大动脉粥样硬化型脑梗死患者脑微出血的危险因素及预后分析

Risk Factors and Prognostic Analysis of Cerebral Microbleeds in Patients with Large Artery Atherosclerotic Stroke

摘要: 目的：探讨合并脑微出血(cerebral microbleeds, CMB)大动脉粥样硬化型脑梗死(large artery ather-osclerotic stroke, LAAS)患者的危险因素，以及脑微出血对大动脉粥样硬化型脑梗死预后影响。方法：纳入2016~2022年就诊于青岛大学附属医院的大动脉硬化型脑梗死患者353例，依据是否有脑微出血分为有CMB组与无CMB组，分析LAAS患者发生CMB的影响因素以及CMB对LAAS患者预后的影响。结果：多因素Logistic回归分析结果显示年龄(P = 0.043)和高血压病史(P = 0.004)是LAAS患者CMB的危险因素。Kaplan-Meier生存分析示，有CMB组平均生存时间、累计生存率低于无CMB组患者，对LAAS患者进行单因素COX回归分析，两组在再发脑梗死以及全因死亡结局上均存在显著差异，CMB组更容易发生以上结局，两组在颅内出血结局上无显著差异。总体而言，有CMB组患者比无CMB组患者更易出现不良预后(HR = 0.397, 95% CI, 0.260~0.606; P = 0.000)。对有CMB组进行多因素COX回归分析示，年龄和血清C反应蛋白(C-reactive protein, CRP)水平是LAAS患者的预后不良(包括再发脑梗死、颅内出血、全因死亡)的独立危险因素。结论：年龄和既往高血压病史是LAAS患者CMB发生的常见原因。CMB增加了LAAS患者再发脑梗死以及全因死亡的风险，但不增加颅内出血的风险。年龄和血清CRP水平是合并CMB的LAAS患者预后不良的独立危险因素。

Abstract: Objective: To investigate the risk factors of cerebral microbleeds (CMB) in patients with large artery atherosclerotic stroke (LAAS) and the effect of cerebral microbleeds on the prognosis of large artery atherosclerotic stroke. Methods: 353 patients with cerebral infarction due to large artery atherosclerosis in the Affiliated Hospital of Qingdao University from 2016 to 2022 were enrolled in this study, which were divided into CMB group and non-CMB group based on the presence or absence of cerebral microbleeds to analyze the factors influencing the occurrence of CMB in LAAS patients and the impact of CMB on the prognosis of LAAS patients. Results: Multifactorial logistic regression analysis showed that age (P = 0.043) and history of hypertension (P = 0.004) were risk factors for the development of CMB in patients with LAAS. Kaplan-Meier survival analysis showed that the group with CMB had a shorter overall survival than the group without CMB. Conducting univariate COX regression analysis on LAAS patients, significant differences were observed in both recurrent stroke and overall mortality outcomes between the two groups. The non-CMB group was less prone to experiencing the aforementioned outcomes, with no significant difference between the groups in terms of cerebral hemorrhage outcomes. Univariate COX regression analysis of patients with LAAS showed that patients in the group with CMB were more likely to have a poor prognosis than those in the group without CMB (HR = 0.397, 95% CI, 0.260~0.606; P = 0.000). Multifactorial COX regression analysis of the group with CMB showed that age and C-reactive protein were the risk factors for poor prognosis in patients with LAAS who developed CMB. Conclusions: Age and a history of previous hypertension are common causes of CMB in patients with LAAS. CMB increases the risk of recurrent cerebral infarction as well as all-cause mortality in patients with LAAS, but not cerebral hemorrhage. Age and serum CRP levels are independent risk factors for poor prognosis in patients with LAAS.