摘要
目的探讨缺血性脑卒中患者脑微出血(cerebral microbleeds,CMBs)潜在的危险因素。方法选取2017年12月—2019年1月收治的84例缺血性脑卒中住院患者,将患者分为CMBs组(n=36)和无CMBs组(n=48),通过头颅MRI检查对颅内CMBs的程度和部位进行分级,并结合其详细的资料,包括年龄,性别,吸烟及饮酒史,糖尿病疾病史、高血压疾病史,收缩压、舒张压水平,脑白质疏松(LA)的程度,血低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、血三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、血高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、同型半胱氨酸、D-二聚体水平,活化部分凝血活酶时间(activated partial thromboplastin time,APTT),单因素分析筛选CMBs的潜在危险因素(P<0.05),将筛出的潜在危险因素进行Spearman轶相关分析,分析其与CMBs的相关性。结果(1)与无CMBs组比较,CMBs组LA更严重、收缩压及舒张压均明显增高(P<0.05)。(2)与轻度CMBs组比较,中、重度CMBs组有饮酒史患者比例、收缩压水平增高,LA更严重(均P<0.05);混合CMBs组、深部/幕下CMBs组和脑叶CMBs组在收缩压水平、舒张压水平、HDL-C水平、APTT比较差异均有统计学意义(P<0.05)。(3)LA的严重程度和收缩压水平与CMBs的数量呈中度正相关(r=0.485,P=0.003;r=0.437,P=0.008),舒张压水平与CMBs的数量呈弱正相关(r=0.358,P=0.032),HDL-C水平与CMBs的数量呈弱负相关(r=-0.379,P=0.023)。结论缺血性脑卒中患者LA程度,收缩压及舒张压水平与CMBs密切相关,可能为CMBs形成的重要危险因素。饮酒史、LA程度、收缩压水平可影响CMBs的病变严重程度,收缩压、舒张压、HDL-C水平、APTT则可影响CMBs的分布部位。
Objective The aim is to explore the potential risk factors for cerebral microbleeds(CMBs)in ischemic stroke(IS).Methods Eighty-four IS inpatients from December 2017 to January 2019 were selected in this study,which were divided into CMBs group(n=36)and non-CMBs group(n=48).Their CMBs were counted concerning the severity and location by cranial MRI,in combination with their detailed characteristics such as age,sex,history of smoking and drinking,history of diabetes,history of hypertension,systolic and diastolic blood pressure levels,degree of leukoaraiosis,the levels of low density lipoprotein cholesterol(LDL-C),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C)and activated partial thromboplastin time(APTT).Univariate analysis was conducted to screen the potential risk factors of CMBs,followed by stepwise test using Spearman correlation analysis.Results①CMBs group showed increased systolic and diastolic blood pressure levels,more serious leukoaraiosis compared with the non-CMBs group(P<0.05).②There were significant differences in the proportion of patient with history of drinking,degree of leukoaraiosis,and systolic blood pressure levels between the moderate to severe-CMBs group and mild-CMBs group(P<0.05),and the former reveals a greater number and a higher severity or level.Marked differences in HDL-C level,APTT,systolic and diastolic blood pressure levels were shown between mixed,deep/subtentorial and lobular CMBs subgroups(P<0.05).③There were moderate positive correlation between leukoaraiosis severity or systolic blood pressure levels and the number of CMBs(r=0.485,P=0.003;r=0.437,P=0.008).There was also a positive correlation between diastolic blood pressure level and the number of CMBs(r=0.358,P=0.032)and a negative correlation between HDL-C level and the number of CMBs(r=-0.379,P=0.023).Conclusions Among IS patients,the systolic and diastolic blood pressure levels,degree of leukoaraiosis were strongly associated with CMBs,and may be important risk factors for CMBs.The history of drinking,degree of leukoaraiosis and systolic blood pressure levels could influence lesion severity of CMBs,while the location of CMBs could be affected by HDL-C level,APTT,systolic and diastolic blood pressure levels.
作者
牛天童
牛敬忠
刘广志
NIU Tiantong;NIU Jingzhong;LIU Guangzhi(不详;Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中国神经免疫学和神经病学杂志》
CAS
北大核心
2023年第4期233-238,共6页
Chinese Journal of Neuroimmunology and Neurology
基金
国家自然科学基金资助项目(82071342)。
关键词
脑微出血
磁敏感加权成像
缺血性卒中
危险因素
收缩压
舒张压
脑白质疏松
高密度脂蛋白胆固醇
cerebral microbleeds
susceptibility-weighted imaging
ischemic stroke
risk factors
systolic blood pressure
diastolic blood pressure
leukoaraiosis
high density lipoprotein cholesterol
作者简介
通信作者:刘广志,Email:guangzhi2002@hotmail.com。
