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目的探讨脑血管疾病致脑微出血(CMBs)的影响因素分析及其治疗。方法选取赣州市南康区中医院神经内科2015年4月—2017年4月收治的脑血管疾病患者100例,根据有无并发CMBs分为CMBs(+)组58例,CMBs(-)组42例。搜集患者的一般资料、血液检查指标等,采用多因素非条件logistic回归分析脑血管疾病患者并发CMBs的危险因素,根据患者血浆TC水平分为降脂组(n=30)和非降脂组(n=28),降脂组患者给予阿托伐他汀20 mg/d;非降脂组患者未给予阿托伐他汀治疗。3个月后复查SWI,并复查比较血浆总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)。结果两组患者性别、年龄、吸烟史、饮酒史者所占比例、合并急性脑梗死、短暂性脑缺血发作、高血压、冠心病、糖尿病、腔隙性脑梗死、高低密度脂蛋白、高同型半胱氨酸血症者所占比例比较,差异无统计学意义(P>0.05);CMBs(+)组患者合并脑出血、高总胆固醇血症、高尿酸血症者所占比例高于CMBs(-)组(P<0.05)。CMBs(+)组患者病发区域以皮质-皮质下及基底节-丘脑最为常见,患者病情多为轻度,但亦可发展至重度。经多因素logistic回归分析结果显示,脑出血、高总胆固醇血症、高尿酸血症是脑血管疾病患者并发CMBs的危险因素(P<0.05)。治疗前,两组患者TC、LDL-C、出血灶数目比较,差异无统计学意义(P>0.05);治疗后,降脂组患者TC、LDL-C低于非降脂组,出血灶数目少于非降脂组(P<0.05),且降脂组患者各指标治疗前后比较,差异有统计学意义(P<0.05),但非降脂组患者治疗前后各指标间无差异(P>0.05)。结论脑出血、高总胆固醇血症、高尿酸血症是脑血管疾病患者并发CMBs的危险因素,且采用阿托伐他汀钙治疗可有效降低患者TC及LDL-C水平,对CMBs患者具有良好的治疗效果。
Objective To investigate the influencing factors and treatment of cerebral micro-hemorrhage (CMBs) caused by cerebrovascular diseases. Methods One hundred patients with cerebrovascular disease admitted from April 2015 to April 2017 in Nankang Hospital of Traditional Chinese Medicine, Ganzhou were enrolled. According to the presence or absence of CMBs, 58 patients were divided into CMBs (+) group and 42 example. Collecting the general information of patients and blood test indexes, using multivariate non-conditional logistic regression analysis of risk factors of CMBs in patients with cerebrovascular disease, according to the level of plasma TC in patients with lipid-lowering (n = 30) and non-lipid-lowering n = 28). Patients in the lipid-lowering group were given atorvastatin 20 mg / d. Patients in the non-lipid-lowering group were not given atorvastatin. Three months later, the SWI was reviewed, and the levels of plasma total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were compared. Results There were no significant differences in sex, age, smoking history, drinking history, acute cerebral infarction, transient ischemic attack, hypertension, coronary heart disease, diabetes, lacunar infarction, high and low density lipoprotein, (P> 0.05). The proportion of patients with CMBs (+) with cerebral hemorrhage, hypercholesterolemia, and hyperuricemia was significantly higher than those with high homocysteinemia In CMBs (-) group (P <0.05). Cumulative lesions in the CMBs (+) group were most common in the cortical-subcortical and basal ganglia-thalamus. Patients in the CMBs (+) group were mostly mild but also developed to severe. Multivariate logistic regression analysis showed that cerebral hemorrhage, hypercholesterolemia and hyperuricemia were risk factors of CMBs in patients with cerebrovascular disease (P <0.05). Before treatment, the TC, LDL-C and the number of hemorrhagic foci in the two groups had no statistical significance (P> 0.05). After treatment, the TC and LDL-C in the hypolipidemic group were lower than those in the non- (P <0.05). There was a significant difference between before and after treatment in each group (P <0.05), but there was no significant difference between before and after treatment in non-lipid-lowering group (P> 0.05). Conclusions Cerebral hemorrhage, hypercholesterolemia and hyperuricemia are risk factors of CMBs in patients with cerebrovascular disease. And atorvastatin calcium treatment can effectively reduce the level of TC and LDL-C in patients with CMBs, treatment effect.