| Objective: To observe the leukoaraiosis in patients with acute cerebral infarction by multi mode magnetic resonance imaging(MRI),and to analyze the related factors of leukoaraiosis.Method:we collected 65 acute cerebral infarction cases from September 2015 to October 2016 prospectively,which were all middle cerebral artery infarction patients and within 7 days after ACI,and collected the clinicaldata of patients,including gender,age,hypertension,diabetes,hyperli-pidemia and hyperhomocysteinemia,auxiliary examination including ECG,echocardiography,carotid ultrasonography and so on.First,the types and severity of leukoaraiosis(leukoaraiosis,LA)in patients were evaluated with MRI T1WI/T2WI/Fl AIR.Fazekas score was used to group the severity of LA.According to the DWI we evaluated the location of new infarcts(Cortex,subcortical,both).According to different area,including the cortex and subcortical,basal ganglia and thalamus and infratentorial,we statisticed the number of CMBs(cerebral microbleeds,CMBs microbleed),and MCA plaques were studied through HRMRI.Second the data were analyzed statistically,Chi square test was used to determine the distribution of the location of acute cerebral infarction in patients with different severity of LA.The relationship between LA and the number of CMBs or the distribution were analyzed by Spearman rank correlation and chi square test,respectively.The relationship between LA and the presence of large artery plaque in cerebral infarction area was analyzed by Chi square test,the relationship between leukoaraiosis and plaque location was determined by Fisher exact probability method or chi square test,multivariate logisticregression analysis was used to analyze the risk factors.Finally,the discussion and analysis are carried out.Results:1 The subjects were compared in terms of age and sexThere was no significant difference sex between the leukoaraiosis group and the control group,it showed that the sex structure between the two groups was comparable,but the difference in age was statistically significant(P=0.681).The proportion of patients in the case group older than 65 years was greater than that in the control group,indicating that the age structure between the groups was not comparable.The risk of severe leukoaraiosis is increased in patients with hypertension and history of cerebral infarction(P=0.005).2 Analysis of the influencing factors of leukoaraiosis2.1 The relationship between slow medical history and leukoaraiosisWe analyzed the relationship between hypertension,diabetes,hyperlipidemia,cerebral infarction and hyperhomocysteinemia and leukoaraiosis.The result showed that the relationship between hypertension(P=0.008,OR=7.22,95%CI 1.50-34.86)and the history of cerebral infarction(P=0.015,OR=5.0,95%CI 1.27-19.70)and leukoaraiosis was statistically significant.Especially the history of hypertension can increase 6 times,no diabetes,hyperlipidemia,and hyperhomocysteinemia were found to be associated with leukoaraiosis.2.2 The relationship between the location of infarct focus and leukoaraiosis in patients with acute cerebral infarctionComparison of the relationship between acute cerebral infarction location and LA,results showed that the relationship between infarct location and LA was not statistically significant(?2=2.59,P=0.11),so this study still could not believe that LA was associated with acute cerebral infarct location.2.3 The relationship between leukoaraiosis and micro hemorrhage According to the standard,the number of microbleeds was divided into 4levels,respectively 0~3 class,the results showed that the risk of leukoaraiosisincreased gradually with the increase of micro blood output,and the linear trend between the two was statistically significant(?2=15.58,P=0.001).2.4 The relationship between leukoaraiosis and location of micro hemorrhagic foci345 micro hemorrhagic foci were observed in this study,comparison of the distribution of micro hemorrhagic foci between the two groups,the results showed that the proportion of hemorrhage in the LA group was greater than that in the control group,and the proportion of the basal ganglia and thalamus in the control group was larger than that in the LA group,and the difference was statistically significant(?2=20.34,P=0.001).2.5 The relationship between leukoaraiosis and the presence of middle cerebral artery plaquesThe correlation between leukoaraiosis and the presence of middle cerebral artery plaques showed that the correlation between the presence of middle cerebral artery plaques and leukoaraiosis was statistically significant(?2=6.105,P=0.013),patients with plaques in the middle cerebral artery had an increased risk of severe leukoaraiosis.2.6 The relationship between leukoaraiosis and the location of plaques in the middle cerebral arteryA total of 29 patients with plaques in the middle cerebral artery were observed,of whom 4 were excluded from the middle cerebral artery occlusion,and the distribution of the plaques between the two groups was compared,the results showed that the proportion of plaques in the anterior inferior wall of the LA group was greater than that of the control group,while the proportion of the plaque in the posterior wall of the control group was larger than that of the LA group,and the difference was statistically significant(P=0.015).2.7 Multivariate logistic regression analysis of risk factorsIn this study,single factor analysis P < 0.05 factors: age,hypertension,cerebral infarction,hemorrhage and micro patches were using stepwise method into multi factor Logistic regression analysis,the result showed that age,history of cerebral infarction was the independent risk factors ofleukoaraiosis(P=0.004;P=0.012),this study showed that we still could not think that hypertension,micro hemorrhage and plaque presence was an independent risk factor for leukoaraiosis.Conclusion:1 Advanced age and the history of cerebral infarction were the independent risk factor for severe leukoaraiosis.2 There is dose response relationship between leukoaraiosis and the number of micro bleeding,with the increase of micro blood output,the risk of leukoaraiosis was increasing gradually,and the distribution of micro hemorrhagic foci in patients with different severity of leukoaraiosis was different.3 Plaques of the middle cerebral artery may be an important factor for leukoaraiosis,and the incidence of anterior and inferior wall plaques was higher in patients with leukoaraiosis.However,it was not yet believed that the middle cerebral artery plaque was an independent risk factor for leukoaraiosis. |
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