Preliminary Study Of Intracranial Vascular Status And Related Risk Factors In Patients With Hypertensive Intracerebral Hemorrhage

Objective: To investigate the characteristics of intracranial vascular status in patients with hypertensive intracerebral hemorrhage and to analyze the related risk factors so as to provide reference for the evaluation,treatment and secondary prevention of hypertensive intracerebral hemorrhage.Methods: Patients with acute hypertensive intracerebral hemorrhage who were admitted to the Department of Neurology,Affiliated Hospital of Qingdao University from January 2014 to February 2017 were selected as study subjects.All patients were diagnosed with CT examinations.The brain MRI,MRA or CTA,and SWI examinations were improved early.The clinical data,laboratory test results,and imaging data were recorded.The intracranial arterial stenosis and cerebral small vessel disease in hypertensive intracerebral hemorrhage patients were counted.Chi-square test and t-test were used to compare the relative risk factors in different vascular states,and multivariate logistic regression analysis was used to analyze the independent risk factors in different vascular states.Results: 342 patients with acute cerebral hemorrhage were enrolled in this study and divided into four groups according to intracranial vascular status.There were 76 cases(22.2%)only with intracranial arterial stenosis,of which 40 cases(11.7%)had single large stenosis and 36cases(10.5%)had two or more large stenoses.There were 45 cases(13.2%)only with cerebral small vessel disease,15 cases(4.4%)with intracranial arterial stenosis and cerebral small vessel disease.There were 206 cases(60.2%)without intracranial aortic stenosis or cerebral small vessel disease.Of the 342 patients in the study,35(10.2%)had middle cerebral artery stenosis,24(7%)had anterior cerebral artery stenosis,and 30(8.7%)had posterior cerebral artery stenosis.There were 15 cases(4.4%)of internal artery(intracranial)stenosis and 10 cases(2.9%)of vertebrobasilar artery stenosis.In 342 hypertensive intracerebral hemorrhage patients,there were 85 cases(45.9%)of white matter lesions,72cases(21%)of brain microbleeds,10 cases(2.9%)of enlarged perivascular spaces,and lacunas Thirty patients(8.8%)had new MI 6(1.8%).Compared with no intracranial arterial stenosis group,the intracranial arterial stenosis group were older,had more history of smoking and diabetes mellitus,and had higher levels of LDL,total cholesterol and blood glucose(p <0.05).There was more history of ischemic stroke and a higher proportion ofbrain stem hemorrhage(P < 0.05).Multivariate logistic regression analysis showed that there was a significant difference in age(OR=2.446,P<0.01)and diabetes(OR=1.811,P<0.05).Compared with no cerebral small vessel disease group,patients with cerebral small vessel disease were older,had more history of diabetes and a higher CRP level.(p<0.05).There was more history of ischemic stroke and a higher proportion of brain stem hemorrhage(P <0.05).Multivariate logistic regression analysis showed that there was a statistically significant difference in age(OR=2.354,P<0.05).Conclusion: In all subjects,22.2% of hypertensive intracerebral hemorrhage patients had intracranial arterial stenosis.Compared with intracranial arterial stenosis,the proportion of patients with cerebral small vessel disease was low,accounting for 13.2%.In the further statistical analysis,the highest rate of middle cerebral artery stenosis was found,and white matter lesions were more common.Age and diabetes are independent risk factors for intracranial arterial stenosis in patients with hypertensive intracerebral hemorrhage.Age is an independent risk factor for hypertensive intracerebral hemorrhage with cerebral small vessel disease.The intracranial vascular status of patients with hypertensive intracerebral hemorrhage is more complex.It is necessary to further complete the brain MRI,MRA,SWI and other relevant examinations after diagnosis,especially in the older patients with diabetes,which is helpful to assess the risk of hypotension.To provide reference for individualized treatment and secondary prevention in patients with hypertensive intracerebral hemorrhage.