摘要
目的分析自发性脑出血(ICH)患者伴发症状性脑梗死(SCI)的影响因素。方法连续收集2019年5月至2023年3月郑州人民医院卒中中心收治的自发性ICH患者337例。依据新发神经功能缺损症状是否由远离血肿部位磁共振弥散加权成像高信号病变所致分为伴发SCI组(n=22)和未伴发SCI组(n=315)。磁共振同时评估脑小血管病影像标志和脑动脉狭窄(CAS)程度。采用SPSS 25.0统计软件进行数据分析。单因素和多因素Logistic回归分析探讨急性ICH伴发SCI的危险因素,按平均动脉压(MAP)波动三分位进行分层分析。结果与未伴发SCI组比较,伴发SCI组既往缺血性卒中史多,并发肺炎、深静脉血栓比例高,基线收缩压高,MAP变化幅度大,室周白质高信号评分和深部白质高信号(DWMHs)评分高、CAS程度重,均差异有统计学意义(均P<0.05)。多因素Logistic回归分析显示,CAS程度(B=1.095,OR=2.989,95%CI=1.645~5.432,P<0.001)及DWMHs评分(B=0.789,OR=2.201,95%CI=1.163~4.166,P=0.015)是ICH伴发SCI的危险因素。分层分析显示,与轻度CAS患者比较,MAP高分位组中度和重度CAS患者SCI的比例更大(均P<0.05);与轻度DWMHs比较,MAP高分位组重度DWMHs患者SCI的比例更大(P=0.002)。结论严重的CAS和DWMHs是自发性ICH后伴发SCI的独立危险因素,在MAP波动大时影响更明显。
Objective To analyze the risk factors for symptomatic cerebral infarction(SCI)in patients with spontaneous intracerebral hemorrhage(ICH).Methods A total of 337 patients with spontaneous ICH admitted to the stroke center of Zhengzhou People’s Hospital were consecutively collected from May 2019 to March 2023.Patients were divided into the SCI group and without SCI group according to whether the presence of new neurological deficits consistent with diffusion-weighted imaging hyperintense lesions distant from the hematoma.Magnetic resonance was used to quantify cerebral small vessel disease imaging markers and the degree of cerebral artery stenosis(CAS).SPSS 25.0 software was used for data analysis.Univariate and multivariable Logistic regression models were adopted to assess risk factors associated with concomitant SCI.Subgroup analysis stratified by mean arterial pressure(MAP)tertiles was performed.Results Compared with patients without SCI,patients with SCI have more histories of ischemic stroke,higher rates of complication of pneumonia and deep venous thrombosis,higher baseline systolic blood pressure,greater MAP change,higher periventricular white matter hyperintensities score and deep white matter hyperintensities(DWMHs)score,and more severe CAS(all P<0.05).Multivariable regression analysis showed that,the degree of CAS(B=1.095,OR=2.989,95%CI=1.645-5.432,P<0.001)and DWMHs score(B=0.789,OR=2.201,95%CI=1.163-4.166,P=0.015)were risk factors for ICH patients with SCI.Compared with patients with mild CAS,the proportion of SCI significantly increased in patients with moderate and severe CAS in the maximum MAP change group(both P<0.05).Compared with patients with mild DWMHs,the proportion of SCI in patients with severe DWMHs in the maximum MAP change group significantly increased(P=0.002).Conclusion Severe CAS and DWMHs are independent risk factors for SCI after ICH,especially with greater fluctuations in MAP change.
作者
任梦杨
张爱玲
田龙
丁娜
Ren Mengyang;Zhang Ailing;Tian Long;Ding Na(Department of Neurology,the Fifth Clinical Medical College of Henan University of Chinese Medicine(Zhengzhou People's Hospital),Zhengzhou 450003,China)
出处
《中华行为医学与脑科学杂志》
北大核心
2025年第4期340-345,共6页
Chinese Journal of Behavioral Medicine and Brain Science
基金
河南省医学科技攻关计划项目(2018020826)。
关键词
脑出血
自发性
症状性脑梗死
脑动脉狭窄
危险因素
Intracerebral hemorrhage,spontaneous
Symptomatic cerebral infarction
Cerebral artery stenosis
Risk factors
