脑淀粉样血管病相关性脑出血的临床研究  

The Clinical Research of Cerebral Amyloid Angiopathy-related Hemorrhages

作　　者：闫欣[1] 胡洪涛[1] 马志刚[1] 闫立荣[1] 庞英[1] 孙玉衡[1] 

机构地区：[1]北京积水潭医院神经内科,北京100035

出　　处：《中风与神经疾病杂志》2013年第7期638-641,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的分析总结脑淀粉样血管病(cerebral amyloid angiopathy,CAA)相关性脑出血(CAA-relatedhemorrhages,CAAHs)的临床特征、影像表现及预后。方法回顾住院的14例CAAHs,符合"很可能CAA"或"可能CAA"患者的临床及影像学资料,分析本病的临床特征、影像表现及影响预后的因素。结果本组患者的最主要临床表现为头痛(28%),其次是肢体麻木、力弱(20%)。CAAHs患者的出血位置多发于脑后部(很可能CAA枕叶57.1%,可能CAA顶叶36.4%)。脑出血破入脑室的比例为27.2%,出血量5～90ml,平均24ml,59.1%患者CT可见脑白质低密度改变。入院时格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)为13.0(7.0),出院时GCS评分为15.0(4.0),GCS评分出院比入院时明显增加(t=5.850,P=0.000)。1例患者行颅内血肿清除及去骨瓣减压术后死亡,死亡率为7%。出院时改良Rankin量表(modified Rankin Scale,mRS)为3.3±0.4。患者出院时mRS与入院GCS评分(P=0.040)及脑出血体积(P=0.018)显著相关。结论 CAAHs是老年脑出血患者较常见原因,多灶、复发性脑叶出血是影像学特点,CT上脑白质低密度改变很常见。患者预后可能与入院时GCS评分及脑出血体积有显著相关。Objective To analyze clinical characters,imaging manifestation and prognosis factors of cerebral amyloid angiopathy-related hemorrhages（CAAHs） Methods According to Boston criteria for cerebral amyloid angiopathy（CAA）,we retrospectively analysed the patients in neurology department of Beijing Jishuitan Hospital from 2003 January to 2011 October.14 patients（8 males,6 females） fulfilled＂probable CAA＂（6 patients） and＂possible CAA＂（8 patients） criteria.We retrospectively analyzed clinical characters,imaging and risk factors for prognosis.Results The main complain was headache（28%） and the second complain was anesthesia and weakness of the limbs（20%）.There was no significant difference in locations of the hemorrhage,but hemorrhagic lesions were found preferentially in the posterior part（probable CAA in occipital 57.1% and possible CAA in parietal 36.4%）.The portion of hemorrhage rapture into ventricle was 27.2%,the mean hemorrhage volume was 24ml（5 ～ 90ml） and 59.1% patients were with white matter hypotension.On admission the Glasgow Coma Scale（GCS） was 13.0（7.0） and on discharge GCS was15.0（4.0）.There was significant increase on discharge of GCS compared with admission（t = 5.850,P = 0.000）.One patient died after evacuation of hematoma and mortality was 7%.On admission modified Rankin Scale（mRS） was 3.3 ± 0.4.Admission GCS（P = 0.040） and hemorrhage volume（P = 0.018） had significant correlations with prognosis.Conclusion CAA was a common cause of cerebral hemorrhage in old patients.There were special manifestations in the imagines.The prognosis had significant correlations with admission GCS and hemorrhage volume.

关 键 词：脑淀粉样血管病 脑叶出血 影像 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]