脑白质高信号患者中不同部位脑微出血发生的危险因素及其临床意义的研究
发布时间：2018-06-21 05:06
本文选题：脑白质高信号 + 脑微出血 ； 参考：《浙江大学》2014年硕士论文
【摘要】：研究背景 在脑白质高信号(white matter hyperintensities,WMH)严重的患者中,大部分合并有脑内微出血(cerebral microbleeds, CMB s),且临床研究表明,WMH的严重程度和CMBs的数目呈明显正相关,但WMH却不是CMBs的独立危险因素。病理检查证实,不同部位的CMBs病理改变存在差异,其中深部的CMBs主要病理改变为小动脉管壁增厚、玻璃样变性及微动脉瘤的形成,而脑叶的微出血主要病理改变是脑淀粉样血管病变。 研究目的 探究脑白质高信号病人中不同部位CMBs发生的危险因素及CMBs对将来卒中发生的影响。 研究方法 前瞻性连续性收集自2011年7月到2014年1月在我院就诊的具有脑白质高信号,且知情同意接受头颅磁共振ESWAN序列检查的病人。在nagnitude图上评估脑微出血,按照微出血解剖评定量表(Microbleed Anatomical Rating Scale)将其分成深部微出血和脑叶微出血。分别分析深部微出血组与无深部微出血组、脑叶微出血组与无脑叶微出血的基线资料,并行多因素分析。随访研究对象在实验期内发生的脑卒中事件,并分析发生了将来卒中人群与未发生将来卒中人群之间差异,用二元Logotic回归分析探究将来卒中发生的独立危险因素。 研究结果 纳入151例患者,年龄(68.0±12.3)岁,男性82例(54.3%),存在微出血90例(60.3%),其中深部83例(55.0%),脑叶68例(45.0%),深部CMBs合并脑叶CMBs者61例。存在深部微出血患者高血压发病率高(84.3%vs70.6%,p=0.049)、同型半胱氨酸高(16.5±7.3vs12.5±3.9umol/1, p0.001),血维生素B12低(335.3±172.9vs468.3±387.9ug/ml,,p=0.017),TT4低(92.1±27.7vs108.1±56.5pmol/l,p=0.013),用logistic回归进行多因素分析后发现只有血清高同型半胱氨酸浓度(OR=1.16,95%CI：1.05-1.28,p=0.004)是深部CMBs的独立危险因素。脑叶微出血组男性比例高(67.5%vs43.4%,p=0.003),血TT4含量低(88.9±27.1vs107.7±51.8, nmol/1, p=0.010),多因素校正后男性(OR=2.36,95%CI：1.16-4.83, p=0.018)及较高的血清TT4(OR=0.98,95%CI：0.97-0.99,p=0.013)是脑叶CMBs的独立危险因素。 随访期内共有18例患者发生了卒中,其中脑梗塞11例,脑出血7例。发生了将来卒中组患者糖尿病的患病率更高(55.6%vs21.8%,p=0.007)；既往卒中史比例更高(52.9%vs22.6%,p=0.015)；基线CMBs的发生率更高(88.9%vs55.6%,p=0.009)以及基线深部CMBs发生率更高(88.3%vs51.5%,p=0.011)经二元Logistic回归分析校正混杂因素后发现,糖尿病(OR=6.07,95%CI：1.94-18.97,p=0.002)、既往卒中史(OR=4.29,95%CI：1.39-13.23,p=0.011)CMBs(OR=6.24,95%CI：1.28-30.49,p=0.024)以及深部CMBs是将来卒中发生的独立预测因素。 结论 1.WMH患者中,较高的血Hcy和既往卒中史是深部CMBs的独立危险因素男性及较低的血TT4是脑叶CMBs的独立危险因素,深部CMBs与脑叶CMBs的危险因素存在差异。 2.WMH患者中CMBs及深部CMBs均可预测将来卒中,尤其是出血性卒中的发生。
[Abstract]:Background most of the patients with severe white matter hyperintensity (WMHs) have intracerebral microbleeds and cerebral microbleeds, and clinical studies have shown that there is a significant positive correlation between the severity of WMH and the number of CMBs. But WMH is not an independent risk factor for CMBs. Pathological examination showed that there were differences in pathological changes of CMBs in different sites. The main pathological changes of deep CMBs were thickening of arterioles wall, vitreous degeneration and the formation of microaneurysms. The main pathological change of cerebral lobar hemorrhage is cerebral amyloid angiopathy. Objective to investigate the risk factors of CMBs in patients with high signal in white matter and the influence of CMBs on future stroke. Methods prospective consecutive patients with white matter hyperintensity and informed consent to head MRI ESWAN sequence were collected from July 2011 to January 2014. Intracerebral microhaemorrhage was evaluated on nagnitude and divided into deep microhemorrhage and lobar microhemorrhage according to microbleed Anatomical rating scale. The baseline data of deep microhemorrhage group and non-deep microhemorrhage group, cerebral lobe microhemorrhage group and anencephalic microhemorrhage group were analyzed respectively. The stroke events occurred in the experimental period were followed up, and the differences between the future stroke population and the non-future stroke population were analyzed. The independent risk factors of future stroke were analyzed by binary Logotic regression analysis. Results 151 patients, aged 68.0 卤12.3 years, were included in this study. 82 cases of male were diagnosed as 54.3%. There were 90 cases of microhemorrhage, including 83 cases in deep part, 68 cases in lobes and 61 cases in deep CMBs complicated with lobar CMBs. 瀛樺湪娣遍儴寰嚭琛，
本文编号：2047358
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