The clinical value of CT and SWI in evaluating the occurrence of CMBs in diabetic patients with hypertension

Objective With the help of computerized tomography (CT) and susceptibility-weighted imaging (SWI) examinations, to analyze and compare the incidence and the prevalent sites of microbleeds (CMBs) in control group, diabetes group, hypertension group and diabetic hypertension group with intracerebral CMBs. The risk factors for the onset of CMBs also will be explored, in order to provide a basis for the selection of clinical diagnosis and treatment options for CMBs. Methods A collection of 174 non-acute patients in the Department of Neurology of Shandong Electric Power Central Hospital from May 2019 to October 2020, including 101 males and 73 females, aged 45–89 years, with an average age of 72 ± 5 years. Divided into four groups according to disease types: Hypertension with type 2 diabetes group, Hypertension group, Type 2 diabetes group, Control group (no hypertension and type 2 diabetes). All patients underwent CT and MRI SWI sequence scans. The 4 groups of patients were matched in terms of gender and age, excluding the influence of gender and age. The incidence, number and distribution of CMBs in the four groups were counted, and the CT and SWI imaging manifestations of CMBs in the four groups were analyzed and compared. Results CT did not find the incidence of CMBs in the brain of patients. SWI imaging showed that CMBs were detected in 58 of 174 patients (incidence rate 33.3%), and CMBs occurred in 24 cases of diabetes and hypertension group (incidence rate 57.1%). CMBs occurred in 21 cases in the hypertension group (incidence rate 46.7%), 8 cases in the diabetes group (incidence rate 22.2%), and CMBs occurred in 5 cases in the control group (incidence rate 9.8%). The incidence of CMBs in the hypertension group and the diabetes combined with hypertension group was significantly higher than that in the control group ( P < 0.05). There was no significant difference in the incidence of CMBs in patients with simple diabetes compared with the control group. Also, there was no significant difference in the incidence of CMBs between the diabetes combined with hypertension group and the simple hypertension group. Conclusion CT did not find the incidence of CMBs in the brains of patients in the non-acute phase. SWI could clearly show the CMBs of the enrolled patients. Diabetes is less likely to cause an increase in CMBs. Hypertension is significantly related to the occurrence of CMBs. CMBs associated with hypertension or/and diabetes are common in the basal ganglia and thalamus, which is different from cerebral amyloid angiopathy, which provides a basis for the choice of clinical treatment options. 摘要： 目的 借助电子计算机断层扫描(CT)和磁敏感加权成像(SWI)检查, 分析比较对照组、糖尿病组、高血压病组 及糖尿病合并高血压病组患者伴发脑内微出血 (CMBs)的发生率及好发部位, 探讨CMBs发病危险因素, 以期为 CMBs临床诊疗方案选择提供依据。 方法 搜集山东电力中心医院2019年5月一2020年10月神经内科住院非急性 期病人174例, 其中男性101例, 女性73例, 年龄45〜89岁, 平均年龄(72 ± 5)岁。按病种分为4组：高血压病合并 2型糖尿病组、高血压病组、2型糖尿病组、对照组(无高血压病及2型糖尿病)。所有患者均行CT和MRI SWI序列扫 描, 4组患者性别、年龄方面差异无统计学意义。统计4组患者CMBs发生率、数目、分布部位, 分析比较4组患者 CMBs的CT和SWI影像学表现。 结果 CT未发现患者脑内CMBs发病情况, SWI影像学显示174例患者中有 58例出现CMBs(发生率33.3%), 糖尿病合并高血压组24例发生CMBs(发生率为57.1%), 高血压组21例发生 CMBs(发生率为46.7%), 糖尿病组8例发生CMBs(发生率为22.2%), 对照组5例发生CMBs(发生率为9.8%)。高血 压病组及糖尿病合并高血压组比对照组CMBs发生率明显增加 ( P < 0.05), 单纯糖尿病患者比对照组CMBs发生率无 明显差别, 糖尿病合并高血压组CMBs发生率与单纯高血压组比较无明显差别。 结论 CT没有发现非急性期病人患 者脑内CMBs发病情况, SWI能清晰显示入组患者CMBs情况, 糖尿病导致CMBs增多的可能性较小, 高血压病与 CMBs发生显著相关, 高血压病或/和糖尿病患者伴发CMBs常见于基底节及丘脑部位, 与脑淀粉样血管病不同, 为临 床治疗方案的选择提供了依据。