缺血性脑卒中合并脑微出血的相关危险因素分析及SWAN的临床检测价值

目的 探寻缺血性脑卒中患者合并脑微出血(CMBs)与相关危险因素的关系及SWAN序列的临床检测价值。方法 选取本院2013年4月～2015年4月连续收治常规MRI检查确诊的155例缺血性脑卒中患者,根据磁敏感加权成像上有无微出血灶分为CMBs组(76例)和无CMBs组(79例)。比较2组患者的年龄、性别、吸烟史、饮酒史等以及有无高血压病、糖尿病、高脂血症、脑出血等临床相关因素,并记录相关生化指标。对以上因素进行相关性分析,筛选出与CMBs相关的危险因素。记录各危险因素组常规MRI及SWAN序列对CMBs的检出例数。结果 155例缺血性脑卒中患者中有CMBs者76例(占49%),多发生于皮质-皮质下区(占36%); CMBs的发生与年龄、饮酒史、糖尿病及高超敏C反应蛋白水平有关; 多因素Logistic回归显示高血压病、高脂血症、脑白质疏松、脑出血及高纤维蛋白原、高同型半胱氨酸是其独立危险因素(P<0.05); SWAN序列对各危险因素组CMBs阳性检出率明显高于常规MRI序列(P<0.001)。结论 缺血性脑卒中患者伴有高血压病、高脂血症、脑白质疏松、脑出血及高纤维蛋白原、高同型半胱氨酸与CMBs发生密切相关; 对于缺血性脑卒中合并上述高危因素者,可考虑将SWAN列入常规MRI检查以筛查CMBs病灶和评价患者有无出血倾向。

An analysis of risk factors for ischemic stroke complicating cerebral microbleeds and the diagnostic value of MR susceptibility weighted angiography(SWAN)

ObjectiveTo investigate the value of MR susceptibility weighted angiography(SWAN)in diagnosis of ischemic patients complicated with cerebral microbleeds(CMBs)and to explore the related risk factors.Methods 155 consecutive patients of ischemic stroke diagnosed by conventional MRI were enrolled in this study from April 2013 to April 2015. According to the appearance of SWAN, patients were divided into the CMBs group(76 cases)and the non-CMBs group(79 cases). Basic information and relevant clinical data(including gender, age, smoking history, hypertension, hyperlipidemia, diabetes, cerebral hemorrhage and so on)of both groups were collected, and then analyze with χ² test and logistic regression analysis. Collect the number of CMBs on SWAN and conventional MRI sequences of groups with those risk factors above.Results In 155 patients of ischemic stroke, 76 cases(49%)occurred CMBs, and mostly in cortical-subcortical(36%). Patients in CMBs group were correlate with age, drinking history, diabetes and hypersensitive C-reactive protein. Multivariate logistic regression analysis showed that hypertension, hyperlipidemia, cerebral hemorrhage, cerebral leukoaraiosis, high levels of fibrinogen and homocysteine were the independent risk factors(P<0.05). Moreover, The detection rates of CMBs on SWAN were higher than on conventional MRI(P<0.001).Conclusions In patients with ischemic stroke, the occurrence of CMBs is directly associate with hypertension, hyperlipidemia, cerebral hemorrhage, cerebral leukoaraiosis, high levels of fibrinogen and homocysteine; In patients of ischemic stroke with those risk factors above, SWAN can be used as conventional examination for diagnosing the occurrence of CMBs and evaluating the hemorrhagic tendency.