Research On Risk Factors Of CMBs And Its Correlation With APOE Genotype In Patients With Ischemic Stroke

Objective: To explore the risk factors of cerebral microbleeds in patients with ischemic stroke and its correlation with APOE genotypes,in order to make early intervention on the potential risk factors,so as to improve the prognosis of patients with ischemic stroke complicated with cerebral microbleeds.Methods: A total of 208 patients with acute ischemic stroke diagnosed in the Department of Neurology of Shaanxi Provincial people’s Hospital from January 2018 to July 2020 were collected.During hospitalization,T1-weighted imaging,T2-weighted imaging,fluid-attenuated inversion recovery,diffusion weighted imaging,susceptibility-weighted imaging and laboratory examination were performed.The films were reviewed and evaluated by 2 experienced imaging doctors,according to the occurrence,location and severity of CMBs.According to the allele phenotype,the APOE gene was divided into three subtypes: APOE ε 2,APOE ε 3 and APOE ε 4.Univariate,binary and multivariate ordinal logistics regression were used to analyze the risk factors of CMBs,the risk factors of CMBs in different sites and the risk factors of CMBs with different severity.Results:1.A total of 269 patients with ischemic stroke were diagnosed in the Department of Neurology,61 cases were excluded according to the criteria,and finally included in the Department of Neurology.Among them,more than one CMBs,was detected in 53 cases(40%),single lobar CMBs,77 in 53 cases(60%)and deep CMBs,in 22 cases(17%).The severity of CMBs was classified as mild in 43 cases(33%),moderate in 37 cases(28.5%)and severe in 50 cases(38.5%).Among the 208 subjects,there were three subtypes of APOE genotypes,including 29 cases of APOE ε 2(13.9%),116 cases of APOE ε 3(55.8%)and 63 cases of APOE ε 4(30.3%).2.CMBs was detected in 18 cases(13.8%)in the age group of 41-60 years old,was detected in the 61-80 age group(76.9%).Overall,the incidence of CMBs in males is slightly higher than that in females,with a ratio of 43 percent to 18.8 percent.3.Analysis of risk factors for the occurrence of CMBs: there were 130cases(62.5%)in CMBs group,91 males with(70%),age 33-88(68.15 ±9.388),78 patients without CMBs(37.5%),53 males(67.9%),age 32-86(65.21 ±11.86).4.Univariate analysis of CMBs: there were significant differences in current smoking,previous drinking,current drinking(severe)),admission systolic blood pressure,serum cystatin C,serum homocysteine,fasting blood glucose,APOE ε 4 genotype,white matter hypersignal,brain atrophy,carotid atherosclerosis(p<0.05).5.Multivariate analysis of CMBs: there were significant differences in smoking,admission systolic blood pressure,high signal intensity of white matter and APOE ε4genotype(p<0.05).6.Analysis of risk factors of CMBs in different sites: strict cerebral lobe group: 53cases(40%),male 37 cases(69.8%),age 34-85(69.8 ±9.68).Deep group 77 cases(60%),male 54 cases(70.1%);age(67.09 ±9.09).7.Univariate analysis of CMBs at different sites showed that there were significant differences in alcohol consumption(severe),admission systolic blood pressure(SBP)and APOE ε4 genotypes(p<0.05).8.Multivariate analysis of CMBs in different parts showed that APOE ε4 was significantly different(p < 0.05).9.Analysis of risk factors of CMBs with different severity: 32 males(74.4%)in mild group,age 48-88(69.47 ±9.53).There were 29 males(74.7%)in the moderate group,aged 33-85(67.92 ±11.13).Severe group: 29 males(61.7%),aged 50-83(67.23 ±7.67).10.CMBs univariate analysis of different severity: there were significant differences in heavy drinking,previous history of coronary heart disease,previous history of ischemic stroke and history of statins use(p < 0.05).11.Current heavy drinking,previous coronary heart disease and previous history of ischemic stroke are risk factors for the severity of CMBs(p<0.05).Conclusion1.The incidence of CMBs in patients with ischemic stroke is very high,and there is a correlation between the existence of CMBs and cerebrovascular ischemic events.2.Smoking,high systolic blood pressure(SBP),high white matter signal and APOEε4 genotype are the risk factors of CMBs in patients with ischemic stroke.3.APOE ε4 genotype is a risk factor for strict lobar CMBs.4.Current heavy drinking,previous coronary heart disease and previous history of ischemic stroke are risk factors for the severity of CMBs.