脑血管病患者脑微出血的危险因素分析
|
摘要
背景脑微出血是脑小血管病的重要影像学特征。研究认为其与症状性脑出血、认知障碍的发生密切相关。既往研究多集中于社区人群中脑微出血的发生率及危险因素评估,而对于疾病人群如脑血管病患者中危险因素的报道则相对缺乏。目的探讨脑血管病患者脑微出血的危险因素。方法回顾性选取于2009年1月—2014年2月在北京大学第一医院神经内科住院就诊的脑血管病患者200例。收集其临床信息,包括性别、年龄、临床诊断、相关血管危险因素、抗血栓药物使用史及脑血管狭窄程度等。采用年龄相关白质改变(ARWMC)评分量表和脑微出血解剖评分量表(MARS)评价其双侧皮质下区域、基底核区及幕下等区域的白质病变和脑微出血严重程度。结果 200例患者中,71例(35.5%)存在脑微出血,其中1～2个病灶35例(17.5%),3～4个病灶8例(4.0%),≥5个病灶28例(14.0%)。单因素Logistic回归分析结果显示,脑出血、肥胖、重度白质病变、重度皮质下白质病变、重度基底核白质病变、幕下白质病变与脑微出血有关(P<0.05)。相关性分析结果显示,皮质下白质病变、基底核白质病变严重程度与脑微出血计数呈正相关(r=0.338、0.485,P<0.001)。多因素Logistic回归分析结果显示,脑出血〔OR=3.28,95%CI(1.48,7.23)〕、肥胖〔OR=3.86,95%CI(1.32,11.29)〕、重度皮质下白质病变〔OR=2.14,95%CI(1.02,4.48)〕、重度基底核区白质病变〔OR=5.75,95%CI(2.46,13.47)〕是脑血管病患者脑微出血的独立危险因素(P<0.05)。结论脑出血、肥胖、重度白质病变是脑血管病患者脑微出血的独立危险因素;重度基底核白质病变可能是更好的脑微出血预测指标。
Background Cerebral microbleeds(CMBs) are an important neuroimaging feature of cerebral small vessel diseases and are found closely associated with the development of symptomatic intracerebral hemorrhage and cognitive impairment.Previous studies mostly focused on the incidence of and risk factors for CMBs in community populations,while few reports on risk factors in diseased populations such as patients with cerebrovascular diseases are available.Objective To investigate the risk factors for CMBs in patients with cerebrovascular diseases.Methods Two hundred patients with cerebrovascular diseases hospitalized in the Department of Neurology,Peking University First Hospital between January 2009 and February 2014 were retrospectively selected.Clinical information including gender,age,related vascular risk factors,history of use of antithrombotic agents and severity of cerebrovascular stenosis of these patients were collected.The severity of white matter lesions in bilateral subcortical,basal ganglia and subtentorial areas was evaluated using the Age-Related White Matter Changes(ARWMC) scale.And the severity of CMBs in the aforementioned areas was assessed by the Microbleed Anatomical Rating Scale(MARS).Results Among the participants,71(35.5%) demonstrated CMBs,including 35(17.5%) with 1 to 2 CMBs,8(4.0%) with 3 to 4 CMBs and 28(14.0%) with ≥ 5 CMBs.Univariate Logistic regression analysis results showed that cerebral hemorrhage,obesity,severe white matter lesions,severe subcortical white matter lesions,severe basal ganglia white matter lesions and subtentorial white matter lesions were associated with CMBs(P<0.05).Correlation analysis found that the severity of subcortical white matter lesions and basal ganglia white matter lesions was positively correlated with the number of CMBs(r=0.338,0.485,P<0.001).Multivariate Logistic regression analysis showed that cerebral hemorrhage〔OR=3.28,95%CI(1.48,7.23)〕,obesity〔OR=3.86,95%CI(1.32,11.29)〕,severe subcortical white matter lesions 〔OR=2.14,95%CI(1.02,4.48)〕 and severe basal ganglia white matter lesions 〔OR=5.75,95%CI(2.46,13.47)〕 were independent risk factors for CMBs in patients with cerebrovascular diseases(P<0.05).Conclusion Cerebral hemorrhage,obesity and severe white matter lesions are independent risk factors for CMBs in patients with cerebrovascular diseases.In particular,severe basal ganglia white matter lesions showed a closer association with CMBs.
Background Cerebral microbleeds(CMBs) are an important neuroimaging feature of cerebral small vessel diseases and are found closely associated with the development of symptomatic intracerebral hemorrhage and cognitive impairment.Previous studies mostly focused on the incidence of and risk factors for CMBs in community populations,while few reports on risk factors in diseased populations such as patients with cerebrovascular diseases are available.Objective To investigate the risk factors for CMBs in patients with cerebrovascular diseases.Methods Two hundred patients with cerebrovascular diseases hospitalized in the Department of Neurology,Peking University First Hospital between January 2009 and February 2014 were retrospectively selected.Clinical information including gender,age,related vascular risk factors,history of use of antithrombotic agents and severity of cerebrovascular stenosis of these patients were collected.The severity of white matter lesions in bilateral subcortical,basal ganglia and subtentorial areas was evaluated using the Age-Related White Matter Changes(ARWMC) scale.And the severity of CMBs in the aforementioned areas was assessed by the Microbleed Anatomical Rating Scale(MARS).Results Among the participants,71(35.5%) demonstrated CMBs,including 35(17.5%) with 1 to 2 CMBs,8(4.0%) with 3 to 4 CMBs and 28(14.0%) with ≥ 5 CMBs.Univariate Logistic regression analysis results showed that cerebral hemorrhage,obesity,severe white matter lesions,severe subcortical white matter lesions,severe basal ganglia white matter lesions and subtentorial white matter lesions were associated with CMBs(P<0.05).Correlation analysis found that the severity of subcortical white matter lesions and basal ganglia white matter lesions was positively correlated with the number of CMBs(r=0.338,0.485,P<0.001).Multivariate Logistic regression analysis showed that cerebral hemorrhage〔OR=3.28,95%CI(1.48,7.23)〕,obesity〔OR=3.86,95%CI(1.32,11.29)〕,severe subcortical white matter lesions 〔OR=2.14,95%CI(1.02,4.48)〕 and severe basal ganglia white matter lesions 〔OR=5.75,95%CI(2.46,13.47)〕 were independent risk factors for CMBs in patients with cerebrovascular diseases(P<0.05).Conclusion Cerebral hemorrhage,obesity and severe white matter lesions are independent risk factors for CMBs in patients with cerebrovascular diseases.In particular,severe basal ganglia white matter lesions showed a closer association with CMBs.
引文
[1]BOKURA H,SAIKA R,YAMAGUCHI T,et al.Microbleeds are associated with subsequent hemorrhagic and ischemic stroke in healthy elderly individuals[J].Stroke,2011,42(7):1867-1871.DOI:10.1161/STROKEAHA.110.601922.
[2]POELS M M,IKRAM M A,VAN DER LUGT A,et al.Cerebral microbleeds are associated with worse cognitive function:the Rotterdam Scan Study[J].Neurology,2012,78(5):326-333.DOI:10.1212/WNL.0b013e3182452928.
[3]TAKASHIMA Y,MORI T,HASHIMOTO M,et al.Clinical correlating factors and cognitive function in community-dwelling healthy subjects with cerebral microbleeds[J].J Stroke Cerebrovasc Dis,2011,20(2):105-110.DOI:10.1016/j.jstr okecerebrovasdis.2009.11.007.
[4]JEERAKATHIL T,WOLF P A,BEISER A,et al.Cerebral microbleeds:prevalence and associations with cardiovascular risk factors in the Framingham Study[J].Stroke,2004,35(8):1831-1835.DOI:10.1161/01.STR.0000131809.35202.1b.
[5]POELS M M,IKRAM M A,VAN DER LUGT A,et al.Incidence of cerebral microbleeds in the general population:the Rotterdam Scan Study[J].Stroke,2011,42(3):656-661.DOI:10.1161/STROKEAHA.110.607184.
[6]YATES P A,VILLEMAGNE V L,ELLIS K A,et al.Cerebral microbleeds:a review of clinical,genetic,and neuroimaging associations[J].Front Neurol,2014,4:205.DOI:10.3389/fneur.2013.00205.
[7]WAHLUND L O,BARKHOF F,FAZEKAS F,et al.A new rating scale for age-related white matter changes applicable to MRIand CT[J].Stroke,2001,32(6):1318-1322.DOI:10.1161/01.str.32.6.1318.
[8]GREGOIRE S M,CHAUDHARY U J,BROWN M M,et al.The Microbleed Anatomical Rating Scale(MARS):reliability of a tool to map brain microbleeds[J].Neurology,2009,73(21):1759-1766.DOI:10.1212/WNL.0b013e3181c34a7d.
[9]YAMADA S,SAIKI M,SATOW T,et al.Periventricular and deep white matter leukoaraiosis have a closer association with cerebral microbleeds than age[J].Eur J Neurol,2012,19(1):98-104.DOI:10.1111/j.1468-1331.2011.03451.x.
[10]LEE S H,RYU W S,ROH J K.Cerebral microbleeds are a risk factor for warfarin-related intracerebral hemorrhage[J].Neurology,2009,72(2):171-176.DOI:10.1212/01.wnl.0000339060.11702.dd.
[11]LAU K K,LOVELOCK C E,LI L,et al.Antiplatelet treatment after transient ischemic attack and ischemic stroke in patients with cerebral microbleeds in 2 large cohorts and an updated systematic review[J].Stroke,2018,49(6):1434-1442.DOI:10.1161/STROKEAHA.117.020104.
[12]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑小血管病诊治共识[J].中华神经科杂志,2015,48(10):838-844.DOI:10.3760/cma.j.issn.1006-7876.2015.10.004.Chinese Society of Neurology,Chinese Stroke Society.Consensus on diagnosis and treatment of cerebrovascular disease in China[J].Chinese Journal of Neurology,2015,48(10):838-844.DOI:10.3760/cma.j.issn.1006-7876.2015.10.004.
[13]WARDLAW J M,SMITH C,DICHGANS M.Mechanisms of sporadic cerebral small vessel disease:insights from neuroimaging[J].Lancet Neurol,2013,12(5):483-497.DOI:10.1016/S1474-4422(13)70060-7.
[2]POELS M M,IKRAM M A,VAN DER LUGT A,et al.Cerebral microbleeds are associated with worse cognitive function:the Rotterdam Scan Study[J].Neurology,2012,78(5):326-333.DOI:10.1212/WNL.0b013e3182452928.
[3]TAKASHIMA Y,MORI T,HASHIMOTO M,et al.Clinical correlating factors and cognitive function in community-dwelling healthy subjects with cerebral microbleeds[J].J Stroke Cerebrovasc Dis,2011,20(2):105-110.DOI:10.1016/j.jstr okecerebrovasdis.2009.11.007.
[4]JEERAKATHIL T,WOLF P A,BEISER A,et al.Cerebral microbleeds:prevalence and associations with cardiovascular risk factors in the Framingham Study[J].Stroke,2004,35(8):1831-1835.DOI:10.1161/01.STR.0000131809.35202.1b.
[5]POELS M M,IKRAM M A,VAN DER LUGT A,et al.Incidence of cerebral microbleeds in the general population:the Rotterdam Scan Study[J].Stroke,2011,42(3):656-661.DOI:10.1161/STROKEAHA.110.607184.
[6]YATES P A,VILLEMAGNE V L,ELLIS K A,et al.Cerebral microbleeds:a review of clinical,genetic,and neuroimaging associations[J].Front Neurol,2014,4:205.DOI:10.3389/fneur.2013.00205.
[7]WAHLUND L O,BARKHOF F,FAZEKAS F,et al.A new rating scale for age-related white matter changes applicable to MRIand CT[J].Stroke,2001,32(6):1318-1322.DOI:10.1161/01.str.32.6.1318.
[8]GREGOIRE S M,CHAUDHARY U J,BROWN M M,et al.The Microbleed Anatomical Rating Scale(MARS):reliability of a tool to map brain microbleeds[J].Neurology,2009,73(21):1759-1766.DOI:10.1212/WNL.0b013e3181c34a7d.
[9]YAMADA S,SAIKI M,SATOW T,et al.Periventricular and deep white matter leukoaraiosis have a closer association with cerebral microbleeds than age[J].Eur J Neurol,2012,19(1):98-104.DOI:10.1111/j.1468-1331.2011.03451.x.
[10]LEE S H,RYU W S,ROH J K.Cerebral microbleeds are a risk factor for warfarin-related intracerebral hemorrhage[J].Neurology,2009,72(2):171-176.DOI:10.1212/01.wnl.0000339060.11702.dd.
[11]LAU K K,LOVELOCK C E,LI L,et al.Antiplatelet treatment after transient ischemic attack and ischemic stroke in patients with cerebral microbleeds in 2 large cohorts and an updated systematic review[J].Stroke,2018,49(6):1434-1442.DOI:10.1161/STROKEAHA.117.020104.
[12]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑小血管病诊治共识[J].中华神经科杂志,2015,48(10):838-844.DOI:10.3760/cma.j.issn.1006-7876.2015.10.004.Chinese Society of Neurology,Chinese Stroke Society.Consensus on diagnosis and treatment of cerebrovascular disease in China[J].Chinese Journal of Neurology,2015,48(10):838-844.DOI:10.3760/cma.j.issn.1006-7876.2015.10.004.
[13]WARDLAW J M,SMITH C,DICHGANS M.Mechanisms of sporadic cerebral small vessel disease:insights from neuroimaging[J].Lancet Neurol,2013,12(5):483-497.DOI:10.1016/S1474-4422(13)70060-7.