急性缺血性卒中患者合并脑微出血的危险因素及脑微出血对预后的影响  

Risk factors analysis of acute ischemic stroke complicated with cerebral microhemorrhage and the impact of cerebral microhemorrhage on prognosis

作　　者：胡夏生[1] 王迎紫 包姝沄 陈玉辉[1] 龚涛[1] HU Xiasheng;WANG Yingzi;BAO Shuyun;CHEN Yuhui;GONG Tao(不详;Department of Neurology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院神经内科,国家老年医学中心,中国医学科学院老年医学研究院,100730 [2]大连医科大学附属第二医院神经内科,116027

出　　处：《中国神经免疫学和神经病学杂志》2025年第2期95-99,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：中央高水平医院临床科研业务费专项(BJ-2022-119);中国医学科学院项目(BJ-2022-060)。

摘　　要：目的探讨急性缺血性卒中(acute ischemic stroke,AIS)患者合并脑微出血(cerebral microbleeds,CMBs)的相关危险因素及脑微出血对预后的影响。方法采用回顾性病例对照研究方法,收集北京医院神经内科2021年3月至2023年3月住院的AIS患者164例,其中男113例,女51例,年龄(66.70±11.56)岁。根据患者有无CBMs将患者分为CMBs组和无CMBs组,比较两组患者一般临床资料、实验室检查、病情严重程度及预后的差异,采用多因素Logistics回归分析AIS患者发生CMBs的危险因素。结果164例AIS患者发生CMBs有45例(27.4%)。与无CMBs组相比,CMBs组患者中既往脑卒中病史的比例更高(51.11%比28.57%,P<0.01),总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平低(P<0.05),发病3个月的预后良好率更低(57.78%比79.83%,P<0.01),而两组间年龄、性别构成、高血压史、吸烟史、血糖、尿酸等临床资料差异无统计学意义(均P>0.05)。多因素Logistics回归分析显示,既往有脑卒中史(OR=2.517)和入院时活化部分凝血活酶时间(APTT)延长(OR=1.079)是AIS合并CMBs的危险因素(均P<0.05),而入院时高LDL-C(OR=0.496)是AIS合并CMBs的保护因素(P<0.05)。结论高LDL-C水平、既往合并卒中史、APTT时间延长是AIS合并CMBs的独立影响因素。AIS合并CMBs的患者预后较差。Objective To explore the risk factors associated with cerebral microbleeds(CMBs)in patients with acute ischemic stroke(AIS)and the impact of CMBs on prognosis.Methods A retrospective case-control study was conducted to collect 164 patients with AIS admitted to the neurology department of Beijing hospital from March 2021 to March 2023,including 113 males and 51 females,with a mean age of(66.70±11.56)years.Patients were divided into a CMBs group and a non-CMBs group,and the differences in general clinical data,laboratory examination,severity of disease and prognosis between the two groups were compared.Multiple Logistic regression was used to analyze the risk factors of CMBs in AIS patients.Results Among 164 patients with AIS,45 had CMBs(27.4%).Compared with the non-CMBs group,the proportion of patients with a history of stroke was higher in the CMBs group(51.11%vs.28.57%,P<0.01).Laboratory tests showed that the levels of total cholesterol(TC)and low-density lipoprotein cholesterol(LDL-C)were lower(P<0.05),and the rate of good prognosis at 3 months after onset was lower(57.78%vs.79.83%,P<0.01)in the CMBs group.While there were no significant differences in age,gender composition,hypertension history,smoking history,blood glucose and uric acid level between the two groups(all P>0.05).Multivariate logistic regression analysis revealed that a history of stroke(OR=2.517)and prolonged activated partial thromboplastin time(APTT)at admission(OR=1.079)were risk factors for AIS with CMBs(P<0.05).In contrast,high LDL-C at admission was a protective factor for CMBs(P<0.05).Conclusions High LDL-C level,prior history of stroke and prolonged APTT were independent factors for AIS with CMBs.Patients with AIS combined with CMBs have a poor prognosis.

关 键 词：急性缺血性卒中 脑微出血 危险因素 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]