Clinical Characteristics And Correlation Study Between Cerebral Microbleeds And White Matter Lesions In Patients With Ischemic Cerebrovascular Disease

Objective: Ischemia cerebrovascular disease(ICVD),including cerebral infarction and transient ischemic attack(TIA),was a common and frequently occurring disease in neurology department.ICVD accounted for 60% to 70% of cerebral vascular disease.Its disability rate was so high that it brings heavy burden to family and society.Cerebral microbleeds(CMBs)and white matter lesions(WML)were the two kinds of common imaging manifestations of cerebral vascular disease.In recent years,it has caused concern of more and more scholars at home and abroad.At present,there have been few studies about the correlation between CMBs and WML in ischemic cerebrovascular disease.This study applied magnetic resonance(NMR)and magnetic sensitive imaging techniques to observe the distribution characteristics of CMBs and WML in ischemia cerebral vessels disease,and study its predilection site.It precised CMBs and WML classification in severity,analyzed related risk factors,to find out the influence.And the study analyzed the correlation between the severity and diseased region of CMBs and WML,so as to provide evidence of prevention and treatment of ICVD patients and to understand characteristics of CMBS and WML.Methods: Collected ICVD patients in neurology department of Hebei General Hospital from February,2014 to January,2016.Those patients was informed and agreed to undergo brain magnetic resonance imaging(magnetic resonance imaging,MRI),including T1 weighted imaging(T1-weighted imaging,T1WI)and T2 weighted imaging(T2 weighted imaging,T2WI),fluid attenuated inversion recovery(fluid attenuated inversion recovery,flair),magnetic susceptibility weighted imaging(susceptibility weighted imaging,SWI)or enhanced gradient echo T2 star weighted angiography sequence(enhanced gradient echo T2 star weighted angiography,ESWAN).Recorded the baseline data and high blood pressure,diabetes,hyperlipidemia,high homocysteine levels,and other risk factors,and classified CBMs and WML.ICVD patients were divided into CBMs group and non CBMs group.CMBs group was fatherly divided into 4 groups according to the severity,which was divided into level 1-3.Then ICVD patients were divided into WML group and non WML group.WML group scored each region with age-related white matter changes rating scale.The frontal,temporal,occipital region and basal ganglia and scene area with the left and right hemisphere were divided into 10 regions,respectively.Each region was divided into 0 to 3 points,total of 4 standard,according to the severity of white matter lesions.10 areas were given score,which scored a total 0-30 points.The spss21.0 statistical software package was used for statistical analysis and understood CMBS and WML distribution characteristics,and meanwhile logisitic regression was used to analyze the related risk factors;Further application of card test,Spearman rank correlation analysis method were used to discuss the classification of CMBS and WML,and lesion site correlation.Results:1 The study included a total of 180 cases of patients with ischemic cerebral vascular disease,including CMBS 111 cases(61.7%),non CMBs 69 cases(38.3%);CMBs group in cortical and subcortical 80 cases(72.1%),basal ganglia and thalamus in 61 cases(55.0%),below the tentorium regions of 38 cases(34.2%).Three regional CMBs occurred rate by R * C chi square test(x2 2=32.061,P= 0.000),the difference has statistical significance;further among the three groups of pairwise comparison,had a significant statistical difference(any two group P< 0.001).2 Among 80 cases of CMBs in the cortical and subcortical,there were 29 cases of cerebral microbleeds in the pillow lobe(36.3%),24 cases(30%)in the parietal lobe,49 cases(61.3%)in the temporal lobe,28 cases(35%)in the frontal lobe.3 Among 180 cases of ICVD patients,there were 143 cases(79.44%)in the WML group,37 cases of 20.56%)without WML.The distribution was: 69 cases(48.3%)in the basal ganglia,129 cases(90.2%)in the frontal lobe,72 cases(50.3%)in the temporal lobe,85 cases(59.4%)in zhe parietal and occipital lobe,4 cases(2.8%)in the below the tentorium region;frontal lobe and the rest of the four regional groups had significant difference(P< 0.05).4 Logistic regression analysis shown that age(OR1.047,P= 0.002),and the homocysteine(OR4.299,P< 0.001)were the independent risk factors for CMBs.Among the four groups of risk factors,smoking,drinking,hypertension,diabetes,hyperlipidemia,high homocysteinemia group shown no significant difference(P> 0.05);age and CMBs rank correlation shows statistical significance(r=0.191,P= 0.01).5 Logistic regression analysis of the risk factors in the WML: drinking,hypertension,diabetes,hyperlipidemia,high homocysteine,index had no statistical difference(P> 0.05),age and smoking were risk factors for WML(P=0.001,P< 0.001);further application Pearson Pearson correlation analysis,there was a positive correlation between the age and WML score,with statistical significance(r=0.356,P=0.000).6 Using Spearman rank correlation analysis: CMBs four classification and WML total score had statistical significance,and the positive correlation(r=0.393,P=0.393).With the increase of WML total score,Severity of CMBs also increased.WML in the frontal lobe,temporal lobe,parietal-occipital area ratings were positively correlated with CMBs grading(P=0.002,P=0.002,P=0.024),statistically significant.Conclusion:1 The incidence rate of CMBs in ICVD patients from high to low was: cortical and subcortical,basal ganglia and thalamus,below the tentorium region,among which the temporal lobe was the most common;2 The incidence rate of WML in ICVD patients from high to low was: frontal area,parietal-occipital area,temporal area,basal ganglia,below the tentorium region.And frontal lobe was the most easily affected area;3 High homocysteine was a risk factors of CMBs.Smoking was a risk factor for WML;4 Age was a common risk factor for CMBs and WML.As the age increased,the incidence rate of CMBs and WML increased,and so as to the severity;5 The white matter lesions of frontal lobe,temporal lobe and parietal occipital lobe were positively correlated with the severity of CMBs.