伴脑微出血的急性缺血性脑小卒中患者抗血小板治疗及出血转化的预测模型  

Antiplatelet Drug Therapy and Prediction Model for Hemorrhagic Transformation in Patients with Acute Minor Ischemic Stroke with Cerebral Microbleeds

作　　者：王辉 吴权 陈礼龙 陈晋莉 何俊林 周亚军 WANG Hui;WU Quan;CHEN Li-long;CHEN Jin-li;HE Jun-ling;ZHOU Ya-jun(Department of Neurology,Tinglin Hospital of Jinshan District,Shanghai 201505,China;Department of Radiology,Tinglin Hospital of Jinshan District,Shanghai 201505,China;Department of Neurology,Shanghai seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China)

机构地区：[1]上海市金山区亭林医院神经内科,上海201505 [2]上海市金山区亭林医院放射科,上海201505 [3]上海市第七人民医院神经内科,上海200137

出　　处：《中国临床神经科学》2024年第6期669-678,共10页Chinese Journal of Clinical Neurosciences

基　　金：金山区医药卫生类科技创新资金项目(编号:2023-WS-47)。

摘　　要：目的研究伴脑微出血(CMBs)的急性缺血性脑小卒中(MIS)患者抗血小板药物的使用、临床预后与出血转化(HT)的关系。方法收集住院治疗的400例急性MIS患者为研究对象,依据是否存在CMBs分为CMBs组(200例,伴CMBs≥5个)和无CMBs组(200例,对照)的发病6至48 h内的MIS患者的临床特征及用药、头颅MRI等临床资料。CMBs组再分为阿司匹林组(单药,69例)、氯吡格雷组(单药,60例)和联合用药组(阿司匹林与氯吡格雷联合用药,71例)。于治疗前和治疗3周行美国国立卫生研究院卒中量表(NIHSS)评分,单因素及多因素Logistic分析CMBs及HT的危险因素;门诊随访头颅CT评估HT情况,3个月后评估患者改良Rankin量表(mRS)评分。分别比较CMBs 5~9个或≥10个情况下,不同抗血小板治疗组的HT及临床预后。结果高血压病、脑出血史、脑白质高信号是CMBs的独立危险因素。联合用药组和单药组(CMBs5~9个)患者治疗后HT发生少,联合用药组3个月临床预后好于单药组;联合用药组CMBs≥10个患者中HT率升高,3个月临床预后与单药组相当。治疗前NIHSS评分、CMBs≥10个、双重抗血小板治疗、Fazekas评分等级高是伴CMBs急性MIS患者治疗后发生HT的独立危险因素;HT预测模型曲线下面积为0.893。结论伴CMBs急性MIS患者可使用未负荷剂量的两药联合治疗,但其中CMBs≥10个且合并重度脑白质病变的患者使用氯吡格雷联合阿司匹林治疗后HT风险大,可参考预测模型评估HT风险。Aim To study the relationship between the use of antiplatelet drugs and clinical prognosis and hemorrhagic transformation in acute minor ischemic stroke patients with cerebral microbleeds(CMBs).Methods The clinical features,medication,and magnetic resonance imaging(MRI)data were collected from 200 patients with CMBs(≥5)and without CMBs who experienced minor ischemic stroke within 6 to 48 hours of onset.The CMBs group was further divided into a aspirin group(69 cases),a clopidogrel group(60 cases)and a dual-antiplatelet therapy group(71 cases).The National Institutes of Health Stroke Scale(NIHSS)score was performed before and 3 weeks after the treatment.The risk factors of CMBs and hemorrhagic transformation were compared by single factor and multiple factors.Head computer tomography was used to assess the hemorrhagic transformation during outpatient follow-up.The patient’s modified Rankin Scale(mRS)score were evaluated at 3 months.The hemorrhagic transformation and clinical prognosis of each antiplatelet drug treatment group were compared under the condition of 5-9 CMBs or≥10 CMBs.Results Hypertension,history of cerebral hemorrhage and white matter high signal were independent risk factors for CMBs.In the dual-antiplatelet therapy and single-antiplatelet therapy groups,there were fewer occurrences of hemorrhagic transformation after the treatment in CMBs5~9 patients.The 3-month clinical prognosis of the dual-antiplatelet therapy group were better than those of the single-antiplatelet therapy group.Among patients with≥10 CMBs,the hemorrhagic transformation rate increased.The 3-month clinical prognosis were comparable to those of single-antiplatelet.NIHSS score before the treatment,CMBs≥10,dual-antiplatelet therapy,and high level Fazekas scores were independent risk factors for hemorrhagic transformation after treatment in acute minor ischemic stroke patients with CMBs.The area under the curve of the established hemorrhagic transformation prediction model was 0.893.Conclusion Patients with acute minor isc

关 键 词：脑微出血 缺血性脑小卒中 抗血小板 出血转化 阿司匹林 氯吡格雷 联合用药 模型 

分 类 号：R743.32[医药卫生—神经病学与精神病学]