成人贫血并发急性脑梗死的临床特点分析

目的 探讨成人贫血并发急性脑梗死的临床特点。方法 回顾性分析2014年1月～2015年12月本院神经内科收治的18例成人贫血并发急性脑梗死患者的临床资料,总结其贫血特点、脑卒中危险因素、临床表现和脑MRI特点。结果 成人贫血并发急性脑梗死患者占同期所有住院急性脑梗死患者(205例)的比例为8.78%。其中男11例,女7例,平均年龄(60.56±12.50)岁(35～87岁),平均血红蛋白浓度(74.06±14.95)g/L(52～102 g/L); 轻度贫血3例(16.66%),中度贫血12例(66.67%),重度贫血3例(16.66%); 平均血小板计数(311.33±101.48)×10⁹/L(136～455×10⁹/L); 小细胞低色素性贫血14例(77.78%)(9例确诊为缺铁性贫血),缺铁性贫血患者平均血小板计数(375±73.78)×10⁹/L(251～455×10⁹/L)。无脑卒中危险因素者6例(33.33%),脑卒中危险因素1～2项者7例(38.89%),3项以上危险因素者5例(27.78%); 5例有意识障碍(27.78%); 12例病灶累及前循环(66.67%),14例累及分水岭区(77.78%),10例累及放射冠及半卵圆中心(55.56%); 13例为多发性脑梗死(72.22%),15例为小梗死(83.33%)。18例患者均行扩容治疗,4例输注红细胞; 临床治愈及好转者12例(66.67%)。结论 成人贫血并发急性脑梗死患者多为中度贫血,缺铁性贫血占多数,多伴有继发性血小板增多; 患者多缺乏脑血管病危险因素; 病变多位于脑前循环分布区,分水岭区多见,病灶以多发性小梗死灶为主,且多累及放射冠及半卵圆中心。治疗应以扩容及纠正贫血为主。

Clinical analysis on adult patients with anemia complicated with acute cerebral infarction

ObjectiveTo investigate the clinical features of adult patients with anemia complicated withA retrospective study was conducted on 18 anemia patients with stroke acute cerebral infarction.Methods admitted in our hospital from January 2014 to December 2015. The Characteristics of anemia types,stroke risk factors,clinical manifestations and brain imaging data were analyzed.Results During the two years,18 of the 205 stroke patients were found to be anemic(8.78%). The enrolled 18 patients(11 males and 7 females),the average age is 60.56±12.50(35～87 years), and mean hemoglobin concentration is(74.06±14.95)g/L,(52 g/L～102 g/L).3 cases of the 18 patients were found mild anemia in, 12 cases moderate anemia, and 3 cases severe anemia.Mean platelet count is(311.33±101.48)×10⁹/L,(136×10⁹/L～455×10⁹/L).Fourteen patients were found to be microcytic hypochromic anemia(77.78%),nine of which were diagnosed as iron deficiency anemia, and the average platelet count is(375±73.78)×10⁹/L,(251×10⁹/L～455×10⁹/L).Six patients had no stroke risk factors(33.33%),seven patients had 1～2 risk factors(38.89%),and five patients had more than 3 risk factors(27.78%).Five patients had consciousness disturbance(27.78%).Twelve patients(66.67%)presented anterior circulation brain infarctions, fourteen patients(77.78%)had watershed area infarctions,and 12 patients(55.56%)had corona radiata and semi-oval center infarctions.Thirteen patients(72.22%)presented multiple brain infarctions, and 11 patients presented small infarctions.All of the 18 patients underwent fluid expansion treatment,4 cases received transfusion.Twelve patients were clinical cured or improved(66.67%).Conclusion Anemia in adult patients with acute strokes are mostly moderate anemia,most of which are iron deficiency anemia patients and accompanied by thrombocytosis.These patients enrolled in our study lacked of risk factors of stroke.The brain infarctions are mostly involved in the distribution of anterior circulation,especially the watershed area.Most of the lesions are small infarction and usually involved in corona radiata and semi-oval center.The treatment should be based on fluid expansion and anemia correction.