轻型脑卒中患者脑微出血的观察与分析
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摘要
目的观察急性轻型脑卒中患者脑微出血情况及其与TOAST病因分型的关系。方法入选急性轻型脑卒中患者136例,根据磁敏感加权成像上有无脑微出血分为微出血组58例和无微出血组78例。观察脑微出血数量和部位分布,比较2组患者临床资料和TOAST病因分型差异,采用logistic回归分析脑微出血的影响因素。结果入选的136例患者中,脑微出血发生率为42.65%,其中脑微出血≥5个25例(43.10%),纯脑叶13例,纯幕下/深部13例,混合型32例。2组TOAST病因分型比例比较,差异无统计学意义(P=0.567)。与无微出血组比较,脑微出血组高血压比例、尿酸水平、腔隙性脑梗死分级和脑白质疏松分级明显升高,差异有统计学意义(P<0.05,P<0.01)。logistic回归分析显示,尿酸水平(OR=1.009,95%CI:1.002～1.016,P=0.011)、腔隙性脑梗死分级(OR=2.118,95%CI:1.017～4.408,P=0.045)和脑白质疏松分级(OR=3.142,95%CI:1.740～5.676,P=0.000)与脑微出血独立相关。结论轻型脑卒中患者脑微出血发生率较高,脑微出血与TOAST病因分型无关。
Objective To study the relationship between cerebral microbleeds(CMBs)and TOAST etiological classification in acute mild stroke(AMS)patients.Methods One hundred and thirtysix AMS patients were divided into CMBs group(n=58)and CMBs-free group(n=78)according to their magnetic sensitivity-weighted imaging.The volume and distribution of CMBs were recorded.The clinical data and TOAST etiological classification were compared between the two groups.The risk factors for CMBs were analyzed by logistic regression analysis.Results The incidence of CMBs was 42.65%.Of the 136 patients included in this study,CMBs≥5 sites,lobar CMBs,subtentorial/deep CMBs,and mixed CMBs were detected in 25,13,13 and 32 respectively.No significant difference was found in TOAST etiological classification between the two groups(P=0.567).The incidence of hypertension,serum UA level,lacular cerebral infarction and brain white matter lesion grade were significantly higher in CMBs group than in CMBs-free group(P<0.05).Logistic regression analysis showed that serum UA level,lacular cerebral infarction and brain white matter lesion grade were the independent risk factors for CMBs(OR=1.009,95%CI:1.002-1.016,P=0.011;OR=2.118,95%CI:1.017-4.408,P=0.045;OR=3.142,95%CI:1.740-5.676,P=0.000).Conclusion The incidence of CMBs is rather high in AMS patients.CMBs are not related with TOAST etiological classification.
Objective To study the relationship between cerebral microbleeds(CMBs)and TOAST etiological classification in acute mild stroke(AMS)patients.Methods One hundred and thirtysix AMS patients were divided into CMBs group(n=58)and CMBs-free group(n=78)according to their magnetic sensitivity-weighted imaging.The volume and distribution of CMBs were recorded.The clinical data and TOAST etiological classification were compared between the two groups.The risk factors for CMBs were analyzed by logistic regression analysis.Results The incidence of CMBs was 42.65%.Of the 136 patients included in this study,CMBs≥5 sites,lobar CMBs,subtentorial/deep CMBs,and mixed CMBs were detected in 25,13,13 and 32 respectively.No significant difference was found in TOAST etiological classification between the two groups(P=0.567).The incidence of hypertension,serum UA level,lacular cerebral infarction and brain white matter lesion grade were significantly higher in CMBs group than in CMBs-free group(P<0.05).Logistic regression analysis showed that serum UA level,lacular cerebral infarction and brain white matter lesion grade were the independent risk factors for CMBs(OR=1.009,95%CI:1.002-1.016,P=0.011;OR=2.118,95%CI:1.017-4.408,P=0.045;OR=3.142,95%CI:1.740-5.676,P=0.000).Conclusion The incidence of CMBs is rather high in AMS patients.CMBs are not related with TOAST etiological classification.
引文
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[15]丁玲玲,彭斌.颅内大动脉粥样硬化性狭窄中脑微出血发生机制研究进展[J].中华神经科杂志,2017,50(3):231-234.DOI:10.3760/cma.j.issn.1006-7876.2017.03.017.
[16] Ryu WS,Kim CK,Kim BJ,et al.Serum uric acid levels and cerebral microbleeds in patients with acute ischemic stroke[J].PLoS One,2013,8(1):e55210. DOI:10.1371/journal.pone.0055210.
[17]周志明,杨松,岳炫烨,等.急性脑梗死患者脑微出血相关因素分析[J].中华医学杂志,2010,90(7):451-453. DOI:10.3760/cma.j.issn.0376-2491.2010.07.006.
[18] Wardlaw JM,Smith EE,Biessels GJ,et al.Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration[J].Lancet Neurol,2013,12(8):822-838.DOI:10.1016/s1474-4422(13)70124-8.
[19] Chen X,Wang J,Shan Y,et al.Cerebral small vessel disease:neuroimaging markers and clinical implication[J].J Neurol,2019,266(1):232-241. DOI:10.1007/s00415-018-9077-3.
[20]王伟,高山.大脑中动脉狭窄与其深穿支供血区单发脑梗死的关系[J].中华神经科杂志,2008,41(12):812-815. DOI:10.3321/j.issn:1006-7876.2008.12.005.
[21] Ye H,Wang Y,Qiu J,et al.White matter hyperintensities and their subtypes in patients with carotid artery stenosis:a systematic review and meta-analysis[J].BMJ Open,2018,8(5):e020830. DOI:10.1136/bmjopen-2017-020830.
[2] Yang Q,Yang Y,Li C,et al.Quantitative assessment and correlation analysis of cerebral microbleed distribution and leukoaraiosis in stroke outpatients[J].Neurol Res,2015,37(5):403-409. DOI:10.1179/1743132815y.0000000027.
[3] Wilson D,Werring DJ.Antithrombotic therapy in patients with cerebral microbleeds[J].Curr Opin Neurol,2017,30(1):38-47. DOI:10.1097/wco.0000000000000411.
[4] Lau KK,Lovelock CE,Li L,et al.Antiplatelet treatment after transient ischemic attack and ischemic stroke in patients with cerebral microbleeds in 2large cohorts and an updated systematic review[J].Stroke,2018,49(6):1434-1442. DOI:10.1161/strokeaha.117.020104.
[5]王伊龙,赵性泉,刘新峰,等.高危非致残性缺血性脑血管事件诊疗指南[J].中国卒中杂志,2016,11(6):481-491. DOI:10.3969/j.issn.1673-5765.2016.06.011.
[6] Johnston SC,Easton JD,Farrant M,et al.Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA[J].N Engl J Med,2018,379(3):215-225.DOI:10.1056/NEJMoa1800410.
[7] Hao Q,Tampi M,O'donnell M,et al.Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack:systematic review and metaanalysis[J].BMJ,2018,363:k5108. DOI:10.1136/bmj.k5108.
[8] Khatri P,Kleindorfer DO,Yeatts SD,et al.Strokes with minor symptoms:an exploratory analysis of the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator trials[J].Stroke,2010,41(11):2581-2586. DOI:10.1161/strokeaha.110.593632.
[9]武青,王健,王玉洁,等.大脑中动脉狭窄患者软脑膜动脉侧支循环与脑梗死的相关性研究[J].中华老年心脑血管病杂志,2018,20(4):392-395. DOI:10.3969/j.issn.1009-0126.2018.04.015.
[10] Greenberg SM,Vernooij MW,Cordonnier C,et al.Cerebral microbleeds:aguide to detection and interpretation[J].Lancet Neurol,2009,8(2):165-174. DOI:10.1016/s1474-4422(09)70013-4.
[11]叶明,李书国.动态血压与老老年高血压脑白质疏松患者认知功能的关系[J].中华老年心脑血管病杂志,2017,19(5):492-495. DOI:10.3969/j.issn.1009-0126.2017.05.011.
[12] Wang Y,Wang Y,Zhao X,et al.Clopidogrel with aspirin in acute minor stroke or transient ischemic attack[J].N Engl J Med,2013,369(1):11-19.DOI:10.1056/NEJMoa1215340.
[13] Jung KW,Shon YM,Yang DW,et al.Coexisting carotid atherosclerosis in patients with intracranial small-or large-vessel disease[J].J Clin Neurol,2012,8(2):104-108. DOI:10.3988/jcn.2012.8.2.104.
[14] Ding L,Hong Y,Peng B.Association between large artery atherosclerosis and cerebral microbleeds:a systematic review and meta-analysis[J].Stroke Vasc Neurol,2017,2(1):7-14.DOI:10.1136/svn-2016-000049.
[15]丁玲玲,彭斌.颅内大动脉粥样硬化性狭窄中脑微出血发生机制研究进展[J].中华神经科杂志,2017,50(3):231-234.DOI:10.3760/cma.j.issn.1006-7876.2017.03.017.
[16] Ryu WS,Kim CK,Kim BJ,et al.Serum uric acid levels and cerebral microbleeds in patients with acute ischemic stroke[J].PLoS One,2013,8(1):e55210. DOI:10.1371/journal.pone.0055210.
[17]周志明,杨松,岳炫烨,等.急性脑梗死患者脑微出血相关因素分析[J].中华医学杂志,2010,90(7):451-453. DOI:10.3760/cma.j.issn.0376-2491.2010.07.006.
[18] Wardlaw JM,Smith EE,Biessels GJ,et al.Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration[J].Lancet Neurol,2013,12(8):822-838.DOI:10.1016/s1474-4422(13)70124-8.
[19] Chen X,Wang J,Shan Y,et al.Cerebral small vessel disease:neuroimaging markers and clinical implication[J].J Neurol,2019,266(1):232-241. DOI:10.1007/s00415-018-9077-3.
[20]王伟,高山.大脑中动脉狭窄与其深穿支供血区单发脑梗死的关系[J].中华神经科杂志,2008,41(12):812-815. DOI:10.3321/j.issn:1006-7876.2008.12.005.
[21] Ye H,Wang Y,Qiu J,et al.White matter hyperintensities and their subtypes in patients with carotid artery stenosis:a systematic review and meta-analysis[J].BMJ Open,2018,8(5):e020830. DOI:10.1136/bmjopen-2017-020830.