摘要
目的探讨血清同型半胱氨酸(Hcy)与高血压性脑出血(HICH)病人脑微出血(CMBs)的相关性。方法选取2017年10月—2019年6月在我科住院HICH病人168例,根据磁敏感加权成像将病人分为CMBs阳性组和CMBs阴性组,比较两组病人入院时一般临床资料、实验室指标及影像学指标,利用Logistic回归模型分析HICH病人发生CMBs的相关危险因素。根据CMBs病灶个数、部位不同进行严重程度及部位分组,分析Hcy与CMBs的相关性。进一步分析H型HICH病人(血清Hcy≥10μmol/L)CMBs的发病特点。结果168例HICH病人中,CMBs阳性组102例(60.7%),CMBs阴性组66例(39.3%)。CMBs阳性组共发现823个CMBs病灶,位于深部467个(56.7%),脑叶195个(23.7%),幕下161个(19.6%)。CMBs阳性组病人吸烟史构成比、脑白质病变(WML)构成比、收缩压、舒张压、血清Hcy水平均高于CMBs阴性组,而低密度脂蛋白水平低于CMBs阴性组,差异有统计学意义(χ^(2)=4.694、5.381,t=-4.327~2.500,P<0.05)。Logistic回归分析显示,收缩压(OR=1.036,95%CI=1.004~1.068,P=0.026)、WML(OR=2.791,95%CI=1.068~7.290,P=0.036)、Hcy水平(OR=1.089,95%CI=1.014~1.170,P=0.019)是CMBs的独立危险因素。血清Hcy水平与CMBs严重程度呈正相关(r=0.278,P<0.01),不同部位CMBs各组血清Hcy水平比较差异无统计学意义(P>0.05)。H型HICH病人总的及深部CMBs的发生率明显高于非H型HICH病人(χ^(2)=5.085、4.992,P<0.05),而两组间脑叶及混合CMBs发生率比较差异无显著性(P>0.05)。结论在HICH病人中,CMBs于深部分布的频率最高。血清Hcy水平是HICH病人发生CMBs的独立危险因素,且与HICH病人CMBs的严重程度呈正相关。H型HICH病人CMBs发生率较高,且以发生在深部更常见。Hcy可能是缓解CMBs不良临床结局的潜在治疗靶点。
Objective To investigate the association between homocysteine(Hcy)and cerebral microbleeds(CMBs)in patients with hypertensive intracerebral hemorrhage(HICH).Methods A total of 168 patients with HICH who were admitted to our department from October 2017 to June 2019 were enrolled in this study,and according to the results of susceptibility-weighted imaging,the patients were divided into CMBs positive group and CMBs negative group.The two groups were compared in terms of general clinical data on admission,laboratory markers,and imaging parameters,and a Logistic regression model analysis was used to investigate the risk factors for CMBs in patients with HICH.According to the number of CMBs lesions and different locations,the patients were divided into groups based on severity and location,and the association between Hcy and CMBs was analyzed.The characteristics of CMBs were further analyzed for patients with H-type HICH(Hcy≥10μmol/L).Results Among the 168 patients with HICH,there were 102 patients(60.7%)in the CMBs positive group and 66(39.3%)in the CMBs negative group.A total of 823 CMBs lesions were found in the CMBs positive group,among which there were 467 lesions(56.7%)in the deep location,195(23.7%)in the lobe of the brain,and 161(19.6%)in the infratentorial area.Compared with the CMBs negative group,the CMBs positive group had significantly higher constituent ratios of smoking history and white matter lesion(WML),systolic blood pressure,diastolic blood pressure,and serum Hcy level and a significantly lower level of low-density lipoprotein(χ^(2)=4.694,5.381;t=-4.327 to 2.500;P<0.05).The logistic regression analysis showed that systolic blood pressure(OR=1.036,95%CI=1.00-1.068,P=0.026),WML(OR=2.791,95%CI=1.068-7.290,P=0.036),and Hcy level(OR=1.089,95%CI=1.014-1.170,P=0.019)were independent risk factors for CMBs.The serum level of Hcy was positively correlated with the severity of CMBs(r=0.278,P<0.01),and there was no significant difference in the serum level of between CMBs at different locations(P>0.05).The patients with H-type HICH had significantly higher overall incidence rate of CMBs and incidence rate of deep CMBs than those with non-H-type HICH(χ^(2)=5.085,4.992;P<0.05),while there were no significant differences in the incidence rates of lobar and mixed CMBs between the two groups(P>0.05).Conclusion CMBs in the deep location have the highest frequency in patients with HICH.Serum Hcy level is an independent risk factor for CMBs in patients with HICH and is positively correlated with the severity of CMBs.Patients with H-type HICH tend to have a high incidence rate of CMBs,especially CMBs in the deep location.Hcy may be a potential therapeutic target for alleviating the adverse clinical outcome of CMBs.
作者
初敏
刘丽君
李宏
高迪
杨艳红
滕继军
CHU Min;LIU Lijun;LI Hong;GAO Di;YANG Yanhong;TENG Jijun(Department of Neurology,The Affiliated Hospital of Qingdao University,Qingdao 266555,China)
出处
《青岛大学学报（医学版）》
2022年第1期89-94,共6页
Journal of Qingdao University(Medical Sciences)
基金
国家自然科学基金面上项目(31871144)。
关键词
高半胱氨酸
微出血
颅内出血
高血压性
数据相关性
homocysteine
cerebral microbleeds
intracranial hemorrhage,hypertensive
correlation of data
作者简介
第一作者:初敏(1995-),女,硕士研究生;通信作者:滕继军(1967-),男,硕士,副主任医师,硕士生导师。E-mail:drtengjijun@163.com。
