【摘要】：目的調(diào)查大動(dòng)脈粥樣硬化性腦梗死(large artery atherosclerosis,LAA)急性期腦微出血(cerebral microbleeds,CMBs)的檢出率,探討LAA急性期CMBs發(fā)生的相關(guān)危險(xiǎn)因素。方法1.從2016年4月-2017年2月在遼寧省人民醫(yī)院神經(jīng)內(nèi)科住院的首次發(fā)病的,并按照2007年改良版TOAST分型診斷為L(zhǎng)AA急性期的患者共78例,對(duì)這78例患者于急診就診時(shí)采用美國(guó)GEDiscovery MR3.0T磁共振成像系統(tǒng)進(jìn)行頭顱磁共振成像(magnetic resonance imaging,MRI)平掃、彌散加權(quán)成像(diffusion weighted imaging,DWI)、磁共振血管成像(magnetic resonance angiography,MRA)和磁敏感加權(quán)成像(susceptibility-weighted imaging,SWI)序列掃描,排除已經(jīng)發(fā)生CMBs的患者6例及進(jìn)行溶栓治療的7例患者后,共計(jì)65例患者作為研究對(duì)象。入院24h內(nèi)采用美國(guó)國(guó)立衛(wèi)生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS評(píng)分)對(duì)所有入組患者進(jìn)行神經(jīng)功能缺損程度評(píng)分�；颊呓�12小時(shí)后于入院次日晨7時(shí)采取空腹肘正中靜脈血進(jìn)行生化檢查,包括甘油三酯(triglycerides,TG),總膽固醇(total cholesterol,TC),高密度脂蛋白膽固醇(high density lipoprotein cholesterol,HDL-C)和低密度脂蛋白膽固醇(low density lipoprotein cholesterol,LDL-C)、空腹血糖(fasting plasma glucose,FPG)、同型半胱氨酸(homocysteine,HCY)、血尿酸(uric acid,UA)、纖維蛋白原(fibrinogen,FBI)等。入院24小時(shí)到1周內(nèi)再次進(jìn)行頭顱SWI掃描。影像學(xué)圖像分別由磁共振室及神經(jīng)科經(jīng)驗(yàn)豐富的副主任醫(yī)師閱片,若結(jié)論產(chǎn)生分歧,參照CMBs的數(shù)量觀測(cè)量表(Brain Observer Microbleed Scale,BOMBS量表),意見(jiàn)達(dá)成一致后記錄CMBs情況。2.調(diào)查L(zhǎng)AA患者急性期CMBs的檢出率。3.將所有入組患者根據(jù)是否有CMBs分為兩組,即:有CMBs組和無(wú)CMBs組。選取性別、年齡、體重、吸煙、飲酒、高血壓病、2型糖尿病、血脂(TC、TG、HDL-C、LDL-C)、HCY、UA、FBI等因素分別在有無(wú)CMBs兩組間進(jìn)行單因素分析,了解以上因素在兩組間是否有統(tǒng)計(jì)學(xué)差異。4.將上述單因素分析后有統(tǒng)計(jì)學(xué)差異的因素作為自變量,將CMBs作為因變量,進(jìn)行多因素logistic回歸分析,了解CMBs發(fā)生的相關(guān)獨(dú)立危險(xiǎn)因素。結(jié)果1.CMBs的檢出率顯示:LAA急性期患者CMBs的檢出率為60.00%。2.單因素分析顯示:有、無(wú)CMBs兩組間男性、高血壓病、HDL-C、UA有統(tǒng)計(jì)學(xué)差異(P㩳0.05)。3.多因素分析顯示:男性(OR=3.844,95%置信區(qū)間1.277-11.57,P=0.017)、高血壓病(OR=3.204,95%置信區(qū)間1.072-9.575,P=0.037),以上兩個(gè)變量有統(tǒng)計(jì)學(xué)意義。結(jié)論1.LAA急性期患者CMBs的檢出率為60%。2.在LAA急性期患者中,男性、高血壓病、HDL-C、UA可能是CMBs發(fā)生的相關(guān)危險(xiǎn)因素。3.男性、高血壓病是LAA急性期患者CMBs發(fā)生的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective to investigate the detection rate of acute cerebral microhemorrhage (cerebral microbleeds,CMBs) in patients with atherosclerotic cerebral infarction (large artery atherosclerosis,LAA) and to explore the risk factors of CMBs in acute phase of LAA. Method 1. From April 2016 to February 2017, 78 patients were hospitalized in the Department of Neurology, Liaoning Provincial people's Hospital and diagnosed as acute phase of LAA according to the improved version of TOAST classification in 2007. 78 patients were treated with GEDiscovery MR3.0T magnetic resonance imaging (magnetic resonance imaging,MRI), diffusion weighted imaging (diffusion weighted imaging,DWI) and magnetic resonance angiography (magnetic resonance angiography,). MRA) and magnetic sensitive weighted imaging (susceptibility-weighted imaging,SWI) sequence scanning excluded 6 patients with CMBs and 7 patients undergoing thrombolysis therapy. A total of 65 patients were enrolled as subjects of the study. The degree of neurological deficit was scored by National Institutes of Health Stroke scale (National Institutes of Health Stroke Scale,NIHSS) within 24 hours after admission. After fasting for 12 hours, the patients were examined with hollow median elbow vein blood at 7: 00 a.m. after fasting, including triglyceride (triglycerides,TG), total cholesterol (total cholesterol,TC) and high density lipoprotein cholesterol (high density lipoprotein cholesterol,). HDL-C), low density lipoprotein cholesterol (low density lipoprotein cholesterol,LDL-C), fasting blood glucose (fasting plasma glucose,FPG), homocysteine (homocysteine,HCY), serum uric acid (uric acid,UA), fibrinogen (fibrinogen,FBI), etc. SWI scan was performed again within 24 hours to 1 week. The imaging images were read by the deputy chief physician who was experienced in the magnetic resonance room and neurology department respectively. if the conclusion was different, referring to the quantitative observation scale (Brain Observer Microbleed Scale,BOMBS of CMBs), the CMBs was recorded after the agreement was reached. 2. The detection rate of CMBs in acute phase of LAA patients was investigated. 3. All the patients were divided into two groups according to whether they had CMBs, that is, CMBs group and non-CMBs group. Sex, age, weight, smoking, drinking, hypertension, type 2 diabetes mellitus, blood lipid (TC,TG,HDL-C,LDL-C), HCY,UA,FBI and other factors were analyzed by univariate analysis between the two groups with or without CMBs. To find out whether there is a statistical difference between the two groups. 4. Taking the factors with statistical difference as independent variables and CMBs as dependent variables, multivariate logistic regression analysis was carried out to understand the independent risk factors of CMBs. Results the detection rate of 1.CMBs showed that the detection rate of CMBs in patients with acute LAA was 60.00%. Univariate analysis showed that there were significant differences in male, hypertension and HDL-C,UA between the two groups without CMBs (P 鈮，

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