自发性脑出血急性期弥散加权像异常影响因素分析

【摘要】
目的 研究自发性脑出血急性期磁共振成像（magnetic resonance imaging，MRI）弥散加权像（diffusion-weighted imaging，DWI）异常的发生率、影响因素及其与脑出血90 d预后的相关性。
方法 2010年12月～2012年5月，连续入组北京天坛医院急诊就诊的发病24 h之内的自发性脑出血患者，于发病72 h内进行MRI检查，收集患者临床、影像学、实验室检查信息。应用多元Logistic回归分析的方法分析与DWI异常可能的相关因素，并分析DWI异常与90 d预后的相关性。
结果 共有93例自发性脑出血病例纳入本研究，其中11例出现DWI异常，弥散异常发生率为11.8%。DWI异常主要位于皮层、皮层下，多数无临床症状（90.9%）。Logistic回归分析显示与DWI异常相关的因素包括：微出血病灶数目［优势比（odds ratio，OR）1.08；95%可信区间（confidence interval，CI）1.00～1.17；P=0.04］，脑叶出血（OR 5.84；95%CI 1.27～26.96；P=0.02）及发病72 h平均动脉压升高（OR 0.94；95%CI 0.88～0.99；P=0.04）。脑出血后急性期DWI弥散异常的发生和患者短期（90 d）预后相关性无显著统计学意义（P=0.74）。
结论 脑出血后急性期微出血病灶数目、脑叶出血，发病72 h平均动脉压升高与脑出血后急性DWI异常的发生相关，急性期弥散异常的发生和脑出血患者90 d临床预后无显著相关性。

Analysis of Diffusion-weighted Imaging Abnormality in Acute Spontaneous IntracerebraiHemorrhage

Objective To determine the prevalence of diffusion-weighted imaging （DWI） abnormality in a cohort of spontaneous intracerebral hemorrhage （sICH） patients and to analyse its effects on clinical outcomes of 90 days. Methods In our prospective cohort study, patients with slCH within 24 hours were enrolled and had done magnetic resonance imaging （MRI） within 72 hours, and their clinical, imaging and laboratory data were collected. Multivariate Logistic regression analysis was used to analyse the risk factors of signal abnormalities in DWI and the associations between signal abnormalities in DWI and clinical outcomes of 90 days. Results There were totally 93 patients with slCH enrolled in our study. Eleven patients （11.8%） had abnormal signal in DWI, and located at the cortex, subcortex, or asymptomatic （accounting for 90.9%）. The risk factors associated with signal abnormalities in DWI were： the number of microbleeds （odds ratioOR] 1.08; 95% confidence intervalCI] 1.00-1.17; P=0.04）, position of hemorrhage （OR 5.84; 95%CI 1.27-26.96; P=0.02）, and higher mean arterial pressure （MAP） at 72 hours （OR 0.94; 95%CI 0.88-0.99; P=0.04）. The occurrence of signal abnormalities in DWI in acute phase of sICH had no relationship with short-term （90 days） outcomes （P~0.74）. Conclusion Signal abnormalities in DWI can occur in acute phase of slCH. Positions of hemorrhage, microbleeds and MAP within 72 hours are associated with it, but it has no relationship with short-term （90 days） outcomes.