脑微出血与不同亚型缺血性脑卒中的关系及预后分析

目的探讨脑微出血(CMBs)与不同亚型缺血性脑卒中的关系及预后。方法收集2014年3月~2016年5月期间就诊我院,并确诊为缺血性脑卒中的患者116例,根据中国缺血性脑卒中亚型(CISS)标准分为5种亚型,即大动脉粥样硬化型卒中(LAA)、心源性卒中(CS)、其他病因型(OE)、穿支动脉疾病型(PAD)和病因不确定型(UE)。每个亚型分为CMBs组和非CMBs组,比较各组血清相关指标,采用Logistic回归分析每种亚型伴CMBs的影响因素,采用NIHSS评分评价每种亚型伴CMBs的预后情况。结果 PAD组同型半胱氨酸(Hcy)水平(23.32±2.79)μmol/L,明显高于LAA(20.64±3.11)μmol/L、CS(20.7±2.63)μmol/L、OE(18.92±2.91)μmol/L和UE(17.63±3.06)μmol/L,差异具有统计学意义(P0.05)。OE组和LAA组糖化血红蛋白(Hb A1)水平(7.60±0.25和7.11±0.32)明显高于CS组(5.03±0.11)、PAD组(5.10±0.11)和UE组(4.99±0.12),差异具有统计学意义(P0.05);而OE和LAA两组间、CS、PAD和UE三组间Hb A1水平差异不明显(P0.05)。长期饮酒是CS和PAD伴CMBs的独立危险因素;Hcy是每种亚型伴CMBs的独立危险因素;Hb A1是PAD、LAA伴CMBs的独立危险因素。结论 Hcy、Hb A1和长期饮酒是缺血性脑卒中伴CMBs的独立危险因素。不同亚型缺血性脑卒中伴CMBs的预后差异不明显。

Relationship between cerebral microbleeds and different subtypes of ischemic stroke and its prognostic analysis

Objective To investigate the relationship between cerebral microbleeds (CMBs) and different subtypes of ischemic stroke and its prognosis.Methods Totally 116 patients with ischemic stroke in our hospital from March 2014 to May 2016 were enrolled in this study. According to the Chinese ischemic stroke subclassification system, there were 5 subtypes of ischemic stroke, including large artery atherosclerosis (LAA), cardiogenic stroke (CS), stroke with other etiology (OE), penetrating artery disease (PAD), and stroke with undetermined etiology (UE). Then the patients in each subtype were divided into CMBs group and non-CMBs group. The related serum markers were compared between groups. Logistic regression analysis was used to determine the influencing factors for CMBs in each subtype of ischemic stroke, and the National Institutes of Health Stoke Scale was used to evaluate the prognosis of each subtype with CMBs.Results Serum homocysteine (Hcy) level in the PAD group was 23.32±2.79 μmol/L, significantly higher than 20.64±3.11 μmol/L in the LAA group, 20.7±2.63 μmol/L in the CS group, 18.92±2.91 μmol/L in the OE group, and 17.63±3.06 μmol/L in the UE group (P<0.05). Serum hemoglobin A1 (HbA1) level was 7.60±0.25 in the OE group and 7.11±0.32 in the LAA group, which were both significantly higher than 5.03±0.11 in the CS group, 5.10±0.11 in the PAD group, and 4.99±0.12 in the UE group (P<0.05), but there was no significant difference in HbA1 level between the OE and LAA groups or between the CS, PAD, and UE groups (P>0.05). Long-term alcohol consumption was an independent risk factor for CMBs in CS and PAD. Hcy was an independent risk factor for CMBs in each subtype of ischemic stroke. HbA1 was an independent risk factor for CMBs in PAD and LAA.Conclusions Hcy, HbA1, and long-term alcohol consumption are independent risk factors for CMBs in ischemic stroke. The prognosis of ischemic stroke with CMBs is not significantly different between different subtypes.