本文選題：腦微出血 + 磁敏感加權(quán)成像　； 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：研究目的 腦微出血（Cerebral Microbleeds, CMBs）源自病理腦標(biāo)本切片提示的在光學(xué)顯微鏡下觀察到的那些出血后產(chǎn)生的含鐵血黃素沉積。在神經(jīng)影像學(xué)發(fā)達(dá)的21世紀(jì)，對既往發(fā)生的小血管完整性被破壞區(qū)域，引用高強(qiáng)度MRI或梯度－回波T2加權(quán)MRI（Gradient-echo T2-weighted，GRE）或SWI（磁敏感加權(quán)成像）可發(fā)現(xiàn)針孔樣的低信號，證實了病理學(xué)所見的出血后鐵蛋白沉積，通常是因高血壓小動脈病或腦淀粉樣血管病所致。既往大多是關(guān)于腦微出血危險因素的研究，而本研究將腦微出血出血數(shù)量分為輕、中、重后，分析影響腦微出血不同數(shù)量的危險因素及出血轉(zhuǎn)化的因素，是不是微出血數(shù)量的程度與腔隙性腦梗死、腦白質(zhì)病變、腦出血等因素有關(guān)。腦微出血的檢測對潛在的腦小血管病的診斷、抗血小板聚集/抗凝藥物使用的安全性,癥狀性腦出血、認(rèn)知障礙和癡呆的風(fēng)險具有重要的臨床意義。特別是急性心肌梗塞或腦梗死患者需要早期溶栓治療，微出血的識別及評估利弊顯得尤為重要，對于微出血同時伴隨腔隙性腦梗死或腦白質(zhì)病變的缺血性卒中患者長期使用抗血小板聚集或抗凝治療可提供臨床指導(dǎo)意義。 研究方法 持續(xù)收集2011年8月—2013年3月在北京軍區(qū)總醫(yī)院均行頭顱MRI（包含頭部磁共振磁敏感加權(quán)成像(SWI)、Ｔ２ＷＩ、T1WI及ＦＬＡＩＲ）確認(rèn)有腦微出血(CMBs)的患者200例，根據(jù)SWI上CMBs的病灶數(shù)將其分為輕度(1～5個)組111例，中度(6～15個)組86例,重度(≥15個)組30例。單因素分析影響CMBs嚴(yán)重程度的危險因素，在將其危險因素進(jìn)一步分層，將其危險因素和微出血嚴(yán)重程度的關(guān)系行Spearman相關(guān)分析，多因素Logistic回歸分析進(jìn)一步分析其單因素有意義的危險因素。 結(jié)果 ①單因素分析結(jié)果顯示,三組的性別，年齡，糖尿病，高血壓，心房顫動，頸動脈粥樣硬化，凝血和抗血小板治療無顯著性差異（P＞0.05）。微出血的程度隨腔隙性腦梗死灶數(shù)量、腦白質(zhì)疏松程度的增加而增加，腦出血率也隨著CMBs程度的加重而增加，三組間有統(tǒng)計學(xué)意義（P＜0.05）。輕度組和中、重度組合并后的比較，統(tǒng)計學(xué)上仍舊有意義（P＜0.05）。 ②Spearman相關(guān)分析顯示，，CMBs程度與腔隙性腦梗死灶數(shù)量(r=0.392，P＜0.01)及腦白質(zhì)疏松程度(r=0.362，P＜0.01)呈正相關(guān)。 ③將中重度組合并以后進(jìn)行的多因素Logistic回歸分析表現(xiàn)，腔隙性腦梗死灶的數(shù)目(OR=4.259，95%CI:3.064～5.620，P=0.001)、腦白質(zhì)病變程度(OR=3.250，95%CI:2.351～4.665，P=0.003)是影響腦微出血程度的獨立危險因素。CMBs嚴(yán)重程度與腦出血率呈正相關(guān)(OR=1.813，95%CI:1.788～2.581，P=0.029)。 結(jié)論 腦腔隙性梗塞數(shù)目、腦白質(zhì)病變程度及腦出血嚴(yán)重度與CMBs的嚴(yán)重度密切有關(guān)，且成正相關(guān),腔隙性腦梗死灶數(shù)目、腦白質(zhì)疏松程度是影響腦微出血數(shù)量的單獨危險因素。
[Abstract]:Research purpose Cerebral microbleeds (CMBs) originated from the hemosiderin deposits observed under optical microscope in those haemorrhage from pathological brain specimens. In the 21st century when neuroimaging is advanced, pinhole like low signal can be found by using high-intensity MRI or gradient-echo T2 weighted MRI(Gradient-echo T2-weighted GREE or SWI (magnetic sensitive weighted imaging). It is confirmed that the deposition of ferritin after hemorrhage is usually caused by hypertensive arteriopathy or cerebral amyloid angiopathy. Most of the previous studies were about the risk factors of intracerebral microhemorrhage. In this study, the amount of intracerebral microhaemorrhage was divided into three groups: mild, moderate and severe. The risk factors affecting the number and transformation of intracerebral microhemorrhage were analyzed. Whether the amount of microhemorrhage is related to lacunar infarction, white matter lesions, cerebral hemorrhage and other factors. The detection of microhemorrhage is of great clinical significance in the diagnosis of potential microvascular disease, the safety of antiplatelet aggregation / anticoagulant use, symptomatic intracerebral hemorrhage, cognitive impairment and the risk of dementia. In particular, patients with acute myocardial infarction or cerebral infarction need early thrombolytic therapy, so it is very important to identify and evaluate the advantages and disadvantages of microhemorrhage. It can provide clinical guidance for long-term antiplatelet aggregation or anticoagulant therapy in ischemic stroke patients with microhemorrhage accompanied by lacunar infarction or leukoencephalopathy. Research method From August 2011 to March 2013, 200 patients with cerebral microhemorrhage (CMBsS) confirmed by head MRI (including head magnetic resonance magnetic sensitivity weighted imaging (MRI) and magnetic resonance weighted imaging (MRI) T2WIMr T1WI and flare) were continuously collected in the General Hospital of Beijing military region from August 2011 to March 2013. According to the number of CMBs lesions on SWI, they were divided into three groups: the mild group (111 cases), the moderate group (86 cases) and the severe group (鈮

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