急性脑梗死与短暂性脑缺血发作的脑微出血临床特点分析  

Clinical Features of Cerebral Microbleeds in Acute Cerebral Infarct and Transient Ischemic Attack

作　　者：陈淦[1] 周利胜[2] 何杏玲[1] 杨水泉[1] 

机构地区：[1]广东医学院附属三水医院神经内科,广东佛山528100 [2]佛山市高明区人民医院神经内科,广东佛山528500

出　　处：《实用临床医学（江西）》2014年第3期1-4,共4页Practical Clinical Medicine

基　　金：广东省佛山市科技局医学类科技攻关项目(201208312)

摘　　要：目的比较急性脑梗死与短暂性脑缺血发作的危险因素及病理生理TOAST分型,以及这两种缺血性脑血管病有无脑微出血的临床特点,探讨急性脑梗死与短暂性脑缺血发作的病理生理机制和脑微出血在缺血性脑血管病治疗中的意义。方法对急性脑梗死患者86例(ACI组)和短暂性脑缺血发作患者26例(TIA组)进行磁共振梯度回波序列检查,根据有无脑微出血(CMBs)将112例患者分为有CMBs组与无CMBs组。比较ACI组、TIA组的危险因素、病理生理TOAST分型及有CMBs组与无CMBs组的危险因素。结果 ACI组CMBs发生率显著高于TIA组(23.3%比3.8%,P<0.05);在病理生理TOAST分型中,TIA组大动脉粥样硬化型显著高于ACI组(26.9%比9.3%,P<0.05);ACI组、TIA组患者的年龄、性别及高血压、糖尿病、吸烟、总胆固醇、心房纤颤、T2白质高信号评分比较差异均无统计学意义(P>0.05)。有CMBs组收缩压、T2白质高信号的评分均显著高于无CMBs组(P<0.05)。结论急性脑梗死患者脑微出血较短暂性脑缺血发作患者常见,短暂性脑缺血发作的病理生理机制中大动脉粥样硬化较急性脑梗死多见;收缩压水平和T2白质高信号评分是脑微出血的危险因素。Objective To compare the risk factors, TOAST types and clinical characteristics of cerebral microbleeds（CMBs） between acute cerebral infarction（ACI）and transient ischemic attack （TIA）, and to investigate the pathophysiologic mechanisms of ACI and TIA and the significance of CMBs in ischemic cerebrovascular disease. Methods Gradient echo MRI was performed in 86 ACI patients （ACI group） and 26 TIA patients （TIA group）. In addition, these patients were divided into CMBs group and non-CMBs group. Risks factors and TOAST types were compared between ACI group and TIA group. Furthermore, risks factors were compared between CMBs group and non-CMBs group. Results Compared with TIA group, the incidence of CMBs increased but incidence of large artery atherosclerosis decreased in ACI group （23.3% vs 3.8% and 9.3% vs 26.9%, respectively; P〈0.05）. However, there were no significant differences in age, gender and scores of hypertension, diabetes, smoking, total cholesterol, atrial fibrillation and T2 white matter hyperintensity between the two groups （P＆gt;0.05）.Compared with non-CMBs group,scores of systolic pressure and T2 white matter hyperintensity increased in CMBs group （P 〈0.05）.Conclusion The incidence of CMBs in ACI patients is higher than that in TIA patients. The incidence of large artery atherosclerosis in TIA patients is higher than that in ACI patients. Systolic pressure and T2 white matter hyperintensity were the risk factors for CMBs.

关 键 词：急性脑梗死 短暂性脑缺血发作 脑微出血 临床特点 

分 类 号：R743[医药卫生—神经病学与精神病学]