缺血性脑卒中患者合并脑微出血的危险因素分析

目的探讨缺血性脑卒中(cerebral ischemic stroke,IS)患者合并脑微出血(cerebral microbleeds,CMBs)的危险因素。方法回顾性收集2015年1月至2017年5月作者医院神经内科连续收治的IS住院患者1631例,根据是否存在CMBs分为合并CMBs组703例和未合并CMBs组928例。分析两组间性别构成、年龄、血压、体重、体重指数(body mass index,BMI)、血糖、尿酸、三酰甘油(triglycerides,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-c)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-c)、载脂蛋白A(apolipoproteins A,apoA)、载脂蛋白B(apolipoproteins B,apoB)、吸烟史、饮酒史、高血脂史、糖尿病史、高血压史、心脏疾病史、脑白质高信号(white matter hyperintensity,WMH)的差异,并采用多因素Logistic回归分析影响IS患者发生CMBs的危险因素。结果与未合并CMBs组比较,合并CMBs组患者年龄大,男性、吸烟、饮酒、高血压、糖尿病、WMH构成比例高,空腹血糖、尿酸水平高(均P<0.05),而空腹LDL-c和apoA水平较低(均P<0.05)。多因素Logistic回归分析显示吸烟(OR=5.791,95%CI:3.714~9.031,P<0.01)、饮酒(OR=7.306,95%CI:4.926~10.835,P<0.01)、高血压(OR=2.162,95%CI:1.487~3.143,P<0.01)、WMH(OR=3.249,95%CI:1.594~6.625,P<0.01)、LDL-c(OR=0.789,95%CI:0.630~0.989,P<0.05)、apoA(OR=0.696,95%CI:0.369~0.753,P<0.01)是IS合并CMBs的独立危险因素。结论吸烟、饮酒、高血压、WMH、LDL-c、apoA是IS合并CMBs的独立危险因素,且LDL-c和apoA水平下降与CMBs发生增加相关。

The studies of risk factors of cerebral ischemic stroke complicated with cerebral microbleeds

Objective To explore the risk factors of cerebral ischemic stroke(IS)patients with cerebral microbleeds(CMBs).Methods 1631 cases of IS patients who were consecutively hospitalized in the authors′hospital from January 2015 to May 2017 were enrolled retrospectively.According to the presence or absence of CMBs,the patients with IS were divided into two groups:a CMBs group(n=703 cases)and a non-CMBs group(n=928 cases).The differences of gender,age,blood pressure,weight,body mass index(BMI),blood sugar,uric acid,triglycerides(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-c),low-density lipoprotein cholesterol(LDL-c),apolipoproteins A(apoA),apoB,smoking history,alcohol consumption,high cholesterol,history of diabetes,history of hypertension,history of heart disease,white matter hyperintensity(WMH)were compared between the two groups.Then the risk factors for CMBs in IS patients were analyzed by multivariate logistic regression.Results Compared with the non-CMBs group,the age of patients in the CMBs group were older,the proportions of men,smoking,drinking,hypertension,diabetes,WMH,and the levels of blood glucose,uric acid in the combined CMBs group were higher(all P<0.05),while the levels of LDL-c and apoA were lower(both P<0.05).The multivariate logistic regression analysis showed that smoking(OR=5.791,95%CI:3.714-9.031,P<0.01),drinking(OR=7.306,95%CI:4.926-10.835,P<0.01),hypertension(OR=2.162,95%CI:1.487-3.143,P<0.01),WMH(OR=3.249,95%CI:1.594-6.625,P<0.01),LDL-c(OR=0.789,95%CI:0.630-0.989,P<0.05)and apoA(OR=0.696,95%CI:0.369-0.753,P<0.01)were the independent risk factors for CMBs in patients with IS.Conclusions Smoking,alcohol consumption,hypertension,WMH,LDL-c,and apoA are independent risk factors for IS combined with CMBs.Moreover,the decrease of LDL-c and apoA level are associated with an increased risk of CMBs.