Analysis Of The Occurance And Correlated Risk Factors Of Cerebral Microbleeds In Patients With Acute Cerebral Vascular Disease

Objective: Susceptibility weighted imaging(SWI)was applied in the study to investigate cerebral microbleeds(CMBs) of inpatients with acute cerebral vascular disease in Neurology Department and analyze its incidence and distribution, to discuss the relevant risk factors and provide guidance for the prevention and treatment of cerebrovascular disease.Method:1 94 patients with acute cerebral vascular disease admitted to Neurology Department of Tangshan Workers’ Hospital were enrolled in the study, with 54 cases of cerebral infarction, 26 cases of cerebral hemorrhage and 14 cases of transient ischemic attack. Detailed information of patients were kept in record, such as age, sex, history of hypertension, diabetes mellitus, coronary heart disease, history of stroke, smoking, drinking, oral intake of anti-platelet drugs and blood pressure in admission.Head magnetic resonance was performed in sequential scanning of cross-sections T1WI、T2WI、FLAIR、DWI、SWI to observe whether there were CMBs and their number and distribution. The patients were divided into two groups according to the existence of CMBs.The number of cerebral lacune infarction and the seriousness of leukoaraiosis were recorded. Biochemical examinations such as total cholesterol,triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol,uric acid, homocysteine, fasting plasma glucose), fibrinogen were applied. Carotid ultrasonography was applied to record whether there are carotid athero- scierosis plaque.2 Statistical analysis: The Mann-Whitney U or T-test was used to compare quantitative data obtained from two groups. Pearson chi-square test or continuity corrected chi-square test was used to analyze count data related to number-counting. Single-factor and multiple regression analysis were applied to analyze risk factors.Receiver operating characteristic curve(ROC) selects the optimal limit value in determining cerebral microbleeds, with a two-tail statistical difference value as P less than 0.05. All data were analyzed by SPSS 19.0.Results:1 There were 94 patients with acute cerebral vascular disease involved in the study and 49 patients were identified suffering from CMBs. Among 54 patients with cerebral infarction, 28 cases of CMBs detected, accounting 51.9%. Among 26 cases of cerebral hemorrhage, 19 cases were detected with CMBs,accounting 73.1%. Among 14 patients of transient ischemic attack, CMBs were found in 2 patients identified, accounting 14.3%.2 Among 49 patients with CMBs, 448 CMBs lesions were identified. The CMBs were mostly located in the basal ganglia and thalamus region(41 cases,211),and less in cortical-subcortical area(32 cases,174), least in brain stem and cerebellum terriory(21 cases,63).3 The percentage of hypertension, history of stroke, as well as levels of systolic blood pressure and diastolic blood pressure on admission of CMBs- positive group was significantly higher than that of CMBs-negative group(P<0.05). There are no statistical significance on age,sex,diabetes mellitus, smoking, drinking, oral in-take of anti-platelet drugs between two groups(P>0.05).4 The mean level of low-density lipoprotein cholesterol in CMBs-positive group was 3.28±0.99 mmol/L significantly higher than that of 2.88±0.84mmol/L in CMBs-negative group, with P<0.05. There are no statistical significance on fasting plasma glucose, uric acid, fibrinogen, homocysteine, total cholesterol,triglycerides,high-density lipoprotein cholesterol between two groups(P>0.05).5 The grades of cerebral lacune infarction, leukoaraiosis and carotid plaque were statistically significant between two groups(P<0.05).6 Cerebral hemorrhage and transient ischemic attack were statistically significant between two groups(P<0.05). There was no statistical significance on cerebral infarction.7 Using CMBs as dependent variable and other risk factors as independent variable,single-factor Logistic regression analysis showed that the detection of CMBs with hypertension, history of stroke, systolic blood pressure on admission, diastolic blood pressure on admission, low-density lipoprotein cholesterol, carotid plaque, lacunar infarction grade and leukoaraiosis grade correlated[P<0.05, OR=20.391,10.424,1.930,1. 795,1.641, 3.948,6.143,4.720; 95% CI=(6.19 8-67.087),(2.238-48.545),(1.459-2.552),(1.272-2.534),(1.021-2.635),(1.620-9. 621),(2.811-13.427),(2.368-9.410)].The patients with cerebral hemorrhage than transient ischemic attack,cerebral infarction than transient ischemic attack had higher risk of occurring CMBs,the difference had statistical significance[P<0.05, OR=16.286,6.462; 95% CI=(2.888-91.833),(1.319-31.663)].8 With or without CMBs were used as the dependent variable and single-factor analysis P < 0.05 as the independent variable, multiple regression analysis showed hypertension(OR8.854,95%CI 1.711-45.804、P =0.009), systolic blood pressure on admission(OR1.717,95%CI 1.207-2.442、P=0.003) and lacunar infarction grade(OR7.747,95%CI 2.647-22.673、P<0.001) are independent risk factors. Coexistence of hypertension, an increase of systolic blood pressure on admission for every 10 mm Hg, and a level increase of lacunar infarction grade, the incidence of CMBs increases of 7.9, 0.7 and 6.7 fold seperately.9 ROC of systolic blood pressure on admission demonstrated the area of the curve was 0.835(95%CI 0.751-0.920). The optimal predicted systolic blood pressure cutoff value on admission was 157 mm Hg. When systolic blood pressure on admission is or more than 157 mm Hg, the risk of CMBs increases significantly.Conclusions:1 The incidence of CMBs in patients with cerebral hemorrhage and cerebral infarction is higher, with 73.1% inflicted with cerebral hemorrhage and 51.9% with cerebral infarction.2 CMBs were found in several parts of the brain, mostly located in the basal ganglia and thalamus region, and less in cortical-subcortical area, least in brain stem and cerebellum terriory.3 Hypertension, systolic blood pressure on admission, cerebral lacunar infarction grade are independent factors of CMBs incidence. Coexistence of hypertension, an increase of systolic blood pressure on admission for every 10 mm Hg, and a level increase of cerebral lacunar infarction grade, the incidence of CMBs increases of 7.9, 0.7 and 6.7 fold sperately.4 Optimal predicted pressure cutoff value on admission was 157 mm Hg. If systolic pressure is or more than 157 mm Hg, the incidence of CMBs increased significantly.