标题：住院缺血性脑卒中患者并发脑微出血的危险因素

      作者：刘梦，李莹，陈静    天津医院神经内科，天津 300211

      卷次： 2024年35卷10期

      【摘要】 目的 探究住院缺血性脑卒中患者并发脑微出血的危险因素。方法 回顾性分析 2020年 3月至2023年3月天津医院收治的150例住院缺血性脑卒中低分子肝素试验(TOAST)分型中的大动脉粥样硬化型患者的病历资料，并根据磁敏感加权成像(SWI)结果是否具有脑微出血分为两组，其中62例并发脑微出血者纳入观察组，88例未见脑微出血者纳入对照组，收集患者临床资料，并根据观察组患者脑微出血的数量分为轻度组26例(1~5个)、中度组21例(6~15个)和重度组15例(≥15个)，根据观察组患者脑微出血的部位分为脑叶型组15例、深部/慕下型组18例和混合型组29例，比较观察组与对照组、不同程度脑微出血组、不同部位脑微出血组患者间的一般资料及实验室指标[糖化血红蛋白(HbA1c)、血细胞分析中的中性粒细胞计数除以淋巴细胞计数所得的比值(NLR)、同型半胱氨酸(HCY)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL)、胱抑素C(CysC)等]，并采用Spearman相关分析各因素与脑微出血数量的相关性，并采用多因素Logistic回归分析缺血性脑卒中患者并发脑微出血的危险因素。结果 观察组患者的年龄、CysC水平分别为(67.81±11.53)岁、(1.83±0.50) mg/L，明显高于对照组的(62.46±9.81)岁、(0.75±0.43) mg/L，差异均有统计学意义(P<0.05)；观察组患者的高血压史、缺血性脑血管病史、脑白质疏松(LA)分级占比明显高于对照组，差异均有统计学意义(P<0.05)，但两组患者在性别、糖尿病史、冠心病史、吸烟史、饮酒史、HbA1c、NLR、HCY、TC、TG、LDL-C、HDL方面比较差异均无统计学意义(P>0.05)；轻度组患者的高血压占比、CysC水平均低于中度组，而中度组则低于重度组，重度组患者的LA分级比中度、轻度组更严重，差异均有统计学意义(P<0.05)，而三组患者在性别、糖尿病史、冠心病史、吸烟史、饮酒史、HbA1c、NLR、HCY、TC、TG、LDL-C、HDL水平方面比较差异均无统计学意义(P>0.05)；脑叶型组有高血压的比例低于深部/慕下型组，深部/慕下型组低于混合型组，脑叶型组有缺血性脑血管病史的比例高于混合型组，混合型组高于深部/慕下型组，混合型组蛋白质疏松LA分级比深部/慕下型组、脑叶型组更严重，差异均有统计学意义(P<0.05)，而三组在性别、糖尿病史、冠心病史、吸烟史、饮酒史、HbA1c、NLR、HCY、TC、TG、LDL-C、HDL水平上比较差异均无统计学意义(P>0.05)；Spearman相关分析结果显示，高血压、缺血性脑血管病史、LA程度、CysC水平与不同程度的脑微出血均呈正相关(r=0.466、0.421、0.794、0.678，P<0.05)；多因素Logistic回归分析结果显示，年龄、高血压史、缺血性脑血管病史、LA、CysC均是缺血性脑卒中患者并发脑微出血的危险因素(P<0.05)。结论 年龄、高血压、脑白质疏松、卒中史是住院缺血性脑卒中患者并发脑微出血的危险因素，为指导住院缺血性脑卒中患者并发脑微出血患者的个体化防治提供参考依据。
      【关键词】 缺血性脑卒中；脑微出血；危险因素；脑白质疏松；住院；年龄；高血压史；脑磁敏感成像
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2024）10—1400—06

Risk factors of cerebral microhemorrhage in hospitalized ischemic stroke patients.
LIU Meng, LI Ying, CHEN Jing.Department of Neurology, Tianjin Hospital, Tianjin 300211, CHINA
【Abstract】 Objective To explore the risk factors of cerebral microhemorrhage in hospitalized ischemic strokepatients. Methods The medical records of 150 patients with large atherosclerosis in the Trial of ORG10172 in Acute Stroke Treatment (TOAST) classification of ischemic stroke admitted to Tianjin Hospital from March2020 to March 2023 were retrospectively analyzed, and the patients were divided into two groups according to the re-sults of magnetic sensitivity weighted imaging (SWI): 62 patients with cerebral microhemorrhage were included in theobservation group, and 88 patients without cerebral microhemorrhage were included in the control group. The clinical da-ta of the patients were collected. According to the number of cerebral microhemorrhage, patients in the observationgroup were divided into a mild group (26 cases, with the number of 1 to 5), a moderate group (21 cases, with the numberof 6 to 15) and a severe group (15 cases, with the number of ≥15). According to the sites of cerebral microhemorrhagein the observation group, there were 15 cases in the lobular group, 18 cases in the deep/below the tentorium type group,and 29 cases in the mixed type group. The general data and laboratory indicators [glycated hemoglobin (HbA1c), ratio ofneutrophil to lymphocyte ratio (NLR), homocysteine (HCY), total cholesterol (TC), triglyceride (TG)] were comparedbetween the observation group and the control group, among the patients with different degrees of cerebral microhemor-rhage, and among patients with cerebral microhemorrhage at different sites. Spearman correlation analysis was used toanalyze the correlation between various factors and the number of cerebral microbleeds, and multivariate Logistic regres-sion was used to analyze the risk factors of cerebral microbleeds in patients with ischemic stroke. Results The age andCysC levels of patients in the observation group were (67.81±11.53) years and (1.83±0.50) mg/L, respectively, whichwere significantly higher than (62.46±9.81) years and (0.75±0.43) mg/L in the control group (P<0.05); the proportion ofpatients with history of hypertension, history of ischemic cerebrovascular disease, and classification of leukoaraiosis(LA) in the observation group was significantly higher than that in the control group (P<0.05). However, there were nosignificant differences in gender, history of diabetes, history of coronary heart disease, smoking history, drinking history,HbA1c, NLR, HCY, TC, TG, LDL-C, and HDL between the two groups (P>0.05). The proportion of hypertension andthe level of CysC were significantly lower in the mild group than the moderate group, and also in the moderate groupthan the severe group; the classification of LA in the severe group was more serious than those in the moderate and mildgroups; the differences were statistically significant (P<0.05). There were no significant differences in gender, history ofdiabetes, history of coronary heart disease, smoking history, drinking history, HbA1c, NLR, HCY, TC, TG, LDL-C, andHDL levels among the three groups (P>0.05). The proportion of hypertension was significantly lower in the lobar groupthan the deep/below the tentorium type group, and also in the deep/below the tentorium type group than the mixedgroup; the proportion of patients with history of ischemic cerebrovascular disease in the lobar group was significantlyhigher than that in the mixed group, and the classification of LA in the mixed group was more serious than that in thedeep/below the tentorium type group and the lobar group; the differences were statistically significant (P<0.05). Therewere no significant differences in gender, history of diabetes, history of coronary heart disease, smoking history, drinkinghistory, HbA1c, NLR, HCY, TC, TG, LDL-C, and HDL levels among the three groups (P>0.05). Spearman correlationanalysis showed that hypertension, history of ischemic cerebrovascular disease, classification of LA, CysC level werepositively correlated with different degrees of cerebral microhemorrhage (r=0.466, 0.421, 0.794, 0.678, P<0.05). Multi-variate Logistic regression analysis showed that age, history of hypertension, history of ischemic cerebrovascular dis-ease, classification of LA, and CysC were all risk factors for cerebral microhemorrhage in patients with ischemic stroke(P<0.05). Conclusion Age, hypertension, LA, and history of stroke are risk factors for cerebral microhemorrhage in in-patients with ischemic stroke, providing reference for individualized prevention and treatment of inpatients with isch-emic stroke complicated with cerebral microhemorrhage.
      【Key words】 Ischemic stroke; Cerebral microhemorrhage; Risk factors; Leukoaraiosis; Hospitalized; Age; Histo-ry of hypertension; Magnetoencephalography