近期皮质下小梗死患者合并脑出血病灶临床特征及相关因素分析  

Analysis of coexisting and associated factors of intracerebral hemorrhage lesions in patients with recent subcortical small infarct

作　　者：吴峥嵘[1] 宗策 张珂[1] 刘红兵 赵颖颖[2] 王艳红[1] 高远[1] 许予明[1] Wu Zhengrong;Zong Ce;Zhang Ke;Liu Hongbing;Zhao Yingying;Wang Yanhong;Gao Yuan;Xu Yuming(Department of Neurology,the First Affiliated Hospital of Zhengzhou University,NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease,Zhengzhou 450052,China;Department of General ICU,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院神经内科、国家卫生健康委脑血管病防治重点实验室,郑州450052 [2]郑州大学第一附属医院综合ICU,郑州450052

出　　处：《中华医学杂志》2025年第7期529-536,共8页National Medical Journal of China

摘　　要：目的探索近期皮质下小梗死(RSSI)患者合并磁敏感加权成像(SWI)序列上确认的脑出血病灶的临床特征及相关因素。方法回顾性收集2019年1月至2022年12月期间入住郑州大学第一附属医院神经内科的豆纹动脉区RSSI患者。收集人口学信息、既往病史、实验室及影像资料。观察患者脑SWI序列上脑出血病灶的合并情况,根据是否合并脑出血将RSSI患者分为合并脑出血组(n=37)和非脑出血组(n=324)。同时观察脑叶微出血(CMBs)、脑表面铁沉积(cSS)、很可能的脑淀粉样血管病(CAA)等出血相关影像特征的合并情况。应用多因素logistic回归模型分析RSSI患者合并脑出血病灶的相关因素。结果共纳入豆纹动脉区RSSI患者361例,年龄(60±12)岁,男性243例(67.3%)。其中,37例(10.2%)患者合并脑出血病灶,主要表现为严格深部型[29例(78.4%)],其他还包括严格脑叶型[2例(5.4%)],幕下型[2例(5.4%)],混合型[4例(10.8%)]。共有30例(8.3%)合并严格脑叶CMBs,5例(1.4%)合并cSS,23例(6.4%)符合Boston 2.0标准的很可能的CAA。多因素logistic回归模型分析显示,基底节区高级别扩大的血管周围间隙(HEPVS)(OR=3.356,95%CI:1.208~9.320,P=0.020)是合并脑出血病灶的相关因素。当以脑小血管病(CSVD)总负荷评分代表其他CSVD影像标志物代入分析时,CSVD总负担评分(OR=2.319,95%CI:1.596~3.372,P<0.001)亦是合并脑出血病灶的相关因素。结论RSSI患者中,10.2%合并SWI上可见的脑出血病灶,且主要表现为非严格脑叶型。CSVD总负荷,尤其是基底节区HEPVS与其合并脑出血相关。Objective To explore the clinical characteristics and related risk factors of intracerebral hemorrhage(ICH)lesions identified on susceptibility‑weighted imaging(SWI)sequences in patients with recent subcortical small infarct(RSSI).Methods The patients with lenticulostriate artery territory RSSI admitted to the Department of Neurology,the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2022 was retrospectively collected.Demographic information,past medical history,laboratory,and imaging data were collected.Observe the ICH lesions in patients on the brain SWI sequence and divide RSSI patients into the coexisting‑ICH group(n=37)and the non‑ICH group(n=324)according to whether they have ICH.At the same time,the hemorrhage‑related imaging features coexisting such as cerebral microbleeds(CMBs),cerebral surface siderosis(cSS),and probable cerebral amyloid angiopathy(CAA).Multifactorial logistic regression model was used to analyze the associated factors of ICH lesions in RSSI patients.Results A total of 361 patients with RSSI in the lenticulostriate artery territory area were included.The mean age was(60±12)years,with 243 male patients(67.3%).Among them,37 patients(10.2%)had coexisting ICH lesions,mainly presenting as strict deep type[29 cases(78.4%)],with others including strict lobar type[2 cases(5.4%)],infratentorial type[2 cases(5.4%)],and mixed type[4 cases(10.8%)].30 cases(8.3%)had concomitant strict lobar CMBs,5 cases(1.4%)had cSS,and 23 cases(6.4%)met the Boston 2.0 criteria for probable CAA.Multivariate logistic regression model analysis revealed that the high‑grade enlargement of perivascular spaces in the basal ganglia(HEPVS)(OR=3.356,95%CI:1.208-9.320,P=0.020)were associated with the presence of ICH lesions.When the total cerebral small vessel disease(CSVD)burden score was used to represent other CSVD imaging markers for analysis,the CSVD total burden score(OR=2.319,95%CI:1.596-3.372,P<0.001)was also found to be associated with the presence of ICH lesions.Conclusion

关 键 词：脑出血 近期皮质下小梗死 脑微出血 皮质表面铁沉积 血管周围间隙 横断面研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]