缺血性卒中患者二级预防相关脑微出血形成的危险因素分析

目的 探讨缺血性卒中患者二级预防时脑微出血(CMBs)形成的危险因素,为脑血管病的防治提供依据和指导.方法 收集明确诊断为急性缺血性卒中的患者,且在应用抗血小板聚集药物治疗4 d内完成磁敏感加权成像(SWI)检查,对纳入的患者随访12个月,12个月后复查SWI,记录随访前后CMBs的数量和部位.结果 共纳入了94例患者,其中发现伴CMBs患者50(53.2%)例,经二分类Logistics回归分析发现:高血压病史(OR=1.2,95%CI=1.07~1.61,P=0.004)、年龄(OR=2.2,95%CI=1.25~3.92,P=0.006)是CMBs形成的独立危险因素,且年龄每增加10岁,CMBs患病率增加2.2倍,经ROC曲线分析发现:年龄曲线下面积为0.695(95%CI=0.588~0.802),年龄预测CMBs的最佳cutoff值为62岁,当患者年龄≥62岁时,发生CMBs的风险明显增高.在12个月的随访中有22例患者复查SWI检查,发现新增CMBs病灶33个,经Wilcoxon非参数配对秩和检验结果显示随访后CMBs数量的中位数是2.5个,基线时是1个(Z=-3.1,P=0.002),随访前后CMBs数量差异有统计学意义.结论 对于年龄≥62岁、高血压病史、规律应用抗血小板聚集药物的缺血性卒中患者,应定期监测CMBs的数量和部位,以指导二级预防治疗方案.

Risk factors of cerebral microbleeds in ischemic stroke patients for secondary prevention

Objective To discuss the risk factors of cerebral microbleeds(CMBs) in ischemic stroke patients for secondary prevention in order to provide guidance for the prevention and treatment of cerebrovascular disease.Methods Patients with acute ischemic stroke were enrolled in the study. They re-ceived susceptibility weighted imaging(SWI) within 4d after initiation of antiplatelet treatment. After 12-month follow-up, the patients received SWI again. The presence and number of CMBs at baseline and during follow-up were documented.Results Totals of 94 patients with acute ischemic stroke were enrolled and 50 patients(53.2%) companied CMBs. Bivariate Logistic regression analysis showed that hypertension(OR=1.2,95%CI=1.07-1.61, P=0.004) and age(OR=2.2,95%CI=1.25-3.92,P=0.006) were independent risk factors of CMBs. With increas-ing of age for 10 years, the incidence of CMBs would increase 2.2 times. ROC curve showed that the area under the age curve was 0.695(95%CI=0.588-0.802) and the best cutoff of predictive age was 62 years old. The risk of CMBs increased significantly in patients who was older than 62. There were 22 cases received SWI again after fol-low-up, and 33 new CMBs lesions were identified. Wilcoxon nonparametric matched-pairs test revealed significant difference between numbers of CMBs before and after follow-up(1 vs 2.5,Z=-3.1,P=0.002).Conclusions Patients older than 62, with history of hypertension and antiplatelet agents should be monitored regularly about number and position of CMBs, which could guide secondary prevention and treatment programs.