| Objective:To explore the relationship between serum homocysteine(Hcy)levels and cerebral microbleeds(CMBs)in patients with hypertensive intracerebral hemorrhage(HICH),and to analyze risk factors for CMBs in patients with HICH.Methods:We collected clinical information of HICH patients when they hospitalized from October 2017 to June 2019 in the Affiliated Hospital of Qingdao University,including age,gender,past history(diabetes,coronary artery disease,atrial fibrillation),smoking history,alcohol history,medication history(statins,hypoglycemic drugs and antihypertensive drugs),blood pressure level at admission and duration of hypertension,relevant laboratory blood test results including Hcy,lipids,glucose,activated partial thromboplastin time,prothrombin time,fibrinogen,urea nitrogen,uric acid,creatinine,and imaging data.Based on the presence of CMBs on MRI magnetic susceptibility weighted imaging,the study subjects were divided into:CMBs positive group and CMBs negative group,and the above information was compared between the two groups for statistical differences.IBM SPSS software version 25.0 was applied to statistically analyze the variables.Variables with P<0.1 were included in multifactorial logistic regression to assess the independent risk factors of CMBs.The receiver operating characteristic curve(ROC)were used to evaluate the role of serum Hcy levels on the prediction of CMBs in patients with HICH.Finally,we used spearman rank correlation and KW test to evaluate the relationship between serum Hcy levels and CMB s in patients with HICH.The difference was considered statistically significant at p<0.05.Results:1.168 patients with hypertensive intracerebral hemorrhage were included in this study,of which 102(60.7%)were in the CMBs-positive group and 66(39.3%)were in the negative group.823 CMBs lesions were found in total within the CMBs-positive group,with a predominantly deep distribution of 467(56.7%),195(23.7%)in the cerebral lobes,and 161(19.6%)in the subscenes.There were 14 patients(13.7%)with mild CMBs(1-2 lesions);65 patients(63.7%)with moderate CMBs(3-9 lesions);and 23 patients(22.6%)with severe CMB s(≥10 lesions).2.The prevalence of whole-brain CMBs(65.9%vs.46.7%,P=0.024)and deep CMBs(35.8%vs.17.8%,P=0.025)were significantly higher in patients with H-type hypertensive cerebral hemorrhage(Hcy≥10 umol/L)than in non-H-type hypertensive cerebral hemorrhage(Hcy<10umol/L)patients.However,significant difference was not found in terms of lobar and mixed CMB s.3.In the CMBs-positive group of HICH patients,Hcy levels,smoking history compositi-on ratio,Fazekas score,diastolic and systoloic blood pressure were higher than CMBs-negative patients,while LDL levels were lower than CMBs-negative patients,and the differences were statistically significant(P<0.05).Multi-factor logistic regression analysis revealed that serum Hcy level(OR=1.094,95%CI=1.019-1.174,P=0.013),Fazekas grades(OR=1.285,95%CI=1.035-1.595,P=0.023)and SBP(OR=1.034,95%CI=1.003-1.065,P=0.030)were independent risk factors for CMBs in patients with HICH.4.The ROC curve showed that serum Hcy can predict the risk of HICH combined with CMBs(AUC=0.721,95%CI=0.641-0.800,P<0.001),and the optimal threshold of the ROC curve was 11.83 μmol/L using the Youden index maximum as the cut-off point.The sensitivity was 71.6%and the specificity was 68.2%.5.Serum Hcy level was positively correlated with the severity of CMBs in patients with HICH(P=0.005,r=0.278),but not with the distribution of CMBs.Conclusion:1.CMBs are more common in patients with HICH and are mainly distributed in the deep area.2.The incidence of CMBs is higher in patients with H-hypertensive cerebral hemorrhage,and CMBs are more common in the deep part in patients with H-hypertensive cerebral hemorrhage.3.Serum Hcy level is an independent risk factor for CMBs in patients with HICH and is positively correlated with the severity of CMBs in patients with HICH.4.SBP and Fazekas scores are also independent risk factors for CMBs in HICH. |
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