| Background and purposeCerebral small vessel include small artery, small vein and arteriole. Now researchers prefume that the definition of Cerebral small vessel disease is the abnormality of the artery, whose diameter is below 400um. It contain cerebral lacune infarction, cerebral hemorrhage, leukoaraiosis,Binswanger's disease.LA is the clinical syndrome caused by a variety of different causes, which described by MRI (Magnetic Resonance Imaging, MRI).But the pathology and pathogenesis of LA remain unclear, there is still controversy.Studys found that LA had a higher prevalence in the aged, and closely related with cognitive impairment in patients, have a epidemiological link with cerebrovascular disease, particularly lacunar infarction and cerebral hemorrhage.Cerebrovascular disease especially the ischemic stroke are often accompanied by LA.Patients who had a history of stroke and vascular cognitive dysfunction are often suffering with LA.Patients who had a serious LA have a higher risks of suffering stroke and myocardial infarction, and stroke recurrence rate are significantly higher.Cerebral microbleeds (CMBs) is a kind of cerebral microvascular changes, which is described in the MRI susceptibility weighted imaging(SWI),and the exact pathogenesis and clinical significance of which are unclear. Pathology studys have confirmed that CMBs is the perivascular hemosiderin deposition, the diseased region is usually<1.5cm, and have small peripheral infarction. CMBs is considered having correlation with cognitive impairment, cerebral hemorrhage, stroke,hypertension, diabetes and atherosclerosis risk factors such as hyperlipidemia, etc.CMBS have potential value in clinical diagnosis, prevention,treatment and prognosis judgment of hemorrhagic and ischemic stroke.It is of clarify the pathogenesis of importance clinical significance to clarify the pathogenesis.ObjectsThere were 113 cases be colleted in this study,which were being hospitalized in june 2009 to December 2009.Sixtyeight cases of theme were being hospitalized in neurology department in NanFang Hospital and the other fortyfive cases were in neurology department in ShanTou Center Hospital.Seventyfour cases are male (69.9%),thirtynine casas are female(30.1%).The average age is 61.33±1.32 years. Fortyone patients were without stroke.Fortyfive patients had lacunar infarction. Sixteen patients had stroke such as cerebral infarction or intracerebral hemorrhage excepting lacunar infarction.Eleven lacunar infarction patients were with other stroke.Methods1.The information of the patients are including sex, age, smoking, drinking, hypertension,diabetes, cholesterin(CHOL),triglyceride(TG),high density lipoprotein (HDL),low density lipoprotein(LDL), fibrinogen(FIB).All cases were examinated by MRI,which including T1WI,T2WI,FLAIR, SWI. LA is scored and classificated according to MRI.According to Schelten'method, PVCLA is scored from 0-12 scores,classificated from 0-3 levels.LA in subcortex is classificated from 0-3 levels.We measured the CCR。Scoring the CMBs in 4 areas as follows:(1)massive cortical;(2) basal ganglia and thalamus;(3)brain stem; (4) cerebellum。The severity of CMBs is classificated to 4 levels by CMBs'number: level-0,0 piece;level-1,1-4 pieces;level-2,5-9 pieces;level-3,more then 10 pieces.2.The data is statisticsed by software SPSS 13.0.Mean of measurement data is signifed as x±s,counting data is analysised byχ2 test.The other test be used are as followed:Spearman test, Kruskal Wallis H test, Mann Whitney test, Binary Logistic analysis.The significant level is a=0.05。Result1.PVCLA is sighificant correlation of age,hypertension,diabetes,lacunar infarction,SBP,GLU,CHOL.χ2/Z=5.634,12.932,7.953,13.673,2.862,2.808, 3.152;P=0.000,0.000,0.005,0.000,0.004,0.005,0.002.LA in subcortex is sighificant correlation of age,hypertension, lacunar infarction, SBP, DBP, CHOL.χ2/Z=4.768,17.134,5.979,3.840,2.999,3.330;P=0.000,0.000,0.014,0.000,0.003, 0.001.2.PVCLA and LA in subcortex are analysised with risk factores of blood vessel by Spearman test. PVCLA is sighificant correlation of age,drinking, hypertension, diabetes, lacunar infarction,SBP,DBP, GLU in the result.rs=0.579,0.221,0.481, 0.247,0.447,0.377,0.270,0.186;P=0.000,0.019,0.000,0.008,0.000,0.000,0.004, 0.048.LA in subcortex is sighificant correlation of age,hypertension, lacunar infarction,SBP,DBP, CHOL in the result. rs=0.451,0.389,0.230,0.363,0.283, 0.315;P=0.000,0.000,0.014,0.000,0.002,0.001.3.The level of PVCLA and LA in subcortex are analysised with risk factores of blood vessel by Spearman test. The level of PVCLA is sighificant correlation of age, drinking,hypertension, diabetes, lacunar infarction,SBP,DBP, in the result. rs=0.606,-0.257,0.428,0.236,0.791,0.382,0.258;P=0.000,0.006,0.000,0.012, 0.000,0.000,0.006.The level of LA in subcortex is sighificant correlation of age, hypertension, lacunar infarction, SBP,DBP, CHOL in the result. rs=0.488,0.416, 0.319,0.386,0.326,0.231;P=0.000,0.000,0.001,0.000,0.000,0.014.4.LA is analysised with risk factores of blood vessel by Bivariate Logistic.LA is sighificant correlation of age,hypertension,SBP, lacunar infarction in the result. OR=1.071,4.106,2.855,7.931;P=0.024,0.002,0.022,0.005.As controlling factors, LA is analysised with risk factores of blood vessel by Partial.With controlling hypertension and lacunar infarction, LA is sighificant correlation of age in the result. rs=0.405,P=0.000.With controlling hypertension and age, LA is sighificant correlation of lacunar infarction in the result.rs=0.202,P=0.034. With controlling lacunar infarction and age,LA is not correlation of hypertension in the result. rs=0.109, P=0.253.5.CMBs is analysised with risk factores of blood vessel.CMBs is sighificant correlation of age, hypertension, diabetes, lacunar infarction, SBP, DBP, GLU,HDL in the result. x2/Z=5.034,8.759,15.718,6.451,2.862,2.318,2.652,2.595;P=0.000, 0.003,0.000,0.011,0.004,0.020,0.011,0.017.6.CMBs's scoring and CMBs's classification are respectively analysised with risk factores of blood vessel by Spearman test.CMBs's scoring is sighificant correlation of hypertension,lacunar infarction, SBP, DBP, GLU in the result. rs= 0.459,0.350,0.515,0.579,0.261;P=0.002,0.022,0.000,0.000,0.005.CMBs's classification is sighificant correlation of age, hypertension, diabetes, lacunar infarction, SBP, DBP, GLU, HDL in the result. rs=0.470,0.320,0.412,0.253,0.268, 0.195,0.273,-0.256;P=0.000,0.001,0.000,0.007,0.004,0.039,0.003,0.006.7.CMBs is analysised with risk factores of blood vessel by Bivariate Logistic. CMBs is sighificant correlation of age, diabetes, SBP, lacunar infarction in the result. OR=1.077,3.671,1.271,2.634,2.349;P=0.001,0.015,0.001,0.035,0.036,0.001.CMBs's classification is analysised with risk factores of blood vessel by Linear Regression. The result as follows:CMBs's classification is sighificant correlation of age(B=0.018,t=2.259, P=0.026) and diabetes(B=0.774,t=2.789, P=0.006).As controlling the fators, CMBs is analysised with risk factores of blood vessel by Partial.The result as follows:with controlling hypertension, diabetes, lacunar infarction, CMBs is sighificant correlation of age (rs=0.357,P=0.000).With controlling age, diabetes, lacunar infarction, CMBs is sighificant correlation of hypertension(rs=0.032, P=0.751).With controlling hypertension, age, lacunar infarction, CMBs is sighificant correlation of hypertension diabetes (rs= 0.278, P=0.003).With controlling hypertension, diabetes, age, CMBs is sighificant correlation of lacunar infarction(rs=0.035,P=0.714).8.The areas that CMBs happened are different. x2=47.487,P=0.0018.As comparing each area, massive cortical VS basal ganglia and thalamus and massive cortical VS brain stem and massive cortical cerebellum and basal ganglia VS cerebellum is Z=4.075,6.218,4.751,3.047;P=0.000,0.000,0.000,0.002.9.Patients with both LA and CMBs is sighificant correlation of age, diabetes, lacunar infarction,GLU,HDL.χ2/Z=2.858,7.579,4.753,2.423,2.151.P=0.004, 0.006,0.029,0.005,0.034.10.The distribution of CMBs's classification in different classification of PVCLA is different.χ2=36.438,P=0.000.The distribution of CMBs's classification in different classification of LA in subcortex is different either.χ2=25.811, P=0.002. Level-3 CMBs in total Level-2 and Level-3 of PVCLA is 84.7%,and in total Level-2 and Level-3 of LA in subcortex is 61.64%.11.There are sighificant correlation between CMBs and LA,CMBs's classification and classification of PVCLA, CMBs's classification and classification of LA in subcortex, classification of PVCLA and classification of LA in subcortex. rs=0.439,0.506,0.448,0.787.P=0.000,0.000,0.000,0.000.12.The relation between CCR and LA in subcortex, CCR and classification of LA in subcortex, CCR and CMBs are inverse correlation. rs=-0.146,-0.188,-0.145; P=0.040,0.046,0.042.13.As controlling age, hypertension, diabetes, lacuna infarction,CCR with CMBs and classification of LA in subcortex are still inverse correlation.rs=-0.197,-0.180.P=0.040,0.031.14.PVCLA, LA in subcortex, CMBs are respectively divide into normal group and disease group.Then two groups analysis by ROC curve.The result as follows: the areas of PVCLA, LA in subcortex, CMBs are 0.392,0.400,0.404,(<0.50). P=0.092,0.076,0.089.15.Analysis the difference between CCR and the classification of LA in subcorte. The result is F=1.331,P=0.269(>0.05).Analysis the difference between CCR and the classification of PVCLA. The result is F=1.307,P=0.276.Analysis the difference between the classification of LA in subcorte and PVCLA.The result is F=1.444, P=0.234.16.Analysis CCR and the classification of LA in subcorte by Linear. The result is t=-2.000,P=0.048.Conclusion1.Senility, hypertension, SBP, lacunar infarction, CHOL are risk factors for LA。Age,hypertension, lacunar infarction are significantly collated with LA.Age, lacunar infarction are independenct risk factors.2.Senility, hypertension, diabetes, lacunar infarction, low HDL are risk factors for CMBs。Age, diabetes are independenct risk factors.CMBs happened in different areas such as massive cortical>basal ganglia and thalamus>brain stem and cerebellum.3.Senility, diabetes, lacunar infarction, hyperglycemia, low HDL are risk factors for patients LA with CMBs。CMBs and LA are risk factors to each other. There's inverse correlation between CCR and LA, CCR and CMBs. CMBs and LA are independenct risk factors for corpus callosum shrinking.
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