Abstract: Background　Cerebral microbleeds （CMBs） are an important neuroimaging feature of cerebral small vessel diseases and are found closely associated with the development of symptomatic intracerebral hemorrhage and cognitive impairment.Previous studies mostly focused on the incidence of and risk factors for CMBs in community populations，while few reports on risk factors in diseased populations such as patients with cerebrovascular diseases are available.Objective　To investigate the risk factors for CMBs in patients with cerebrovascular diseases.Methods　Two hundred patients with cerebrovascular diseases hospitalized in the Department of Neurology，Peking University First Hospital between January 2009 and February 2014 were retrospectively selected.Clinical information including gender，age，related vascular risk factors，history of use of antithrombotic agents and severity of cerebrovascular stenosis of these patients were collected.The severity of white matter lesions in bilateral subcortical，basal ganglia and subtentorial areas was evaluated using the Age-Related White Matter Changes （ARWMC） scale.And the severity of CMBs in the aforementioned areas was assessed by the Microbleed Anatomical Rating Scale （MARS）．Results　Among the participants，71（35.5%） demonstrated CMBs，including 35（17.5%） with 1 to 2 CMBs，8（4.0%） with 3 to 4 CMBs and 28（14.0%） with ≥5 CMBs.Univariate Logistic regression analysis results showed that cerebral hemorrhage，obesity，severe white matter lesions，severe subcortical white matter lesions，severe basal ganglia white matter lesions and subtentorial white matter lesions were associated with CMBs （P<0.05）．Correlation analysis found that the severity of subcortical white matter lesions and basal ganglia white matter lesions was positively correlated with the number of CMBs （r=0.338，0.485，P<0.001）．Multivariate Logistic regression analysis showed that cerebral hemorrhage〔OR=3.28，95%CI（1.48，7.23）〕，obesity〔OR=3.86，95%CI（1.32，11.29）〕，severe subcortical white matter lesions 〔OR=2.14，95%CI（1.02，4.48）〕 and severe basal ganglia white matter lesions 〔OR=5.75，95%CI（2.46，13.47）〕 were independent risk factors for CMBs in patients with cerebrovascular diseases （P<0.05）．Conclusion　Cerebral hemorrhage，obesity and severe white matter lesions are independent risk factors for CMBs in patients with cerebrovascular diseases.In particular，severe basal ganglia white matter lesions showed a closer association with CMBs.

Key words: Cerebrovascular disorders, Cerebral microbleeds, Cerebral hemorrhage, Obesity, Leukoence phalopathies, Basal nuclei, Root cause analysis

摘要： 背景　脑微出血是脑小血管病的重要影像学特征。研究认为其与症状性脑出血、认知障碍的发生密切相关。既往研究多集中于社区人群中脑微出血的发生率及危险因素评估，而对于疾病人群如脑血管病患者中危险因素的报道则相对缺乏。目的　探讨脑血管病患者脑微出血的危险因素。方法　回顾性选取于2009年1月—2014年2月在北京大学第一医院神经内科住院就诊的脑血管病患者200例。收集其临床信息，包括性别、年龄、临床诊断、相关血管危险因素、抗血栓药物使用史及脑血管狭窄程度等。采用年龄相关白质改变（ARWMC）评分量表和脑微出血解剖评分量表（MARS）评价其双侧皮质下区域、基底核区及幕下等区域的白质病变和脑微出血严重程度。结果　200例患者中，71例（35.5%）存在脑微出血，其中1~2个病灶35例（17.5%），3~4个病灶8例（4.0%），≥5个病灶28例（14.0%）。单因素Logistic回归分析结果显示，脑出血、肥胖、重度白质病变、重度皮质下白质病变、重度基底核白质病变、幕下白质病变与脑微出血有关（P<0.05）。相关性分析结果显示，皮质下白质病变、基底核白质病变严重程度与脑微出血计数呈正相关（r=0.338、0.485，P<0.001）。多因素Logistic回归分析结果显示，脑出血〔OR=3.28，95%CI（1.48，7.23）〕、肥胖〔OR=3.86，95%CI（1.32，11.29）〕、重度皮质下白质病变〔OR=2.14，95%CI（1.02，4.48）〕、重度基底核区白质病变〔OR=5.75，95%CI（2.46，13.47）〕是脑血管病患者脑微出血的独立危险因素（P<0.05）。结论　脑出血、肥胖、重度白质病变是脑血管病患者脑微出血的独立危险因素；重度基底核白质病变可能是更好的脑微出血预测指标。

关键词: 脑血管障碍, 脑微出血, 脑出血, 肥胖症, 脑白质病, 基底核, 影响因素分析