Analysis Of Risk Factors Of Cerebral Microbleeds In Patients With Acute Ischemic Stroke

ObjectiveThe purpose of this study is to explore the incidence,distribution and risk factors of cerebral microbleeds in patients with acute ischemic stroke.Methods1.Patients who were diagnosed as acute ischemic stroke(AIS)were enrolled in Shandong Provencial Qianfoshan Hospital from January 1,2019 to January 31,2021,and patients meet with the Korean modified TOAST classification as large-artery atherosclerosis.The general clinical data,relevant laboratory data and brainmagnetic resonance which included with diffusion-weighted imaging(DWI),susceptibility weighted imaging(SWI)and another imaging data were collected.The incidence,distribution and severity of cerebral microbleeds(CMBs)were analyzed.2.The patients were divided into the CMBs group and the non-CMBs group firstly,then the CMBs group was divided into the lobar type,deep/infratentorial type or mixed type according to the location of CMBs.According to the number of CMBs,they were divided into the grade 1(1-3 CMBs),grade 2(4-6 CMBs),and grade 3(more than 7 CMBs).The risk factors of CMBs were analyzed respectively in the above groups.3.According to the type of blood pressure in patients with hypertension,the patients were divided into H-type hypertension group,non-H-type hypertension group,then the relationship between hypertension and CMBs was analyzed;According to the duration of hypertension,the patients were divided into four groups:0 year,0-5 years,6-10 years and more than 10 years,then the relationship between the duration of hypertension and the severity of CMBs was analyzed.All statistical analyses were performed using SPSS version 22.0.A two-sided P value less than 0.05 was considered significant statistically.Results1.A total of 175 patients were enrolled in this study,including 60 patients with CMBs(34.29%)and 115 patients without CMBs(65.71%).Among the patients with CMBs,there were 38 patients with CMBs grade 1(63.33%),13 patients with CMBs grade 2(21.67%),9 patients with CMBs grade 3(15%).Seventeen patients(28.33%)had lobar CMBs strictly,15 patients(25%)had deep/infratentorial CMBs strictly,28 patients(46.67%)had mixed CMBs.2.The constituent ratios of hypertension,leukoaraiosis,the history of ischemic cerebrovascular diseases,taking antiplatelet drugs or statins in CMBs group were higher than those in non-CMBs group,and the differences were significant statistically(P<0.05).Further binary Logistic regression analysis showed that leukoaraiosis and the history of ischemic cerebrovascular diseases were independent risk factors of CMBs(P<0.05).There were no statistical differences in the gender,history of diabetes,history of smoking,history of drinking alcohol,blood homocysteine(Hcy),triglyceride(TG),total cholesterol(TC),high-density lipoprotein(HDL),low-density lipoprotein(LDL),serum Cystatin C(Cys-C),uric acid,neutrophil-to-lymphocyte ratio(NLR),high-sensitivity C-reactive protein(Hs-CRP),and glycated hemoglobin Alc(HbAlC)between these two groups(P>0.05).3.The constituent ratios of the leukoaraiosis and the history of ischemic cerebrovascular diseases were different statistically among the lobar type,deep/infratentorial type and mixed type(P<0.05).Further analysis of pairwise comparison showed that the difference in the constituent ratio of leukoaraiosis between deep/infratentorial type and mixed type of CMBs was significant statistically(P<0.0167).There were statistical differences in the constituent ratios of the history of ischemic cerebrovascular diseases between lobar type and deep/infratentorial type,the lobar type and mixed type,the deep/infratentorial type and mixed type(P<0.05).In addition,there were no statistical differences in gender,smoking,drinking alcohol,hypertension,diabetes,taking antiplatelet medications or statins,age,Hcy,TG,TC,HDL,LDL,Cys-C,uric acid,NLR,Hs-CRP and HbA1C among these three groups(P>0.05).4.There were statictical differences in NLR and Hcy among the CMBs grade 1,grade 2 and grade 3(P<0.05).Further pairwise comparison showed that there was a statistical difference in NLR between CMBs grade 1 and grade 3,and there was a statistical difference in Hcy between CMBs grade 2 and grade3(P<0.05),another results showed that there were no statistical differences in gender,leukoaraiosis,smoking,drinking alcohol,hypertension,the history of ischemic cerebrovascular diseases,diabetes,taking antiplatelet medications or statins,age,TG,TC,HDL,LDL,Cys-C,uric acid,Hs-CRP and HbA1C among these three groups(P>0.05).5.The constituent ratios of H-type hypertension in the CMBs group and non-CMBs group were 93.9%and 85.5%,respectively,and there were no statistical differences between these two groups(P>0.05).The constituent ratios of H-type hypertension among the CMBs gradel-3 groups were 92.9%,100.0%,87.5%,respectively,and there were no statistical differences among these three groups(P>0.05).The constituent ratios of H-type hypertension among the lobar type,deep/infratentorial type and mixed type were 100.0%,92.3%,92.0%,respectively,and there were no statistical differences among these three groups(P>0.05).6.The relationship between the classification of the hypertension course and the grade of CMBs was analyzed by Spearman correlation.The results showed that the Spearman’s correlation coefficient was 0.316(P<0.05),indicating that there was a positive correlation between the course of hypertension and the severity of CMBs.Conclusions1、CMBs is common in patients with acute ischemic stroke,and its detection rate in this study was 34.29%,among which mixed cerebral microbleeds was the most common,accounting for 46.67%.2、In patients with acute ischemic stroke,hypertension,taking antiplatelet drugs or statins,the increase of NLR level are risk factors for CMBs,while leukoaraiosis and the history of ischemic cerebrovascular disease are independent risk factors of CMBs.In addition,the course of hypertension is positively correlated with the severity of cerebral microbleeds.3、Patients with mixed CMBs are most often to be complicated with leukoaraiosis,and patients with lobar CMBs are most often to be complicated with the history of ischemic cerebrovascular diseases.