急性脑梗死患者合并脑微出血的心脑血管事件发生的研究

目的研究急性脑梗死合并脑微出血(CMB)患者后期心脑血管事件的发生率和危险因素。方法将109例急性脑梗死患者分为CMB组38例和无CMB组71例,对其进行前瞻性研究,给予梯度回波T_2~*WI或磁敏感加权成像,并对患者的临床资料和影像学特点进行分析。平均随访(9.5±3.7)个月。结果与无CMB组比较,CMB组脑梗死和脑出血两者兼有,单纯脑出血比例明显升高(7.9%vs 1.4%,P<0.05;10.5%vs 0,P<0.01)。CMB组共检出CMB 153个。在随访中,1 6例患者再发脑卒中,包括11例脑梗死,5例脑出血。5例脑出血患者中有3例服用阿司匹林,2例接受抗凝治疗。CMB组有2例脑出血患者的出血部位与CMB部位相同。结论 CMB是脑微小血管病变特征之一;是急性缺血性脑血管病患者后期发生脑出血的危险因素之一;CMB对脑卒中患者长期服用阿司匹林或者抗凝治疗具有重要意义。

Effect of cerebral microbleeds on cardiac and cerebral vascular events following acute cerebral infarction

Objective To study the incidence and risk factor of cardiac and cerebral vascular events in patients with acute cerebral infarction accompanying cerebral microbleeds(CMB).Methods One hundred and nine acute cerebral infarction patients were divided into CMB group(n = 38) and non-CMB group(n = 71).The patients underwent gradient echo T_2-weighted MRI or magnetic susceptibility-weighted imaging.Their clinical data and imaging characteristics were analyzed. The patients were followed up for 9.5±3.7 months.Results The proportions of acute cerebral infarction and CMB were significantly higher in CMB group than in non-CMB group(7.9%vs 1.4%,P<0.05;10.5%vs 0,P<0.01).One hundred and fifty-three CMB were detected in CMB group.Of the 16 patients who had relapse of cerebral stroke during the follow-up,11 had cerebral infarction and 5 had intracerebral hemorrhage(3 were treated with aspirin and 2 received anti-coagulant therapy).The bleeding site was similar to that of CMB in 2 patients of CMB group.Conclusion CMB are one of the characteristics of cerebral microvascular lesion and one of the risk factors for cerebral bleeding in patients with acute ischemic cerebral vessel disease,and are of great importance in the long-term aspirin or anti-coagulant therapy for those with cerebral stroke.