腔隙性脑梗塞患者脑内微出血的发生、分布及其意义

目的 探讨脑内微出血在腔隙性梗塞病人中的发生率及在脑内各区域的分布情况,以及与其他微小血管病变包括脑白质改变和腔隙性梗塞之间的关系。方法 连续入选腔隙性脑梗塞病人82例。记录一般临床资料、实验室检查及神经精神功能评分包括入院时的美国国立卫生研究院卒中评分(NIHSS)和发病三个月时的Barthel生活指数(BI)和简易精神状态量表(MMSE)。所有病人均进行头颅MR检查观察脑内微出血的数目及部位,脑白质改变的程度和腔隙性脑梗塞的数目及部位。数据处理均采用SPSS软件进行。结果 22例患者(27％)存在脑内微出血,数目由1～42个,分布于脑内不同部位包括皮层-皮层下、丘脑基底节区、小脑和脑干。微出血的数目与腔隙性梗塞的数目以及脑白质改变的程度显著相关(r=0.297,0.552;P=0.007,<0.001)。3个月时微出血组病人的MMSE和BI有低于无微出血组病人的趋势(22.56 vs 24.53,16.71 vs 19.11),但无统计学差异(P=0.162,0.052)。结论 脑内微出血在腔隙性脑梗塞中发生率较高,且与脑白质改变的严重程度以及腔隙性梗塞的数目相关。提示脑内微出血是另外一种微小血管病损的标志,可能代表着更为严重的小血管壁的损害,更为直接地提示出血倾向,在腔隙性脑梗塞的治疗及预防过程中应予以相应的重视。

Frequency, distribution and clinical implication of microbleeds in patients with lacunar infarcts

Objective To investigate the frequency and location of intracerebral microbleeds in patients with lacunar iniarcts and the correlation with the severity of white matter changes and number of lacunar infarcts. Methods Eighty-two patients with lacunar infarcts vvere recruited consecutively. MR was performed and clinical risk factors, neuropsychiatric functions including NIHSS, MMSE, BI were evaluated at the same time in each patient. The incidence and the number of IMBs, the number of lacunar iniarcts and severity of white matter changes were studied on MR images. The dala was analyzed with SPSS. Results Twenty-two (27 % ) patients were found with IMBs which were noted simultaneously in various parts of the brain. The number of IMBs ranged from 1 to 42 which distributed at different parts of brain including cortical-subcortical, thalamus-basai ganglia, cerebellum and brain stem. There was a correlation between the number of IMBs and the number of lacunar infarcts or severitv of white malter changes ( r = 0.297, 0.552, P = 0.007, < 0.001) . There was some tendency that MMSE and BI were lower in the patients with IMBs than those without (22.56 vs 24.53, 16.71 vs 19.11). But the differences were not significant (P = 0.162, 0.052).Con-clusions IMBs can be detected in a proportion of patients vvith lacunar infarcts and were associated with severity of while matter changes and number of lacunar infarcts. The results suggest that IMBs may be an idicator of advanced microangionathy with an in-creased risk of bleeding which should be taken into consideration during the treatment of lacunar infarcts.