脑微出血与脑动脉粥样硬化的相关性分析

Correlation of cerebral atherosclerosis with cerebral microbleeds in patients with acute ischemic stroke

摘要:

目的 脑微出血（CMBs）是脑内小血管病的重要表现之一，与脑动脉粥样硬化负荷的相关性仍不明确。该研究旨在探讨二者的相关性。方法 连续入组首发急性缺血性脑卒中入院于广东医学院附属深圳南山医院的患者，根据磁敏感加权成像（SWI）的扫描结果有无CMBs分为CMBs组（63例）和非CMBs组（67例）；根据脑卒中患者动脉粥样硬化病变的位置分为颅内、颅外及颅内外混合病变。脑动脉粥样硬化负荷分别从病变血管段的数量及狭窄程度分别进行评估。详细记录患者的人口统计学资料、生物化学变量、血管病的危险因素和SWI序列结果显示的CMBs数量，并进行比较和分析。结果 最终入组受试者130例，有序logistic回归分析显示，脑动脉粥样硬化负荷与CMBs数量显著正相关（病变血管段数，OR＝1.22，95%CI：1.05～1.42，P＝0.012；血管狭窄程度，OR＝1.25，95%CI：1.12～1.40，P＜0.001）；尤其颅内动脉粥样硬化负荷与CMBs的数量显著正相关（病变血管段数，r＝0.51，P＝0.004；血管狭窄程度，r＝0.62，P＜0.001）。结论 CMBs与脑动脉粥样硬化密切相关，尤其颅内动脉硬化与CMBs之间或许存在更加紧密的联系。

Abstract:

Objective Cerebral microbleeds (CMBs) are one of main manifestations of cerebral small vessel diseases. However, the association between cerebral atherosclerosis and CMBs remains unclear. The aim of this study is to investigate their relationships. Methods Consecutive patients with first-ever ischemic stroke admitted in the Nanshan Hospital from January 2013 to October 2014 were recruited in this study. They were divided into CMBs group (n＝63) and non-CMBs group (n＝67) according to the results of susceptibility-weighted imaging (SWI). Based on the locations of arterial stenotic lesions, they also were assigned into intracranial vessel group, extracranial vessel group and combined group. The presences and extents of the involved vessels and steno-occlusion were used to evaluate the cerebral atherosclerotic burden. The demographic data, biochemical variables, vascular risk factors and numbers of CMBs were collected, compared and analyzed. Results A total of 130 subjects were enrolled. Ordinal logistic regression analysis showed that the extent of atherosclerotic burden was positively correlated with the numbers of CMB (the numbers of arterial lesions, OR＝1.22, 95%CI 1.05?1.42, P＝0.012; the extents of steno-occlusion, OR＝1.25, 95%CI 1.12?1.40, P＜0.001). Especially, the intracranial atherosclerosis was more significantly positively correlated with the numbers of CMBs (the number of arterial lesions, r＝0.51, P＝0.004; the extents of steno-occlusion, r＝0.62, P＜0.001). Conclusion CMBs are closely associated with cerebral atherosclerosis, and the association may be closer between the intracranial atherosclerosis with CMBs.