Clinical Risk Classification Of Hypertention And Analysis Of Cerebral Microbleeds Correlative Factors

ObjectiveTo detect the number and distribution of CMBs lesions in hypertensive patients by magnetic susceptibility sequence(SWI),and to explore the correlation between CMBs lesions and hypertension course,risk stratification,and the relationship between related risk factors and CMBs,so as to provide more valuable information and intervention measures for the prevention of hemorrhagic stroke in clinical hypertensive patients.Materials and MethodsFrom January 2016 to October 2018,147 hospitalized patients with essential hypertension were randomly selected,including 82 males and 65 females,with an average age of 64 years.The course of hypertension ranged from six months to 40 years.Eighty patients regularly took antihypertensive drugs and their blood pressure was well controlled,and 67patients did not take drugs or discontinued drugs.Detailed clinical data of all patients were recorded and laboratory blood test indicators were collected.All patients were divided into four groups according to the cardiovascular risk of hypertension:low risk,medium risk,high risk and extremely high risk.All patients underwent magnetic resonance imaging(including T1WI,T2WI,T2 Flair,DWI and SWI sequences),and the SWI images were post-processed to record the number and distribution of CMBs lesions.SPSS19.0 software was used for statistical analysis to determine the independent risk factors of CMBs.According to the number of CMBs lesions,CMBs lesions were divided into three grades(mild,moderate and severe),and whether the independent risk factors affected the severity of CMBs was observed.P less than 0.05 has statistical significance.Results147 patients with essential hypertension,aged 45-83 years,82 males and 65 females,were included in this study.60 patients(40.8%)in CMBs positive group had 402 lesions.Among them,249(55.7%)had CMBs in deep brain region,113(28.1%)in deep brain white matter,136(33.8%)in basal ganglia region,107(32.6%)in lobe and 46(11.6%)in subten-torial area.Among all risk stratification of hypertension,there were 11 cases in low risk group,1case has CMBs(9.1%),40 cases in medium risk group,7 cases have CMBs(17.5%),41 cases in high risk group,12 cases have CMBs(29.3%)and 55 cases in extremely high risk group and 40 cases have CMBs(72.7%).Kruskal-wallis test and Spearman rank sum test showed that the positive rate of CMBs was positively correlated with the risk stratification of hypertension(Chi-Square=38.768,P<0.001;rs=0.497,P<0.001);the severity of CMBs was positively correlated with the risk stratification of hypertension(Chi-Square=8.591,P=0.035<0.05;r_s=0.274,P=0.034<0.05).Univariate and multivariate logistic analysis showed that duration of hypertension,LDL,total cholesterol and anticoagulant therapy were independent risk factors for CMBs(P<0.05);Spearman rank correlation analysis showed that serum LDL and total cholesterol levels were weakly negatively correlated with the severity of CMBs(P<0.05,r_s were negative,and the absolute value was less than 0.4).ConclusionThe CMBs lesions in hypertensive patients are predominantly located in the deep brain white matter and basal ganglia region.There is a significant correlation between the incidence and grade of CMBs and the cardiovascular risk stratification of hypertension.The higher the risk stratification,the greater the possibility of CMBs and the more the number of CMBs.The duration of hypertension,low-density lipoprotein and total cholesterol,anticoagulation therapy are independent risk factors for CMBs.Density lipoprotein and total cholesterol were negatively correlated with the severity of CMBs.