脑微出血对脑梗死后卒中复发的影响  

Impact of cerebral microbleeds on stroke recurrence after cerebral infarction

作　　者：吴波娜[1] 吴婧 曹德峰[1] 马爱金[1] 陈文亚[1] WU Bona;WU Jing;CAO Defeng;MA Aijin;CHEN Wenya(Department of Neurology,Wujin People's Hospital Affiliated to Jiangsu University,Wujin Clinical College of Xuzhou Medical University,Changzhou 213017,Jiangsu,China)

机构地区：[1]江苏大学附属武进医院神经内科徐州医科大学武进临床学院,常州213017

出　　处：《医学研究与战创伤救治》2023年第10期1072-1076,共5页Journal of Medical Research & Combat Trauma Care

基　　金：江苏省高效重点实验室开放课题(XZSYSKF2023025)。

摘　　要：目的 对脑微出血与急性脑梗死后复发性卒中进行研究,探讨伴有脑微出血的患者出现卒中复发的时间规律,为该类患者的二级预防精准化治疗方案提供新的临床依据。方法 收集2015年1月至2019年6月常州市武进人民医院神经内科住院的432例急性脑梗死患者。根据纳入标准最后纳入413例患者。根据有无脑微出血分为无脑微出血组(n=172),脑微出血组(n=241)。脑微出血按数目分为无、轻度(132例)、中度(79例)、重度(30例)。根据脑微出血分布位置分为脑叶组、深部组及混合组。随访2年,分析两组缺血性卒中复发及出血性复发之间的差异性,并分析不同程度及位置的脑微出血对卒中复发的影响。结果 413例患者在随访2年内有75例(18.16%)患者出现卒中复发,缺血性卒中和出血性卒中复发分别为62例(15.01%)、13例(3.15%)。脑微出血组高血压及缺血性卒中复发比例高于无脑微出血组(P<0.05)。脑微出血组2年累积卒中复发率明显高于无脑微出血组(P_(Log-Rank)=0.001)。多元COX回归显示脑微出血(RR=2.09, 95%CI:1.21~3.60)是脑梗死后卒中复发的独立危险因素,进一步分析提示脑微出血为脑梗死后缺血性卒中复发的独立危险因素(RR=2.09,95%CI:1.15~3.81)。不同数目的脑微出血脑梗死复发率差异有统计学意义(P=0.014)。结论 即使长期抗栓治疗,伴有脑微出血的患者出现脑梗死复发率仍高于无脑微出血患者,且随着时间延长,脑出血风险亦增加,提示伴有脑微出血的脑梗死抗栓治疗仍需按指南使用抗栓治疗。Objective We studiedthe correlation of cerebral microbleeds(CMB)and recurrent stroke after acute cerebral infarction,and observed the time regularity of recurrent stroke to provide a new clinical basis for the precise treatment of secondary pre-vention of acute cerebral infarction with CMB.Methods A total of 413 patients diagnosed with acute cerebral infarction were select-ed among 432 patients who were admitted to the hospital from January 2015 to June 2019 and divided into the CMB group(n=241)and non-CMB group(n=172)according to imaging examination.According to the location of CMB,241 patients were divided into the cerebral lobe group,deep group and mixed group.Witha follow-up of 2 years,the differences of ischemic stroke recurrence and hemor-rhagic recurrencewere compared,and the influences of different degrees and locations of CMB on strokerecurrence were analyzed.Results There were 172 patients without CMB,132 patients with mild CMB,79 patients with moderate CMB and 30 patients with se-vere CMB.Seventy-five patients had recurrent stroke within 2 years of follow-up,including 18 patients in the non-CMB group and 57 patients in the CMB group.Within the follow-up of 2 years,of the 413 patients,75(18.16%)had recurrent stroke,62(15.01%)had ischemic stroke,and 13(3.15%)had hemorrhagic stroke.The recurrence rates of hypertension and ischemic stroke in the CMB group were higher than those in non-CMB group(P<0.05).The 2-year cu-mulative stroke recurrence in the CMB group was significantly higher than that in non-CMB group(P_(Log-Rank)=0.001).Multiple Cox regres-sion showed that CMB(RR=2.09,95%CI:1.21-3.60,P=0.01)was an independent risk factor for stroke recurrence after cerebral in-farction.Further analysis suggested that CMB was an independent risk factor for ischemic stroke recurrence after cerebral infarction(RR=2.09,95%CI:1.15-3.81,P=0.018),rather than an independent risk factor for hemorrhagic recurrent stroke(RR=1.63,95%CI:0.42-6.32,P=0.48).The recurrence rate of cerebral infarction in different degrees of CMB w

关 键 词：脑微出血 复发 脑梗死 颅内出血 

分 类 号：R743.34[医药卫生—神经病学与精神病学]