| Background and objectivesIn recent years,with the development and progress of magnetic resonance imaging technology,the detection rate of CMBs has gradually increased,and more and more neurologists have begun to pay attention to CMBs and their various negative effects.CMBs refer to subclinical lesions caused by the destruction of cerebral small blood vessels,resulting in micro blood leakage and hemosiderin deposition.Previous studies have suggested that CMBs are asymptomatic,while current studies have shown that CMBs may be not only closely related to stroke,post-stroke depression and cognitive impairment,but also can predict the risk of their occurrence.However,there is no consistent study on the specific pathogenesis,risk factors and cognitive effects of CMBs.Our study analyzed the clinical and imaging data of patients with AIS in our hospital,the purpose was to investigate the risk factors of CMBs and analyze their correlation with cognitive function,so as to provide a basis for early prevention,early diagnosis and early treatment of cerebrovascular diseases and CMBs,and to reduce the prevalence of cognitive disorders.MethodsThis study retrospectively analyzed the case data of 258 patients with acute ischemic stroke who were admitted to our hospital from October 2017 to October 2018 and met the inclusion criteria of this study.According to the MRI results,they were divided into CMBs positive group and CMBs negative group.Statistical methods were used to analyze the risk factors of CMBs and their effects on cognitive function.The study further based on the Microbleed Anatomical Rating Scale to classify MBS-positive patients into mild CMBs group(1-4),moderate CMBs group(5-9),and severe CMBs group(?10)and the differences in cognitive function among the three groups were compared.Results1.General Information: A total number of 258 AIS patients were enrolled in the study,including 139 males(53.9%)and 119 females(46.1%);the mean age was 62.90±11.62 years.There were 153(59.3%)patients in the CMBs positive group,including 101 in the mild group(66.0%),29 in the moderate group(19.0%),and 23 in the severe group(15.0%).The number of CMBs are range from 1 to 30.Mild group was more common seen among all group.105 people(40.7%)in the CMBs negative group,the prevalence of CMBs was 58.9%.The CMBs of 16 patients located in infratentorial tissue,accounting for 10.5%;28 cases of CMBs involving the brain lobar,accounting for 18.3%;involving the deep brain tissue were 34 cases,accounting for 22.9%;74 patients distributed two or more areas at the same time,accounting for 48.3%.The prevalence of CMBs varied from age to age: it was 1.6% in patients younger than 40 years,5.4% in 41-50 years,17.1% in 51-60 years,and 35.3% in patients older than 60 years old.2.Analysis of risk factors for CMBs:After analyzing general and biochemical indicators of patients with positive and negative CMBs,we found that age,hypertension,history of atrial fibrillation,previous history of AIS,and history of antiplatelet and anticoagulant medications use may be the risk factors for CMBs(P<0.05).The factors above were substituted into multivariate logistic regression analysis,and the result showed that age(P=0.026,OR=0.391),hypertension(P=0.001,OR=0.359),previous history of AIS(P=0.004,OR=0.569),antiplatelet(P=0.000,OR=4.600),and anticoagulant drug use(P=0.021,OR=6.066)may be the independent risk factors for CMBs.3.Correlation between CMBs and cognitive function: After analyzing the MMSE and MOCA total scores of the two groups of patients and the scores in various cognitive fields,it was found that the scores of MMSE,MOCA total score and execution ability,attention,language,abstract thinking,delayed memory and orientation were significantly lower in the CMBs positive group than in the CMBs negative group,which was statistically significant(P<0.05).4.Differences in cognitive function among patients with different degrees of CMBs: The orientation and executive scores of patients with severe CMBs were lower than those of patients with mild to moderate CMBs(P<0.05);attention,language,abstraction of patients with moderate and severe CMBs,both thinking and delayed recall scores were smaller than those in the mild CMBs group,P < 0.05.5.Correlation between the number of CMBs and cognitive function: After adjusting for age,previous AIS history,education years and other factors,the Spearman rank correlation test found that the number of CMBs was not only negatively correlated with MOCA score(r=-0.471,P<0.05),there was also a negative correlation between cognitive domains such as execution force(r=-0.328,P<0.05),attention(r=-0.458,P<0.05),language(r=-0.388,P<0.05),abstract thinking(r=-0.329,P<0.05),delayed memory(r=-0.406,P<0.05),and orientation(r=-0.259,P<0.05).Conclusions1.Age,hypertension,history of AIS,previous antiplatelet,anticoagulant drug use history are independent risk factors for CMBs.2.CMBs may lead to cognitive decline,especially in terms of executive power,attention,language,abstract thinking,delayed memory,orientation,and so on.3.The more the number of CMBs in patients with AIS,the more serious decline in cognitive function. |
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