Naka H, Nomura E, Takahashi T, Wakabayashi S, Mimori Y, Kajikawa H, Kohriyama T, Matsumoto M
Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
AJNR Am J Neuroradiol. 2006 Apr;27(4):830-5.
Previous studies have shown microbleeds to be a risk factor for intracerebral hemorrhage and white matter hyperintensity (WMH) to be a risk factor for ischemic stroke. This study was performed to determine whether combinations of the presence or absence of microbleeds and advanced WMH are risk factors for subsequent recurrent stroke types.
In 266 patients with stroke, microbleeds on T2*-weighted MR images were counted, and WMH on T2-weighted images was graded. Patients were divided into 4 groups by the combinations of the presence or absence of microbleeds and advanced WMH and were followed up for stroke recurrence.
During a mean follow-up period of 564.8 +/- 220.5 days, 26 patients developed recurrent strokes, including 10 intracerebral hemorrhages and 16 ischemic strokes. Patients with microbleeds without advanced WMH (n = 42) developed only intracerebral hemorrhages (n = 8), and the recurrence rate of intracerebral hemorrhage in those patients estimated by the Kaplan-Meier method was the highest in the 4 groups (14.3% in 1 year and 21.2% in 2 years). In contrast, patients with advanced WMH without microbleeds (n = 39) developed only ischemic strokes (n = 6), and the estimated recurrent rate of ischemic stroke in those patients was the highest in the 4 groups (10.5% in 1 year and 17.4% in 2 years). Cox proportional hazards regression analysis revealed that microbleeds were associated with intracerebral hemorrhage (hazard ratio [HR], 85.626; 95% confidence interval [CI], 6.344-1155.649) and that advanced WMH was negatively associated with intracerebral hemorrhage (HR, 0.016; 95% CI, 0.001-0.258). Advanced WMH was associated with ischemic stroke (HR, 10.659; 95% CI, 2.601-43.678).
It appears that patients at high risk of subsequent intracerebral hemorrhage or ischemic stroke can be identified by combinations of the presence or absence of microbleeds and advanced WMH.
既往研究表明，微出血是脑出血的危险因素，而白质高信号（WMH）是缺血性卒中的危险因素。本研究旨在确定微出血的有无与重度WMH的组合是否为后续复发性卒中类型的危险因素。
对266例卒中患者，计数T2*加权磁共振图像上的微出血，并对T2加权图像上的WMH进行分级。根据微出血的有无与重度WMH的组合将患者分为4组，并随访卒中复发情况。
在平均564.8±220.5天的随访期内，26例患者发生复发性卒中，包括10例脑出血和16例缺血性卒中。有微出血但无重度WMH的患者（n = 42）仅发生脑出血（n = 8），采用Kaplan-Meier法估计，这些患者的脑出血复发率在4组中最高（1年时为14.3%，2年时为21.2%）。相反，有重度WMH但无微出血的患者（n = 39）仅发生缺血性卒中（n = 6），采用Kaplan-Meier法估计，这些患者的缺血性卒中复发率在4组中最高（1年时为10.5%，2年时为17.4%）。Cox比例风险回归分析显示，微出血与脑出血相关（风险比[HR]，85.626；95%置信区间[CI]，6.344 - 1155.649），重度WMH与脑出血呈负相关（HR，0.016；95%CI，0.001 - 0.258）。重度WMH与缺血性卒中相关（HR，10.659；95%CI，2.601 - 43.678）。
微出血的有无与重度WMH的组合似乎可用于识别后续发生脑出血或缺血性卒中的高危患者。
