脑微出血对脑梗死急性期强化抗栓治疗后出血转化风险的研究  

Effect of combined clopidogrel-aspirin treatment for acute cerebral ischemic infarction on a correlation between cerebral microbleeds and hemorrhagic transformation

作　　者：都冬琳 吴波娜[1] 吴婧 毛伦林[1] 王利惠[1] 张金[1] Hao Donglin Wu Bona Wu Jing Mao Lunlin Wang Lihui Zhang Jin(Department of Neurology, Wujin People＇s Hospital Affiliated to Jiangsu University, Changzhou 213002, China)

机构地区：[1]江苏大学附属武进人民医院神经内科,常州213002

出　　处：《中华老年医学杂志》2017年第4期391-394,共4页Chinese Journal of Geriatrics

基　　金：常州市武进区科技发展计划项目（WS201405）

摘　　要：目的探讨脑微出血（CMBs）是否增加脑梗死急性期阿司匹林及氯吡格雷强化抗栓治疗后脑梗死后出血转化（HT）的风险，为伴有CMBs的缺血性卒中急性期治疗提供新证。方法对在我科连续住院登记诊断为脑梗死的患者进行筛选，共148例患者入组，所有患者行头颅磁共振SwI系列扫描，并根据CMBs分为无、有CMBs两组；进一步按CMBs解剖位置分为脑叶、深部及混合组，比较有、无CMBs及其不同位置CMBs对脑梗死后HT发生的影响；Logistic回归分析不同的脑血管病危险因素及CMBs对脑梗死后HT发生的影响。结果6例患者临床怀疑脑淀粉样血管病予以排除，最终142例患者最后纳入研究，其中64例患者无CMBs，78例患者有CMBs，CMBs检出率为54．9％；有CMBs组高血压患病率、尿酸水平均高于无CMBs组（X2=6．96，t=2．04，P=0．010、0．040）；无CMBs组HT发生率为12．5％（8例），有CMBs组脑出血转化为21．8％（17例），两组比例差异无统计学意义（X2=2．09，P=0．150）。78例CMBs患者中脑叶组15例，发生HT6例（40．0％）；深部组48例，发生HT6例（12．5％）；混合性组15例，发生HT5例（33．3％）；3组HT的发生率比较差异有统计学意义（X2=6．52，P=0．038），脑叶组更易出现HT。Logistic回归分析结果显示，CMBs不是脑梗死后HT发生的危险因素（OR=1．95，95％CI：0．78～4．87，P=0．150），心房颤动（OR=6．48，95％CI：2．45～17．19，P=0.000）及血糖（OR=1．02，95％CI：1．43～1．94，P=0．020）是脑梗死后HT发生的危险因素。结论CMBs不增加脑梗死急性期强化抗栓治疗后HT发生的风险，但对于伴有脑叶CMBs的脑梗死患者需谨慎使用双抗。Objective To investigate effects of combined clopidogrel-aspirin treatment for acute cerebral ischemic infarction on a correlation between cerebral microbleeds （CMBs）and hemorrhagic transformation（HT）, so as to provide a new evidence for acute phase treatment of ischernic stroke with CMBs. Methods One hundred and forty-eighty patients with acute cerebral infarction meeting the inclusion criteria were consecutively admitted to our hospitals. All patients underwent susceptibility weighted imaging（SWI） to detect CMBs. Patients were classed into two groups：with and without CMBs and subdivided into brain lobe group, deep group and mixed group. The influence of CMBs or not and CMBs different positions on the post-infarction HT was compared. Logistic regression analysis was used to assess the relationship between HT and the related risk factors. Results The 142 patients finally were included in the study,with 64 patients without CMBs and 78 with CMBs. The detection rates of CMBs were 54.9%. Hypertensive prevalence rate（x2 = 6.96, P = 0. 010 ） and the levels of uric acid （t = 2.04, P = 0. 040） were higher in CMBs group than group without CMBs. The incidence rate of HT was 12.5% （8 cases）in no CMBs group,and 21.8%（17 cases）in the CMBs group（x2 = 2. 09,P〈0. 150）. 6 in 15 patients（40. 0%）patients experienced HT in lobar CMBs group; 6 patients（12.5%）experienced HT in 48 patients with deep CMBs group; 5 patients （ 33.3% ） experienced HT in 15 patients with mixed CMBs group. There was statistically significant difference in HT incidence rate（x2 = 6. 52, P = 0. 038）among the 3 groups. Lobar CMBs are more vulnerable for HT. Logistic regression analysis showed that atrial fibrillation（OR = 6. 48,95 % CI = 2. 45 17. 19, P =0. 000） and hyperglycemia（OR= 1.02,95% CI： 1.43-1.94,P=0. 020） were risk factors for HT, instead of CMBs（OR=I. 95,95% CI：0. 78-4. 87,P=0. 150）. Conclusions CMBs do not increase the risk of hemorrhage transformation in cerebral ischemie infarctio

关 键 词：脑梗死 脑出血 血小板聚集抑制剂 

分 类 号：R277.733.3[医药卫生—中医学]