Neurology:中老年人脑微出血的检出率为7%

2021-11-13 “脑血管病及重症文献导读”公众号 “脑血管病及重症文献导读”公众号

脑微出血

脑微出血(Cerebral microbleeds,CMBs)是在T2*加权GRE或敏感性加权成像(SWI)上发现的小(<10mm)、低信号、卵圆形或圆形的影像学表现。病理学上主要对应于小动脉附近富含含铁血黄素的沉积物,被认为是过去报道的显微镜下出血。它们越来越多地被认为是与脑小血管病(small vessel disease,SVD)相关的一系列影像学特征之一,与缺血性腔隙性卒中和脑出血相关的小血管动脉病变具有共同的病理生理过程。病理学提示,脑叶CMBs对应于脑淀粉样血管病(CAA),而深部CMBs可能提示小动脉硬化。

许多研究分析了CMBs的危险因素。他们认为CMBs与年龄、高血压、肥胖和糖尿病等一系列危险因素相关。使用氯吡格雷或抗凝剂等药物也被证明与较高的CMB患病率相关。然而,这些危险因素对不同位置的CMBs是否同样重要,以及其与脑叶、深部和幕下CMBs之间的关系是否存在差异,这些问题仍然存在。

MRI对CMBs的敏感性是一个复杂的问题,取决于许多因素,包括扫描仪场强、采集序列,以及是否使用梯度回波或更敏感的敏感性加权序列(SWI)等,许多研究采用了多个不同的扫描仪。

2021年10月来自英国剑桥大学的Dongwei Lu等在 Neurology 上公布了他们的研究结果,他们利用英国生物银行(UK Biobank)研究的数据,对8000多名健康中老年人的危险因素与CMBs之间的关系进行了研究。

在英国生物银行研究中8159名参与者的MRI扫描适合CMB分析。在2台相同的3.0T扫描仪上获取大脑SWI成像数据。

扫描时的平均年龄为62.1±7.4岁。572名(7.0%)参与者检测到一个或多个明确的CMB。在CMBs患者中,439例(76.7%)为脑叶CMBs,103例(18.0%)为深部CMBs,83例(14.5%)为幕下CMBs。

年龄是所有区域CMBs的独立危险因素。APOE4与男性与脑叶 CMBs呈正相关,而较高的体重指数与脑叶CMBs呈负相关。高血压、吸烟和饮酒与深部CMBs相关,但与脑叶CMBs无关。只有年龄与幕下CMBs相关。控制白质高信号病变体积(作为小血管疾病严重程度的标志物)后,相关性没有变化。

最终作者认为,在这项大规模人群研究中,采用低灵敏度和高特异性检测系统检测到的CMB患病率为7%。脑叶和深部CMBs的危险因素是不同的,提示存在不同的病理生理过程。

原始出处:

Dongwei Lu, Junfeng Liu, Andrew D. MacKinnon, et al. Prevalence and Risk Factors of Cerebral Microbleeds: Analysis From the UK Biobank. Neurology. 2021 Aug 18;10.1212/WNL.0000000000012673.

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    2022-07-12 yinhl1978
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