| BackgroundPrevious studies have reported that cerebral microbleeds (CMBs)were always seen in patients with white matter hyperintensities(WMH). Moreover, the severity of WMH has a positive correlation with the number of CMBs. Pathological researches have proved that the pathologic change of CMBs was different according to CMBs’ distribution. For CMBs located in the perforator artery supply area, the main pathological change was hypertensive arteriopathy, while for the CMBs located in lobar, their main pathological change was cerebral amyloid angiopathy(CAA).ObjectiveTo explore the risk for CMBs distribute in different regions, and evaluate the affects of CMBs distribute in different regions to future stroke.MethodsWe conducted a continuously prospective study including patients with WMH whom signed a Informed Consent to receive a Magnetic Resonance Imaging scan, from July,2011to January,2014. We then evaluated the CMBs on the magnitude images of ESWAN(enhanced gradient echo T2star weighted angiography) sequence, and devided CMBs into deep CMBs and lobar CMBs according to the Microbleed Anatomical Rating Scale, which was used to devided CMBs according to their distributions. We analysed the baseline characteristics and their influence on future stroke of deep CMBs and lobar CMBs respectively, and we used logistic regression analysis to adjust the Confounding factors.Results151patients were included in our study, and their mean age was68.0(29.0-85.0) years old, the proportion of men was54.3%. There were90patients had CMBs, among them83patients with deep CMBs while68patients with lobar CMBs and61patients with deep combined lobar CMBs. For deep CMBs patients, the frequency of hypertension and the frequency of previous stroke was higher than those without deep CMBs(84.3%vs70.6%, p=0.049and33.3%vs16.4%, p=0.037,respectively). The concentration of serum homocysteine was higher in patients with deep CMBs (16.47±7.31vs12.45±3.86umol/l,p=0.001),while serum TT3(3.92±0.67vs4.16±0.69pmol/1, p=0.046) and TT4(92.13±27.66vs108.09±56.55pmol/l,p=0.029) were lower in patients with deep CMBs. Moreover after multi-variate analysis higher serum homocysteine was an independent predictor of deep CMBs (OR=1.16,95%CI:1.05-1.28, p-0.004)Men was more seen in the patients with lobar CMBs (67.6%vs44.6%, p=0.005). Serum TT4was lower in patients with lobar CMBs (88.90±27.07vs107.69±51.81pmol/l,p=0.010), and after adjusted for serum homocysteine and the frequency of previous stroke, male (OR=2.36,95%CI:1.16-4.83, p=0.018) and lower serum TT4(OR=0.98,95%CI:0.97-0.99, p=0.013)There were18patients (7for intracranial hemorrhage and11for ischemic stroke)suffered a stroke in the follow-up period. Univariate analysis show that deep CMBs,diabetes mellitus and previous stroke were more seen in the patients with future stroke, and logistic regression showed that CMBs (OR=6.24,95%CI:1.28-30.49, p=0.024),diabetes mellitus (OR=6.07,95%CI:1.94-18.97, p=0.002) and previous stroke (OR=4.29,95%CI:1.39-13.23, p=0.011) were independent predictors of future stroke.ConclusionsFor deep CMBs, higher serum homocysteine was its independent predictor, while for lobar CMBs, male and lower serum TT4were its independent predictors, that means risk for deep CMBs and lobar CMBs were different in patients with WMH. Moreover, deep CMBs not lobar CMBs was an independent predictors of futrue stroke in patients with WMH. |
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