急性脑梗死合并脑微出血有关危险因素的研究

目的 了解急性脑梗死合并CMBs的相关危险因素,探讨急性脑梗死患者发生CMBs的机制.方法 2005年3月～2007年12月住院的脑梗死患者651例,全部研究对象进行MRI自旋回波序列(SE)、快速自旋回波序列(FSE)、场回波序列(FE)、梯度回波(GRE)扫描,并对58种影响因素进行调查,对有关危险因素进行分型、分类、分级后,用卡方检验和多元回归方法进行分析.结果 多因素Logistic回归分析发现平均动脉压、心衰、APTT为微出血患病的独立危险因素(P<0.05).Ⅲ级高血压是CMBs的相关因素(P=0.024),入院时平均动脉压每增高1mmHg,微出血风险加大5.5%(P=0.000);有心衰史的患者微出血风险增加5.299倍(P=0.042);APTT升高1秒,微出血发生的可能增加6%(P=0.007).Ⅱ级及以上脑白质稀疏、Ⅱ～Ⅲ级腔隙性梗死亦是脑微出血的相关因素.结论 (1)平均动脉压、心衰、APTT为微出血患病的独立危险因素;(2)CMBs的发生可能与急性脑梗死无直接关系;(3)抗栓溶栓治疗不是CMB发生的危险因素;(4)急性脑梗死合并CMBs的患者在颅内较大血管病变的同时,亦存在着广泛的微血管病.     

缺血性卒中患者脑微出血的相关因素分析

目的 探讨缺血性卒中患者发牛脑微出血(CMBs)的相关因素. 方法 对85例急性缺血性卒中患者进行磁共振检查,其中包括梯度回波T2加权成像(GE-T2~*WI),并对患者的临床资料和影像学特点进行分析. 结果 26例(30.6%)患者中共检出CMBs 124个,每位患者的CMBs数目在1～16个之间.CMBs在基底节丘脑区和皮质一皮质下区分布较多,在幕下区较少见.发生在脑十的CMBs可有相关症状及体征.CMBs数目与年龄、腔隙性梗死数目及白质疏松程度评分有相关性(r=0.243,P=0.025;r=337,P=0.002;r=0.438,P=0.000).CMBs在GE-T2~*WI上显影良好,部分CMBs可在自旋叫波(SE)T2WI及DWI序列上显影. 结论 CMBs是脑微小血管病变标志,主要预测因素有高龄、多发腔隙性梗塞和白质疏松.     

无高血压病史急性脑梗死患者脑内微出血的临床研究

目的 探讨有、无高血压的急性脑梗死患者中脑内微出血(cerebral microbleeds,CMBs)的危险因素和影像学上分布特点的不同.方法 连续性收集急性脑梗死患者,进行磁共振扫描,包括T1、T2 加权相以及梯度回波序列(gradient-echo T2 *,GRE-T2*).分析患者临床特点、MRI上脑白质病变的严重程度和CMBs病灶的分布特点.结果 共入选998例急性脑梗死患者,CMBs发生于273例患者,其中62例无高血压病史.在无高血压病史的急性脑梗死患者中CMBs发生率为18.5%(62/335),低于有高血压病史的急性脑梗死患者(211/663,31.8%,P＜0.0001).无高血压患者的CMBs局限于皮层和皮层下者占40.3%(25/62),高于有高血压的患者(20.4%,43/211,P=0.001).脑白质病变的严重程度,入院时收缩压是无高血压病史急性脑梗死患者发生CMBs的独立危险因素.结论 有高血压和无高血压的急性脑梗死患者CMBs分布部位有所不同,后者更多地集中于皮层和皮层下.控制血压在有、无高血压病史的CMBs患者均必要.     

溶栓、抗凝、抗血小板治疗与脑微出血及脑梗死后出血性转换的关系

目的探讨溶栓、抗凝、抗血小板治疗与脑微出血及脑梗死后出血性转换的关系,以便预防出血性转换的发生。方法对我院神经内科2005年3月-2007年12月住院的678例急性脑梗死患者和361例正常对照进行前瞻性研究。卡方检验对不同组别伴CMB的发病率,溶栓后合并出血性转换率进行比较,通过logistic回归分析确定溶栓、抗凝、抗血小板与CMB的相关性及与梗死后出血的相关性。全部研究对象进行MRI自旋回波序列(SE)、快速自旋回波序列(FSE)、场回波序列(FE)及梯度回波(GRE)扫描。结果脑微出血患病率在对照组、梗死组、梗死后出血组依次升高,分别为11%、22.6%、40.7%,(χ2=29.521,P=0.000),通过单因素logistic回归分析发现患者经抗血小板、低分子肝素钙抗凝,尿激酶溶栓治疗均与脑微出血的患病无关。梗死后脑出血单因素Logistic回归分析梗死后继发脑出血与房颤,脑微出血及溶栓治疗有关,与血浆纤维蛋白原浓度呈负相关。多因素logistic回归分析发现继发脑出血的独立危险因素为房颤、溶栓治疗,溶栓治疗的脑梗死患者继发出血的发生率增大6.51倍,伴有房颤的脑梗死患者继发脑出血的几率增大4.90倍。血浆纤维蛋白原浓度是保护性因素,每升高1g/L,继发出血者减少为原来的一半。结论 CMB不是脑梗死后出血转化的高危因素,溶栓、抗凝、抗血小板治疗不增加CMB的发病率,CMB并不增加溶栓、抗凝、抗血小板治疗的出血危险性,溶栓和房颤是梗死后出血的危险因素。     

脑微出血的影像学与脑卒中临床研究

目的：探讨脑微出血（CMBs）与脑卒中发生和发展之间的关系。方法：对脑出血50例（脑出血组）、腩梗死50例（脑梗死组）和非腩血管病患者30例（对照组）行常规磁共振序列加梯度回波T2^＊加权（GRE—T2^＊）检查，分别记录CMBs的发生例数、部位、数日，脑卒中部位，脑白质疏松情况和患者高血压、高血脂、糖尿病等资料。结果：CMBs发生率在腩出血组为76％，脑梗死组为36％，对照组为10％。CMBs的发生与高血压、脑卒中病史、年龄和脑白质疏松有关；与血脂和血糖无关。结论：CMBs在脑卒中患者中有较高的发生率，加强对CMBs的充分认识，对于提高脑卒中的防治有重要意义。     

3.0T MRI诊断高血压性脑微出血的价值

目的比较MRI不同扫描序列检出高血压性脑微出血（CMBs）的能力。方法对215例高血压患者行颅脑常规MRI和梯度回波T2^＊加权（GRE T2^＊-WI）扫描，并对其中的21例行磁敏感加权成像（SWI）扫描，比较不同扫描序列检出CMBs的差异，以及分析CMBs在GRE T2^＊-WI上的分布。结果215例患者中，GRE T2^＊-WI检出的CMBs最多（112例，961个CMBs），其次为T2WI、DWI、T2 Flair和T1WI。在GRE T2^＊-WI上，脑不同部位CMBs的分布不同，以皮质-皮质下区最多，小脑最少。21例行SWI的患者中，SWI检出267个CMBs。结论在MRI检出高血压患者CMBs方面，GRE T2^＊-WI序列应作为首选，SWI是检出CMBs的辅助检查方法。     

腔隙性脑梗死合并脑微出血临床及影像学特征研究

目的探讨腔隙性脑梗死患者合并脑微出血(cerebral microbleeds,CMBs)的临床及其影像学特征。方法采用前瞻性研究方法,连续收集2013年8月~2015年9月在本院神经内科住院的腔隙性脑梗死患者120例,根据有无CMBs将患者分为有CMBs组(39例)和无CMBs组(81例),比较2组间基本临床资料、生化指标及影像学特点是否存在差异,并采用多因素逐步Logistic回归模型分析CMBs发生的独立危险因素。结果 120例腔隙性脑梗死患者中合并CMBs39例(32.5%),其中2组年龄(t=6.373,P0.001)、高血压病(χ~2=5.385,P=0.02)、高尿酸(χ~2=4.474,P=0.04)、腔隙性脑梗死数目(t=8.773,P0.001)以及脑白质疏松程度评分(t=7.964,P0.001)比较差异具有统计学意义。Logistic回归分析显示,年龄、高血压病、腔隙性脑梗死数目以及脑白质疏松程度评分是腔隙性脑梗死患者发生CMBs的独立危险因素。结论腔隙性脑梗死患者CMBs发生与年龄、高血压病、腔隙性脑梗死数目以及脑白质疏松程度有关。     

脑梗死患者微出血危险因素分析

目的探讨脑梗死急性期患者的脑微出血(cerebral microbleeds,CMBs)的危险因素。方法连续搜集2014年1月至2016年12月于福建医科大学附属第一医院神经内科住院的脑梗死急性期患者255例。根据脑微出血的部位和数目进行分组:幕下CMBs无或轻度组/中重度组、皮质CMBs无或轻度组/中重度组、深部CMBs无或轻度组/中重度组,比较不同部位各亚组之间估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)水平及常见动脉硬化危险因素等的差异,并行多因素回归分析。结果共有140例患者(54.9%)存在CMBs。在幕下组中,中重度CMBs患者伴低eGFR水平的比例较无/轻度CMBs患者高(P=0.024)。低eGFR水平(OR=3.874,95%CI:1.261～11.901,P=0.018)、高血压病程(OR=2.128,95%CI:1.004～4.510,P=0.049)是幕下中重度CMBs的独立危险因素。结论肾功能不全、长高血压病程是脑梗死患者发生幕下中重度微出血的危险因素。     

脑微出血与椎-基底动脉形态在脑干梗死中的相关性研究

目的研究脑干梗死患者脑微出血(CMBs)与椎-基底动脉形态的关系。方法对204例脑干梗死患者行头颅MRI+磁敏感加权成像(SWI)及头颈MRA检查,根据CMBs情况将患者分为脑干CMBs阳性组与阴性组。比较两组椎-基底动脉形态特点,分析脑干梗死患者CMBs与椎-基底动脉形态独立相关因素。结果头颅SWI检查结果显示,112例患者有脑干CMBs(阳性组),92例脑干无CMBs(阴性组)。阳性组椎-基底动脉异常发生率(78.6%)显著高于阴性组(58.7%)(χ~2=9.432,P=0.002)。与阴性组比较,阳性组椎动脉狭窄、椎动脉发育不良及基底动脉迂曲、延长的比率显著增高(均P0.05)。Logistic回归分析显示,椎动脉发育不良、基底动脉迂曲延长是脑干脑CMBs的独立危险因素(OR=1.859,95CI%:1.056~3.270,P=0.032;OR=1.745,95CI%:1.010~3.018,P=0.046)。结论伴有椎-基底动脉形态异常脑干梗死患者脑干CMBs发生率高。脑干CMBs与椎动脉发育不良、基底动脉迂曲延长独立相关。     

影响急性皮质下脑梗死后进展性运动功能缺损的相关因素分析

目的:研究影响急性皮质下脑梗死患者发病后进展性运动功能损伤的相关因素.方法:选取120例急性皮质下脑梗死患者,将其分为进展性运动功能损伤组和非进展性运动功能损伤组,再比较两组患者的磁共振成像(MRI)资料、人口统计学、相关危险因素之间的差异,再从影像学的角度分析急性皮质下脑梗死后进展性运动功能损伤的相关因素.结果:两组患者的年龄、性别、吸烟史、饮酒史、既往卒中史、总胆固醇及发病到入院时间等相关基础指标比较差异无显著意义(t=-0.427,P=0.670;x2=1.284,P=0.257;x2 =2.667,P=0.10;x2 =3.636,P=0.057;x2 =3.386,P=0.066;t=1.383,P=0.169;t=-0.145,P=0.885);两组患者影像学检查除了颅内血管狭窄或数比较差异无显著意义(x2=0.114;P=0.736),其它比较如梗死层面、梗死部位等差异均具有显著意义(x2 =2.663,p=0.009;x2=24.371,P＜0.001);急性皮质下脑梗死组梗死灶扩大和梗死复发者较非急性皮质下脑梗死组多(x2=38.462,P＜0.001;x2=24.198,P＜0.001).而两组患者中无任何改变者急性皮质下脑梗死组较非急性皮质下脑梗死组显著较低(x2 =5.687,P=0.017).结论:影响急性皮质下脑梗死后进展性运动功能损伤的相关因素可能是放射冠部位梗死、大脑中动脉闭塞、大脑中动脉狭窄以及梗死灶的扩大和梗死的复发.     

Silent cerebral microbleeds on susceptibility-weighted imaging of patients with ischemic stroke and leukoaraiosis

OBJECTIVE: Cerebral microbleeds (CMBs) are an increasingly recognized in patients with cerebrovascular disease who undergo the new MRI techniques. Susceptibility-weighted MRI is sensitive to detect silent microbleeds which are associated with microangiopathy from atherosclerosis, amyloid angiopathy or asymptomatic elderly individuals. CMBs are intracerebral old hemosiderin deposits in the perivascular space, and the clinical significance of such 'microbleeds' remains controversy. We investigated the incidence of microbleeds among different ischemic stroke subtypes and the severity of leukoaraiosis. METHODS: In this study, we collected 137 patients (73.5 +/- 9.1 years old, 84 men and 53 women) who were divided into five groups: atherothrombotic infarction (34 patients), cardioembolic infarction (24 patients), lacunar infarction (35 patients), other determined or undetermined infarction (21 patients) and control (23 patients), in which 52 had primary stroke and 62 had recurrent stroke. Microbleeds were counted and leukoaraiosis was graded using susceptibility-weighted, T1-, T2- and FLAIR MRI with a 3.0 T system. RESULTS: Microbleeds were high in lacunar infarction (25.7%) and atherothrombotic infarction patients (20.6%). Microbleeds were low in patients with cardioembolic infarction (4.2%). Both microbleeds (> or =grade 2) and leukoaraiosis in severity (> or =grade 2) were higher in the recurrent stroke group (14.5 and 48.4%) than those in the primary stroke group (3.8 and 7.7%). Leukoaraiosis (r=0.803, p<0.05) and recurrent stroke (r=0.708, p<0.05) were significantly associated with microbleeds. CONCLUSIONS: Asymptomatic CMBs are observed with a markedly higher frequency in recurrent stroke, and are closely associated with the severity of leukoaraiosis.     

卒中合并脑微出血的影像学研究

目的 探讨ICH和脑梗死患者合并脑微出血（cerebral microbleeds，CMBs）数量分级及部位分布差异。 方法 连续选取2017年8月-2018年12月在北京市大兴区人民医院神经内科病房住院且资料完整的 卒中患者，分为ICH和脑梗死两组。收集患者发病2周内头颅MRI磁敏感加权成像影像，统计ICH与脑梗 死患者中CMBs数量分级及部位分布特点。 结果 共入组患者234例，其中ICH组79例，脑梗死组155例。ICH组合并CMBs 65例（82.3%），其中 CMBs＞5个的患者41例（51.9%）；脑梗死组合并CMBs 73例（47.1%），其中CMBs＞5个的患者21例 （13.6%），两组差异有统计学意义（P＜0.001）。ICH组中，CMBs同时累及脑叶和深部脑组织的患者40例 （50.6%）；脑梗死组中，CMBs同时累及脑叶和深部脑组织的患者25例（16.1%），两组差异有统计学意 义（P＜0.001）。 结论 CMBs病灶＞5个多见于ICH患者；CMBs同时累及脑叶及深部脑组织多见于ICH患者。     

Silent cerebral microbleeds on susceptibility-weighted imaging of patients with ischemic stroke and leukoaraiosis

Abstract

Objective: Cerebral microbleeds (CMBs) are an increasingly recognized in patients with cerebrovascular disease who undergo the new MRI techniques. Susceptibility-weighted MRI is sensitive to detect silent microbleeds which are associated with microangiopathy from atherosclerosis, amyloid angiopathy or asymptomatic elderly individuals. CMBs are intracerebral old hemosiderin deposits in the perivascular space, and the clinical significance of such 'microbleeds' remains controversy. We investigated the incidence of microbleeds among different ischemic stroke subtypes and the severity of leukoaraiosis.

Methods: In this study, we collected 137 patients (73.5 ± 9.1 years old, 84 men and 53 women) who were divided into five groups: atherothrombotic infarction (34 patients), cardioembolic infarction (24 patients), lacunar infarction (35 patients), other determined or undetermined infarction (21 patients) and control (23 patients), in which 52 had primary stroke and 62 had recurrent stroke. Microbleeds were counted and leukoaraiosis was graded using susceptibility-weighted, T1-, T2- and FLAIR MRI with a 3.0 T system.

Results: Microbleeds were high in lacunar infarction (25.7%) and atherothrombotic infarction patients (20.6%). Microbleeds were low in patients with cardioembolic infarction (4.2%). Both microbleeds (≥grade 2) and leukoaraiosis in severity (≥grade 2) were higher in the recurrent stroke group (14.5 and 48.4%) than those in the primary stroke group (3.8 and 7.7%). Leukoaraiosis (r=0.803, p<0.05) and recurrent stroke (r=0.708, p<0.05) were significantly associated with microbleeds.

Conclusions: Asymptomatic CMBs are observed with a markedly higher frequency in recurrent stroke, and are closely associated with the severity of leukoaraiosis.     

Cerebral microbleeds in patients with hypertensive stroke

Abstract. Objective: To analyse the topography of cerebral microbleeds (CMBs) visualized by T2*-weighted gradient-echo MR imaging in the supratentorial brain area, based on the anatomical classification of the regions and the arterial territories. Background: CMBs are associated with hypertension and the risk of intracerebral hemorrhage; however, little is known about the cerebral topography of CMBs. Methods: We examined 164 consecutive patients with hypertensive stroke who underwent T2*-weighted gradient-echo MRI. The anatomical locations and the vascular territories of the CMBs were determined in the subcortical white matter, basal ganglia/internal capsule and thalamus along the standard axial slices. Results: We detected 2,193 CMBs in 98 patients (13.4±39.0 per patient). The CMBs showed a significant predilection for the temporo-occipital area of the subcortical white matter, the posterolateral part of the upper putamen, and the lateral nuclei of the mid-level thalamus. The most common arterial territories were those of the middle-posterior cerebral artery in the white matter, the middle cerebral artery in the basal ganglia, and the thalamogeniculate artery in the thalamus. Conclusions: These findings were quite similar to the cerebral topography of intracerebral hemorrhage described in the literature. Our results suggest that CMBs are regionally associated with intracerebral hemorrhage.     

Homocysteinemia is Associated with the Presence of Microbleeds in Cognitively Impaired Patients

Background & ObjectiveHomocysteine is possibly associated with cerebral small vessel diseases such as leukoaraiosis, silent brain infarction and cerebral microbleeds, which are in turn associated with cognitive dysfunction. We aimed to examine the relationships between cerebral microbleeds (CMBs) and plasma total homocysteine (tHcy) level, methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and cognitive function.MethodsA total of 819 patients with memory disturbance who visited a dementia clinic consecutively were included in this study. We retrospectively collected demographic, clinical and laboratory data including tHcy level, MTHFR C677T polymorphism and Mini-Mental State Examination (MMSE). All patients underwent brain MRI including fluid attenuated inversion recovery (FLAIR) image and T2*-weighed gradient-echo (GRE) image. Logistic regression analysis was performed to test the association between risk factors and the presence of microbleeds.ResultsOne hundred and sixty-one (19.7%) patients had CMBs, of whom 88 (54.7%) had CMBs in the lobar region. CMBs were more common in older hypertensive male patients with hyperhomocysteinemia. In multivariable analysis, plasma tHcy remained an independent predictor of the presence of CMBs after adjusting other confounders (OR: 1.035, 95% CI: 1.009-1.062, p = 0.009). Higher plasma tHcy level was also associated with number of CMBs, TT MTHFR genotype, and lower MMSE scores.ConclusionsElevated plasma tHcy level is related to high prevalence of CMBs and cognitive dysfunction. Lowering plasma tHcy could be helpful in cognitively impaired patients who have CMBs or the MTHFR TT genotype.     

磁共振指导下脑微出血的精准诊疗

脑微出血（cerebral microbleeds,CMBs）作为脑小血管病的一种,与各种血管危险因素密切 相关,其中脑叶CMBs还与淀粉样脑血管病相关。CMBs不仅提高了复发症状性脑出血的风险,还可能引 起认知障碍甚至痴呆。本文主要就CMBs在磁共振磁敏感序列的影像特点和诊断标准等方面进行综 述,通过神经影像学检查方法提高CMBs诊断的准确率,为CMBs的精准诊断和治疗提供重要依据。     

脑微出血与急性缺血性卒中溶栓后出血转化的相关性研究

目的分析脑微出血(cerebral microbleeds,CMBs)与急性缺血性卒中溶栓治疗后出血转化(hemorrhage transformation,HT)的相关性。方法连续纳入80例发病6 h内急性缺血性卒中患者,根据磁敏感加权成像(susceptibility weighted imaging,SWI)图像上有无CMBs,将患者分为两组:CMBs阳性组和CMBs阴性组;同时根据CMBs病灶的发生部位和数量对患者进行分组和分级。参照欧洲协作性急性卒中研究Ⅱ(European Cooperative Acute Stroke StudyⅡ,ECASSⅡ),对梗死溶栓后HT分类进行改良分组,分为HT阴性、HT-1型和HT-2型。应用χ~2检验对CMBs阳性组和阴性组中的HT分型情况、CMBs阳性患者中不同发生部位的HT分型情况、CMBs不同数目分级的HT分型情况进行统计学分析,P0.05为差异有显著性。结果 CMBs在缺血性卒中患者中占31.3%,CMBs阳性组、CMBs阴性组之间年龄差异有显著性(P0.05);CMBs发生率、发生部位、数目差异在HT阴性组、HT-1型、HT-2型之间均无显著性(P0.05),但CMBs阳性患者发生HT-2型比率高于CMBs阴性患者。结论 CMBs阳性、CMBs部位及数目与梗死后HT无明确相关性,CMBs不应作为急性缺血性卒中溶栓治疗的绝对溶栓禁忌,但可增加溶栓后HT的危险。