缺血性卒中患者脑内微出血特点及危险因素的研究

目的 探讨脑内微出血在缺血性卒中患者中的发生率及在脑内各区域的分布情况，观察缺血性卒中亚型之间微出血发生率的差异，初步分析其相关因素及其与腔隙性脑梗死、脑白质病变等微小血管病变程度之间的关系。方法 连续入选261例心源性栓塞型、大动脉粥样硬化型及小动脉闭塞型3个亚型的缺血性卒中患者。记录患者一般临床资料及实验室检查结果，应用头颅磁共振梯度回波T2*加权成像（gradient-echoT2*-weighted，GRE-T2*）观察脑内微出血的数目及部位，同时观察腔隙性脑梗死数目和部位以及脑白质病变程度。结果 80例患者（30.70%）存在脑内微出血，数目为1～109个。微出血最常见于皮质-皮质下区（46.09%），其次位于基底节区（27.80%）。各亚型中小动脉闭塞型患者脑内微出血的发生率最高（53.30%）。高血压、腔隙性脑梗死数目及脑白质改变程度为缺血性卒中患者脑内微出血发生的独立危险因素，比值比（odds ratio，OR）分别为4.364、1.190和1.310；脑内微出血的分级与腔隙性梗死分级（r =0.519，P <0.001）及白质改变程度（r =0.437，P <0.001）显著相关。结论 微出血在缺血性卒中患者特别是小动脉闭塞患者中发生率较高，微出血与腔隙性脑梗死数目及脑白质改变明显相关。

Study of Cerebral Microbleeds in Patients with Ischemic Stroke

Objective To investigate the frequency and location of cerebral microbleeds（CMBs） in patients with ischemic stroke, to compare the incidences among subtypes, and to analyze the correlation factors and the correlation with the number of lacunar infarcts and the severity of white matter changes（WMC）. Methods Two hundred and sixty-one patients with ischemic stroke were recruited consecutively. The included patients were classified into 3 subtypes consist of cardioembolism, large artery atherosclerosis and small artery occlusion（SAO） according to pathogenesis. The data of the clinical character and laboratory examination were recorded. The incidence and number of CMBs were studied on magnetic resonance imaging（MRI）, the number of lacunar infarction and severity of WMC were also evaluated. Results Eighty（30.70%） patients were found with CMBs, the number from 1 to 109 which distributed at different parts of brain including cortieal-subeortical area（46.09%）, basal ganglia（27.80%）. The incidences（53.30%） of SAO was the highest among the subtypes. Logistic regression analysis indicated that hypertension, the number of lacunar infarction and severity of white matter changes may served as the independent risk factors for CMBs. There was correlation between the number of CMBs and the number of lacunar infarction or severity of white matter changes.Conclusion It shows a high frequency of CMBs in patients with ischemic stroke especially in the SAO. CMBs are associated with the number of lacunar infarcts（r=0.519, P〈0.001） and severity of white matter changes（r=0.437, P〈0.001）, which indicated CMBs may be an indicator of advanced small artery disease of brain, and the result should be taken into consideration when they are being treated.