SWI),分成CMB组35例和非CMB组66例,先对两组进行单因素分析,再进行二元多因素Logistic回归分析,确定患者发生CMB的独立危险因素。对35例CMB患者按CMB部位分为单纯脑叶组19例,单纯深部组11例,比较两组危险因素的差异。并依据TOAST分型,比较大动脉粥样硬化(large-artery atherosclerosis,LAA)型脑梗死患者和小动脉闭塞(small-artery occlusion,SAO)型脑梗死患者发生CMB的差异。结果CMB组与非CMB组单因素分析结果发现,两组年龄、脂蛋白相关磷脂酶A_(2)(lipoprotein-associated phospholipase A_(2),LP-PLA_(2))、同型半胱氨酸(homocysteine,HCY)、估算的肾小球滤过率(estimated glomerular filtration rate,EGFR)、脑白质疏松(leukoaraiosis,LA)比较,差异均有统计学意义(P<0.05)。进一步多因素分析显示,年龄(OR=1.091,95%CI:1.006~1.184)、HCY(OR=1.164,95%CI:1.034~1.310),LA(OR=3.797,95%CI:1.018~14.154)是不伴高血压病的动脉硬化性脑梗死患者发生CMB的独立危险因素。单纯脑叶CMB组与单纯深部CMB组比较,所有因素差异无统计学意义。SAO组较LAA组CMB发生率高(P<0.05)。结论年龄、HCY、LA是不伴高血压病的动脉硬化性脑梗死患者发生CMB的独立危险因素,不同部位CMB组之间危险因素比较,差异无统计学意义,SAO型脑梗死患者CMB发生率较高。Objective To investigate the risk factors of cerebral microbleeds(CMB)in atherosclerotic stroke patients without hypertension.Methods A total of 101 patients with atherosclerotic stroke who were hospitalized in the Neurology Department of Suzhou Municipal Hospital from May 2018 to July 2020 were selected.All patients had normal blood pressure.The basic data were collected.According to susceptibility-weighted imaging(SWI)of brain MRI,all patients were divided into CMB group(35 cases)and non-CMB group(66 cases).Univariate analysis was performed to compare the two groups first,and then multivariate Logistic regression analysis was performed to determine the independent risk factors for CMB.The 35 patients with CMB were divided into 19 cases in the pure lobar group and 11 cases in the pure deep group according to the location of CMB.The risk factors in CMB patients between the two groups were compared.And according to TOAST classification,the differences for incidence of CMB in patients with large-artery atherosclerotic stroke and those with small-artery occlusive stroke were compared.Results Univariate analysis showed that age,lipoprotein-associated phospholipase A_(2)(LP-PLA_(2)),homocysteine(HCY),estimated glomerular filtration rate(EGFR)and the proportion of leukoaraiosis(LA)were statistically different(P<0.05).Furthermore,multivariate analysis showed that age(OR=1.091,95%CI:1.006-1.184),HCY(OR=1.164,95%CI:1.034-1.310),and LA(OR=3.797,95%CI:1.018-14.154)were independent risk factors for CMB in atherosclerotic stroke patients without hypertension.There were no significant differences in all factors between the pure lobar CMB group and the pure deep CMB group.Compared with the group of large-artery atherosclerotic stroke,the group of small-artery occlusive stroke had a higher incidence of CMB(P<0.05).Conclusion Age,HCY and LA were independent risk factors for CMB in atherosclerotic stroke patients without hypertension.There were no significant differences in risk factors between the different CMB groups.The patient

关 键 词：高血压病 动脉硬化性脑梗死 脑微出血 危险因素 

分 类 号：R743.9[医药卫生—神经病学与精神病学]