国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2014年
5期
371-375
,共5页
陶永丽%宋波%高远%方慧%赵璐%王元元%孙石磊%许予明
陶永麗%宋波%高遠%方慧%趙璐%王元元%孫石磊%許予明
도영려%송파%고원%방혜%조로%왕원원%손석뢰%허여명
卒中%脑缺血%脑出血%磁共振成像%危险因素
卒中%腦缺血%腦齣血%磁共振成像%危險因素
졸중%뇌결혈%뇌출혈%자공진성상%위험인소
Stroke%Brain Ischemia%Cerebral Hemorrhage%Magnetic Resonance Imaging%Risk Factors
目的 探讨急性小动脉闭塞性卒中(small artery occlusion,SAO)患者脑微出血(cerebral microbleed,CMB)的危险因素.方法 纳入完成磁敏感加权成像(susceptibility-weighted imaging,SWI)检查的SAO患者,根据有无CMB分为阳性组和阴性组,比较两组间一般临床资料、生化指标以及影像学资料,采用多变量logistic回归分析确定CMB的独立危险因素,采用Spearman相关分析确定CMB与陈旧性腔隙性梗死和脑白质疏松严重程度的相关性.结果 共纳入109例SAO患者,CMB阳性组47例(43.1％),阴性组62例(56.9％).CMB阳性组年龄[(65.15±12.91)岁对(62.32 ±11.61)岁;t=0.770,P=0.037]、高血压患者构成比(66.0％对32.3％;x2=16.598,P＜0.001)、凝血酶时间[(14.62 ±2.25)s对(16.49 ±4.68)s;=2.400,P=0.041]、部分凝血酶原时间[(34.98 ±5.20)s对(33.47 ±7.00)s;t=1.532,P=0.010]、国际标准化比率(0.94±0.27对0.91±0.10;t=-0.886,P=0.016)、三酰甘油[(1.16±0.51) mmol/L对(1.76±1.36) mmol/L;t=2.699,P=0.005]、低密度脂蛋白胆固醇[(2.49 ±0.72) mmol/L对(2.64±1.37) mmol/L;t=0.641,P=0.046]以及陈旧性腔隙性梗死(x2 =34.961,P＜0.001)和脑白质疏松(x2 =35.161,P＜0.001)分级与CMB阴性组存在显著性差异.多变量logistic回归分析显示,高血压[优势比(odds ratio,OR)6.368,95％可信区间(confidence interval,CI)2.279 ～ 17.799;P＜0.001]、陈旧性腔隙性梗死(OR3.876,95％ CI 1.080 ～ 13.912;P=0.038)和脑白质疏松(OR 16.797,95％ CI 1.433～196.960;P=0.025)是急性SAO患者CMB的独立危险因素,而三酰甘油≥1.52mmol/L是其独立保护因素(OR 0.270,95％ CI 0.074 ～0.983;P =0.047).Spearman相关性分析显示,CMB分级与腔隙性梗死分级(r=0.520,P＜0.001)和脑白质疏松严重程度(r=0.553,P＜0.001)呈显著正相关.结论 高血压、陈旧性腔隙性梗死和脑白质疏松是急性SAO患者CMB的独立危险因素,而三酰甘油≥1.52 mmol/L是其独立保护因素.
目的 探討急性小動脈閉塞性卒中(small artery occlusion,SAO)患者腦微齣血(cerebral microbleed,CMB)的危險因素.方法 納入完成磁敏感加權成像(susceptibility-weighted imaging,SWI)檢查的SAO患者,根據有無CMB分為暘性組和陰性組,比較兩組間一般臨床資料、生化指標以及影像學資料,採用多變量logistic迴歸分析確定CMB的獨立危險因素,採用Spearman相關分析確定CMB與陳舊性腔隙性梗死和腦白質疏鬆嚴重程度的相關性.結果 共納入109例SAO患者,CMB暘性組47例(43.1％),陰性組62例(56.9％).CMB暘性組年齡[(65.15±12.91)歲對(62.32 ±11.61)歲;t=0.770,P=0.037]、高血壓患者構成比(66.0％對32.3％;x2=16.598,P＜0.001)、凝血酶時間[(14.62 ±2.25)s對(16.49 ±4.68)s;=2.400,P=0.041]、部分凝血酶原時間[(34.98 ±5.20)s對(33.47 ±7.00)s;t=1.532,P=0.010]、國際標準化比率(0.94±0.27對0.91±0.10;t=-0.886,P=0.016)、三酰甘油[(1.16±0.51) mmol/L對(1.76±1.36) mmol/L;t=2.699,P=0.005]、低密度脂蛋白膽固醇[(2.49 ±0.72) mmol/L對(2.64±1.37) mmol/L;t=0.641,P=0.046]以及陳舊性腔隙性梗死(x2 =34.961,P＜0.001)和腦白質疏鬆(x2 =35.161,P＜0.001)分級與CMB陰性組存在顯著性差異.多變量logistic迴歸分析顯示,高血壓[優勢比(odds ratio,OR)6.368,95％可信區間(confidence interval,CI)2.279 ～ 17.799;P＜0.001]、陳舊性腔隙性梗死(OR3.876,95％ CI 1.080 ～ 13.912;P=0.038)和腦白質疏鬆(OR 16.797,95％ CI 1.433～196.960;P=0.025)是急性SAO患者CMB的獨立危險因素,而三酰甘油≥1.52mmol/L是其獨立保護因素(OR 0.270,95％ CI 0.074 ～0.983;P =0.047).Spearman相關性分析顯示,CMB分級與腔隙性梗死分級(r=0.520,P＜0.001)和腦白質疏鬆嚴重程度(r=0.553,P＜0.001)呈顯著正相關.結論 高血壓、陳舊性腔隙性梗死和腦白質疏鬆是急性SAO患者CMB的獨立危險因素,而三酰甘油≥1.52 mmol/L是其獨立保護因素.
목적 탐토급성소동맥폐새성졸중(small artery occlusion,SAO)환자뇌미출혈(cerebral microbleed,CMB)적위험인소.방법 납입완성자민감가권성상(susceptibility-weighted imaging,SWI)검사적SAO환자,근거유무CMB분위양성조화음성조,비교량조간일반림상자료、생화지표이급영상학자료,채용다변량logistic회귀분석학정CMB적독립위험인소,채용Spearman상관분석학정CMB여진구성강극성경사화뇌백질소송엄중정도적상관성.결과 공납입109례SAO환자,CMB양성조47례(43.1％),음성조62례(56.9％).CMB양성조년령[(65.15±12.91)세대(62.32 ±11.61)세;t=0.770,P=0.037]、고혈압환자구성비(66.0％대32.3％;x2=16.598,P＜0.001)、응혈매시간[(14.62 ±2.25)s대(16.49 ±4.68)s;=2.400,P=0.041]、부분응혈매원시간[(34.98 ±5.20)s대(33.47 ±7.00)s;t=1.532,P=0.010]、국제표준화비솔(0.94±0.27대0.91±0.10;t=-0.886,P=0.016)、삼선감유[(1.16±0.51) mmol/L대(1.76±1.36) mmol/L;t=2.699,P=0.005]、저밀도지단백담고순[(2.49 ±0.72) mmol/L대(2.64±1.37) mmol/L;t=0.641,P=0.046]이급진구성강극성경사(x2 =34.961,P＜0.001)화뇌백질소송(x2 =35.161,P＜0.001)분급여CMB음성조존재현저성차이.다변량logistic회귀분석현시,고혈압[우세비(odds ratio,OR)6.368,95％가신구간(confidence interval,CI)2.279 ～ 17.799;P＜0.001]、진구성강극성경사(OR3.876,95％ CI 1.080 ～ 13.912;P=0.038)화뇌백질소송(OR 16.797,95％ CI 1.433～196.960;P=0.025)시급성SAO환자CMB적독립위험인소,이삼선감유≥1.52mmol/L시기독립보호인소(OR 0.270,95％ CI 0.074 ～0.983;P =0.047).Spearman상관성분석현시,CMB분급여강극성경사분급(r=0.520,P＜0.001)화뇌백질소송엄중정도(r=0.553,P＜0.001)정현저정상관.결론 고혈압、진구성강극성경사화뇌백질소송시급성SAO환자CMB적독립위험인소,이삼선감유≥1.52 mmol/L시기독립보호인소.
Objective To investigate the risk factors for cerebral microbleed (CMB) in patients with stroke attributable to small artery occlusion (SAO).Methods The patients with acute small-artery occlusive stroke who completed susceptibility-weighted imaging (SWI) examination were enrolled.They were divided into either a positive group or a negative group according to whether they had CMBs or not.The general clinical data,biochemical parameters,and imaging data were compared between the two groups.Multivariate logistic regression analysis was used to identify the independent risk factors for CMBs.Spearman correlation analysis was used to identify the correlations of CMBs with the severity of old lacunar infarcts and leukoaraiosis.Results A total of 109 patients with small-artery occlusive stroke were enrolled,47 (43.1％)were in the CMB positive group and 62 (56.9％) were in the CMB negative group.The age (65.15 ±12.91 years vs.62.32 ± 11.61 years; t =0.770,P =0.037),proportion of hypertension (66.0％ vs.32.3％ ;x2 =16.598,P ＜ 0.001),thrombin time (14.62 ± 2.25 s vs.16.49 ± 4.68 s; t =2.400,P =0.041),partial thromboplastin time (34.98 ± 5.20 s vs.33.47 ± 7.00 s; t =1.532,P =0.010),international normalized ratio (0.94± 0.27vs.0.91± 0.10; t=-0.886,P=0.016),triglyceride (1.16±0.51 mmol/L vs.1.76 ± 1.36 mmol/L; t =2.699,P =0.005],low-density lipoprotein cholesterol (2.49 ±0.72 mmol/L vs.2.64 ± 1.37 mmol/L; t =0.641,P=0.046),as well as the grades of old lacunar infarction (x2 =34.961,P＜0.001) and leukoaraiosis (x2 =35.161,P＜0.001) in the CMB positive group had significant differences with those in the CMB negative group.Multivariate logistic regression analysis showed that hypertension (odds ratio [OR] 6.368,95％ confidence interval [CI] 2.279-17.799; P ＜0.001),old lacunar infarction (OR 3.876,95％ CI 1.080-13.912; P =0.038),and leukoaraiosis (OR 16.797,95％ CI 1.433-196.960; P =0.025) were the independent risk factors for CMBs in patients with acute small-artery occlusive stroke,while triglyceride ≥ 1.52 mmol/L was an independent protective factor for it (OR 0.270,95％ CI 0.074-0.983; P =0.047).Spearman correlation analysis showed that CMB grade and lacunar infarction grade (r =0.520,P ＜ 0.001) and leukoaraiosis severity (r =0.553,P ＜ 0.001)showed a significant positive correlation.Conclusions Hypertension,old lacunar infarction,and leukoaraiosis are the independent risk factors for CMBs in patients with acute small-artery occlusive stroke,and triglyceride ≥ 1.52 mmol/L is its independent protective factor.
