脑微出血部位和负荷与脑梗死抗血小板治疗的相关分析

目的探讨脑微出血(CMB)发生部位和负荷对脑梗死抗血小板治疗风险及获益的影响。方法选择伴CMB的急性脑梗死患者214例,根据CMB发生部位分为单纯脑叶组39例,深部/幕下组62例,混合部位组113例,随访各组新发脑梗死、脑出血情况,并比较各组治疗前及治疗1年后CMB的变化。结果深部/幕下组既往脑梗死、高血压和糖尿病比例明显高于单纯脑叶组和混合部位组(P<0.05)。混合部位组基线CMB数高于单纯脑叶组和深部/幕下组[(8.69±2.75)个vs(6.65±2.47)个、(6.58±3.17)个,P<0.05]。单纯脑叶组脑出血比例明显高于深部/幕下组和混合部位组(12.8%vs 3.2%、2.7%,P<0.05),且发生脑出血患者中4例基线CMB数>5个。深部/幕下组再发脑梗死比例明显高于单纯脑叶组和混合部位组(24.2%vs 7.7%、9.7%,P<0.05)。3组治疗1年后仅部分患者复查头颅MRI,其中单纯脑叶组28例,深部/幕下组40例,混合部位组56例。单纯脑叶组CMB进展比例明显高于深部/幕下组和混合部位组,差异有统计学意义(35.7%vs 12.5%、10.7%,P<0.05),且病灶以脑叶为主。结论抗血小板治疗风险与CMB部位和负荷相关,单纯脑叶CMB抗血小板治疗的脑出血风险增加,治疗后CMB更易进展。深部/幕下CMB患者脑梗死复发风险更高。

Association of location and number of cerebral microbleeds with antiplatelet therapy for cerebral infarction

Objective To study the effect of the location and number of cerebral microbleeds(CMB)on the risk and benefit of antiplatelet therapy for cerebral infarction patients.Methods Two hundred and fourteen acute cerebral infarction(ACI)patients with CMB were divided into simple lobe CMB group(n=39),deep/subtentorium CMB group(n=62),and mixed CMB group(n=113).The patients were followed up,during which the incidence of new ischemic stroke and cerebral hemorrhage was recorded and the CMB were compared before treatment and after 1 year of treatment.Results The past incidence of cerebral infarction,hypertension and DM was significantly higher in deep/subtentorium CMB group than in simple lobe CMB group and mixed CMB group(P<0.05).The number of baseline CMB was significantly greater in mixed CMB group than in simple lobe CMB group and deep/subtentorium CMB group(8.69±2.75 vs 6.65±2.47,6.58±3.17,P<0.05).The incidence of cerebral hemorrhage was significantly higher in simple lobe CMB group than in deep/subtentorium CMB group and mixed CMB group(12.8%vs 3.2%,2.7%,P<0.05).The number of baseline CMB was>5 in 4 cerebral hemorrhage patients.The incidence of recurrent ischemic stroke was significantly higher in deep/subtentorium CMB group than in simple lobe CMB group and mixed CMB group(24.2%vs 7.7%,9.7%,P<0.05).Of the 214 ACI patients included in this study,28 in simple lobe CMB group,40 in deep/subtentorium CMB group and 56 in mixed CMB group underwent MRI again after 1 year of treatment,which showed that the incidence of progressive CMB was significantly higher in simple lobe CMB group than in deep/subtentorium CMB group and mixed CMB group(35.7%vs 12.5%,10.7%,P<0.05).The majority of CMB were located in lobar brain region.Conclusion The risk of antiplatelet therapy is related with the location and number of CMB.The risk of antiplatelet therapy for simple lobe CMB is higher than that for deep/subtentorium and mixed CMB.CMB are easier to progress after antiplatelet therapy.The risk of recurrent cerebral infarction is higher in deep/subtentorium CMB patients than in simple lobe CMB patients and mixed CMB patients.