脑微出血数量的危险因素分析及其出血转化评估

发布时间：2018-05-02 08:57

  本文选题：脑微出血 + 磁敏感加权成像　； 参考：《山西医科大学》2014年硕士论文

【摘要】：研究目的 脑微出血（Cerebral Microbleeds, CMBs）源自病理脑标本切片提示的在光学显微镜下观察到的那些出血后产生的含铁血黄素沉积。在神经影像学发达的21世纪，对既往发生的小血管完整性被破坏区域，引用高强度MRI或梯度－回波T2加权MRI（Gradient-echo T2-weighted，GRE）或SWI（磁敏感加权成像）可发现针孔样的低信号，证实了病理学所见的出血后铁蛋白沉积，通常是因高血压小动脉病或脑淀粉样血管病所致。既往大多是关于脑微出血危险因素的研究，而本研究将脑微出血出血数量分为轻、中、重后，分析影响脑微出血不同数量的危险因素及出血转化的因素，是不是微出血数量的程度与腔隙性脑梗死、脑白质病变、脑出血等因素有关。脑微出血的检测对潜在的脑小血管病的诊断、抗血小板聚集/抗凝药物使用的安全性,症状性脑出血、认知障碍和痴呆的风险具有重要的临床意义。特别是急性心肌梗塞或脑梗死患者需要早期溶栓治疗，微出血的识别及评估利弊显得尤为重要，对于微出血同时伴随腔隙性脑梗死或脑白质病变的缺血性卒中患者长期使用抗血小板聚集或抗凝治疗可提供临床指导意义。 研究方法 持续收集2011年8月—2013年3月在北京军区总医院均行头颅MRI（包含头部磁共振磁敏感加权成像(SWI)、Ｔ２ＷＩ、T1WI及ＦＬＡＩＲ）确认有脑微出血(CMBs)的患者200例，根据SWI上CMBs的病灶数将其分为轻度(1～5个)组111例，中度(6～15个)组86例,重度(≥15个)组30例。单因素分析影响CMBs严重程度的危险因素，在将其危险因素进一步分层，将其危险因素和微出血严重程度的关系行Spearman相关分析，多因素Logistic回归分析进一步分析其单因素有意义的危险因素。 结果 ①单因素分析结果显示,三组的性别，年龄，糖尿病，高血压，心房颤动，颈动脉粥样硬化，凝血和抗血小板治疗无显著性差异（P＞0.05）。微出血的程度随腔隙性脑梗死灶数量、脑白质疏松程度的增加而增加，脑出血率也随着CMBs程度的加重而增加，三组间有统计学意义（P＜0.05）。轻度组和中、重度组合并后的比较，统计学上仍旧有意义（P＜0.05）。 ②Spearman相关分析显示，，CMBs程度与腔隙性脑梗死灶数量(r=0.392，P＜0.01)及脑白质疏松程度(r=0.362，P＜0.01)呈正相关。 ③将中重度组合并以后进行的多因素Logistic回归分析表现，腔隙性脑梗死灶的数目(OR=4.259，95%CI:3.064～5.620，P=0.001)、脑白质病变程度(OR=3.250，95%CI:2.351～4.665，P=0.003)是影响脑微出血程度的独立危险因素。CMBs严重程度与脑出血率呈正相关(OR=1.813，95%CI:1.788～2.581，P=0.029)。 结论 脑腔隙性梗塞数目、脑白质病变程度及脑出血严重度与CMBs的严重度密切有关，且成正相关,腔隙性脑梗死灶数目、脑白质疏松程度是影响脑微出血数量的单独危险因素。
[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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