急性脑梗死合并脑微出血有关危险因素的研究  

The study of the related risk factors about acute cerebral infarctions(ACIs) complicating cerebral microbleeds(CMBs)

作　　者：张春生[1] 金辉[1] 胡喜庆[1] 董昭樱[1] 马春杰[1] 张莹[1] 张静[1] 叶文翔[2] 

机构地区：[1]天津市人民医院神经内科,天津300121 [2]天津第一中心医院神经内科,天津300192

出　　处：《中风与神经疾病杂志》2011年第4期338-343,共6页Journal of Apoplexy and Nervous Diseases

基　　金：天津市卫生局级课题(06KZ17)

摘　　要：目的了解急性脑梗死合并CMBs的相关危险因素,探讨急性脑梗死患者发生CMBs的机制。方法 2005年3月~2007年12月住院的脑梗死患者651例,全部研究对象进行MRI自旋回波序列（SE）、快速自旋回波序列（FSE）、场回波序列（FE）、梯度回波（GRE）扫描,并对58种影响因素进行调查,对有关危险因素进行分型、分类、分级后,用卡方检验和多元回归方法进行分析。结果多因素Logistic回归分析发现平均动脉压、心衰、APTT为微出血患病的独立危险因素（P〈0.05）。Ⅲ级高血压是CMBs的相关因素（P=0.024）,入院时平均动脉压每增高1mmHg,微出血风险加大5.5%（P=0.000）;有心衰史的患者微出血风险增加5.299倍（P=0.042）;APTT升高1秒,微出血发生的可能增加6%（P=0.007）。Ⅱ级及以上脑白质稀疏、Ⅱ~Ⅲ级腔隙性梗死亦是脑微出血的相关因素。结论 （1）平均动脉压、心衰、APTT为微出血患病的独立危险因素;（2）CMBs的发生可能与急性脑梗死无直接关系;（3）抗栓溶栓治疗不是CMB发生的危险因素;（4）急性脑梗死合并CMBs的患者在颅内较大血管病变的同时,亦存在着广泛的微血管病。Objective To obtain the related risk factors about the acute cerebral infarctions（ACIs） complicating cerebral microbleeds（CMBs）.And to discuss the mechanism about ACI patients complicating CMBs.Methods Since March 2005 to Dec 2007,651 admitted patients of cerebral infarction had been studied prospectively.All of them had been studied with MRI scans including SE,FSE,FFE and GRE series.52 related factors had been studied.The related risk factors had been classified and graded,and then analysed with X test and multiple regression analyses.Results After multi-factor logistic regression analysis it was found that the average arterial pressure,heart failure and APTT were the ordinary risk factors of CMBs（P0.05）.The hypertension grade III were the relative factor of CMBs（P=0.024）.During admission when the average arterial pressure elevated by 1 mmHg,the risk factor of CMB could augment by 5.5%（P=0.000）.Those having the history of heart failure the risk of CMB could augment by 5.229 times（P=0.042）.When the APTT elevated by 1 second,the occurance of CMB could add by 6%（P=0.007）.The leukoaraiosis of Grade II and higher grade,and the lacunar infarcts of Grade Ⅱ~Ⅲ were also the related factors of CMBs.Conclusions The average arterial pressure,heart failure and APTT were the ordinary risk factors.The occurance of CMB could have no direct relationship with ACI.The anti-thrombosis and thrombolysis were not the risk factors of the occurance of CMB.The ACI patients complicating CMBs had in the mean time diffuse microvessel diseases.

关 键 词：脑微出血 急性脑梗死 危险因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]