Imaizumi Toshio, Inamura Shigeru, Kohama Ikuhide, Yoshifuji Kazuhisa, Nomura Tatsufumi, Komatsu Katsuya
Department of Neurosurgery, Kushiro City General Hospital, Hokkaido, Japan.
Department of Neurosurgery, Kushiro City General Hospital, Hokkaido, Japan.
J Stroke Cerebrovasc Dis. 2014 Mar;23(3):520-8. doi: 10.1016/j.jstrokecerebrovasdis.2013.04.035. Epub 2013 Jun 22.
Cerebral microbleeds (MBs) on gradient echo T2*-weighted magnetic resonance imaging (MRI) scans are associated with the severity of cerebral microangiopathies. This study investigated the contributions of nascent deep MBs to stroke recurrence.
We prospectively analyzed nascent deep MBs in patients admitted to our hospital who were treated for index strokes between April 2004 and November 2009. The number of nascent deep MBs was counted on T2*-weighted MRI scans around 1 year after the index strokes, and compared to previous MRIs on admission. Stroke recurrence-free rate curves were generated using the Kaplan-Meier method using the log-rank test. The odds ratio for nascent deep MBs was derived using a multivariate logistic regression model that was based on recurrent strokes and other risk factors.
We evaluated the MRIs (interval between MRIs 14.6 ± 5.9 months) of 508 patients (207 women; 68.9 ± 11.5 years), with a follow-up period of 44.1 ± 15.4 months. Repeated T2*-weighted MRI scans revealed 256 nascent deep MBs in 116 of 508 patients. The incidence of deep intracerebral hemorrhage was significantly greater in patients with nascent deep MBs than those without (2.0% vs 0.4% per year, respectively; P < .0001). Multivariate analyses revealed that the rate of nascent deep MBs was significantly elevated in patients whose stroke recurrences took the form of deep intracerebral hemorrhages (odds ratio 5.41; P = .007), when adjusted for hypertension, preexisting MBs, and other risk factors.
Our findings suggested that nascent deep MBs might be associated with stroke recurrence, in particular with deep intracerebral hemorrhage.
梯度回波T2*加权磁共振成像（MRI）扫描上的脑微出血（MBs）与脑微血管病变的严重程度相关。本研究调查了新生深部MBs对卒中复发的影响。
我们对2004年4月至2009年11月期间因首次卒中入院治疗的患者中的新生深部MBs进行了前瞻性分析。在首次卒中后约1年时，通过T2*加权MRI扫描计算新生深部MBs的数量，并与入院时的先前MRI进行比较。使用Kaplan-Meier方法和对数秩检验生成无卒中复发病率曲线。使用基于复发性卒中和其他危险因素的多变量逻辑回归模型得出新生深部MBs的优势比。
我们评估了508例患者（207例女性；年龄68.9±11.5岁）的MRI（MRI间隔时间为14.6±5.9个月），随访期为44.1±15.4个月。重复的T2*加权MRI扫描显示，508例患者中有116例出现256个新生深部MBs。有新生深部MBs的患者发生深部脑出血的发生率明显高于无新生深部MBs的患者（分别为每年2.0%和0.4%；P<.0001）。多变量分析显示，在调整高血压、既往MBs和其他危险因素后，以深部脑出血形式复发卒中的患者中新生深部MBs的发生率显著升高（优势比5.41；P=.007）。
我们的研究结果表明，新生深部MBs可能与卒中复发有关，尤其是与深部脑出血有关。
