症状性小动脉硬化脑小血管病患者脑微出血的危险因素分析

目的 应用头颅MRI的SWI序列检测症状性小动脉硬化脑小血管病(cerebral small vessel disease,CSVD)患者脑微出血(cerebral microbleeds,CMBs)灶，分析不同部位CMBs的临床特征差异及CMBs的危险因素。方法 回顾性纳入2017年3月—2018年10月就诊于新疆昌吉州中医院神经内科的小动脉硬化的CSVD患者。根据有无微出血分为CMBs组与无CMBs组。应用二元logistic回归分析CMBs的独立危险因素；判断CMBs数量分级与独立危险因素的相关性。根据CMBs的位置分为脑叶区亚组、深部区亚组、幕下区亚组。比较脑叶区CMBs与非脑叶区CMBs、深部CMBs与非深部CMBs、幕下区CMBs与非幕下区CMBs亚组之间的临床特征差异。结果 共纳入144例CSVD患者，CMBs组42例(29.2%)，无CMBs组102例(70.8%)，其中脑叶区18例，深部白质区23例，幕下区9例。二元logistic回归分析显示，低载脂蛋白b水平(OR 0.308,95%CI 0.099～0.957,P=0.042)及高空腹血糖值(OR 1.128,9...

Risk factors of Cerebral Microbleeds in Patients with Symptomatic and Atherosclerotic Cerebral Small Vessel Disease

Objective  To analyze the risk factors of cerebral microbleeds (CMBs) in patients with symptomatic and atherosclerotic cerebral small vessel disease (CSVD) , and differences in clinical characteristics of CMBs in different locations.Method  The clinical data of patients with symptomatic and atherosclerotic CSVD from Changji Traditional Chinese Medicine Hospital of Xinjiang between March 2017 and October 2018 were retrospectively analyzed. According to having CMBs diagnosed by SWI or not, the patiens were divided into CMBs group and non-CMBs group. Binary logistic regression analysis was used to determine the risk factors for CMBs, and the correlation of CMBs number classification and independent risk factors was analyzed. In addition, according to the location of CMBs, the differences of clinical characteristics in different location subgroups were compared: lobar and non-lobar region subgroups, deep white matter and non-deep white matter subgroups, infratentorial region and non-infratentorial region subgroups. Results  A total of 144 CSVD patients were included, with 42 patients (29.2%) with CMBs. CMBs were located in lobar region in 18 cases, deep brain region in 23 cases and infratentorial region in 9 cases. Logistic regression analysis showed that lower apolipoprotein B (OR?0.308, 95%CI?0.099-0.957, P=0.042) and higher fasting blood glucose level (OR?1.128, 95%CI?1.015-1.254, P=0.026) , low and middle grade of diastolic pressure, more lacunar cerebral infarcts and lacunar lesions of presumed vascular origin were independent risk factors for CMBs. The grade of CMBs was negatively correlated with the level of apolipoprotein B (r = ﹣0.212, P= 0.011) , positively correlated with the grade of lacunar cerebral infarcts (r = 0.378, P< 0.001) and the grade of lacunar lesions of presumed vascular origin (r = 0.411, P< 0.001) . Compared to the non-lobar region subgroup, lobar region subgroup had the higher BMI (24.4?vs.?23.5, P=0.045) , left ventricular ejection fraction (61.0%?vs.?60.0%, P=0.012) and lower heart rate (75.0 beat per minute?vs.?83.0 beat per minute, P=0.017) , and educational level distribution also had statistical difference between the two groups (P=0.004) . Compared to the non-deep white matter region subgroup, deep white matter region subgroup had a higher male proportion (78.3%?vs.?47.4%, P=0.038) and more lacunar cerebral infarcts (P=0.002) . Conclusion  Low apolipoprotein B level and high fasting blood glucose level, low and middle level of diastolic pressure, more lacunar cerebral infarcts and lacunar lesions of presumed vascular origin were independent risk factors for CMBs. The grade of CMBs was negatively correlated with the level of apolipoprotein B, and positively correlated with lacunar cerebral infarcts number and the grade of lacunar lesions of presumed vascular origin. BMI, left ventricular ejection fraction, heart rate and educational level were correlated with lobar CMBs, while gender and lacunar cerebral infarcts number were correlated with deep white matter CMBs.