脑微出血与脑白质病变及腔隙性梗死关系研究

目的 探讨脑微出血（cerebral microbleeds，CMBs）与脑白质病变（white matter lesions，WML）及腔隙性 梗死（lacunar infarcts，LI）的关系。 方法 连续纳入2010年2月至2012年2月解放军总医院南楼神经内科病房根据病史及头颅影像学检 查确诊患有脑血管病或具有高血压、糖尿病、高脂血症等脑血管病危险因素者217例。采用GE公司 1.5T磁共振成像行头颅常规序列及T2 *血管加权成像（T2 star weighted angiography，SWAN）序列扫 描。记录深部及皮层部位CMBs病灶数，按照Fazekas评分和Scheltens改良量表将脑室旁白质高信号 （peri-ventricular hyperintensities，PVH）和深部白质高信号（deep white m atter hyperintensities，DWMH） 分别评分，根据病灶数量评估LI的严重程度分析CMBs与PVH、DWMH及LI的关系。 结果 随着PVH和DWMH评分的升高，CMBs的检出率分别由41.8%（PVH=1）及40.8%（DWMH=1）升高 至68.8%（PVH=3）及76.9%（DWMH=3）；随着LI数量的增加，CMBs的检出率由46.3%升高至75%。深 部CMBs与PVH及DWMH的严重程度有较强相关性（rs =0.345，P＜0.001；rs =0.346，P＜0.001），与LI 亦显 著相关（r s =0.281，P＜0.001）；而皮层CMBs与PVH及DWMH严重程度仅呈弱相关（r s =0.219，P =0.001； rs =0.189，P =0.005），与LI无显著相关性。 结论 深部CMBs与脑室旁及深部脑白质病变、LI相关。

Relationship between Cerebral Microbleeds and White Matter Lesions and Lacunar Infarcts

Objective To investigate the relationship between cerebral microbleeds(CMBs) and white matter
lesions(WML) and lacunar infarcts(LI).
Methods The identified population inculded 217 patients with cerebral vascular disease or related
risk factors admitted to the Department of Geriatric Neurology of the PLA General Hospital
between February, 2010 and February, 2012. Routine sequence and T2 star weighted angiography
sequence of magnetic resonance imaging were performed with 1.5 Tesla machine maded by
General Electric company. The number of CMBs in deep and cortical brain was record respectively.
The peri-ventricular hyperintensities(PVH) and deep white matter hyperintensities(DWMH) were
scored by Fazekas scale and modified rating scale reviesd by Scheltens. The severity of LI was
classified by the number.
Results As the score of PVH and DWMH increased, the detection rate of CMBs obviously
increased from 41.8% and 40.8% in patient with the severity of PVH=1 and DWMH=1 to 68.8%
and 76.9% in patient with the severity of PVH=3 and DWMH=3. The detection rate of CMBs also
rised with the number of LI increasing. Deep CMBs were closely related to severity of peri-ventricular
and deep WML (rs =0.345, P <0.001; rs =0.346, P <0.001), and were also related to LI (rs=0.281,
P <0.001). Cortical CMBs were mildly related to severity of peri-ventricular WML and deep WML(rs=0.219, P =0.001; rs=0.189, P =0.005), and were not related to LI.
Conclusion Deep cerebral microbleeds are obviously associated with peri-ventricular and deep
white matter lesions and lacunar infarcts.