心房颤动合并脑微出血患者抗凝治疗与症状性出血的相关性分析

目的 探讨非瓣膜性心房颤动合并脑微出血(CMB)抗凝治疗与症状性出血(ICH)的相关性.方法 心房颤动患者198例分为CMB组88例和无CMB组(对照组)110例,CHA2DS2-VASc评分>2分患者进行华法林抗凝治疗,CHA2DS2-VASc评分1分根据获益与风险衡量,行华法林抗凝或阿司匹林抗栓治疗,所有患者行1年随访,症状性出血(ICH)为终点事件,头颅CT以证实.结果 CMB组较无CMB组患者抗凝治疗后出血转化更高,但差异无统计学意义.但按数量进一步分层分析,当微出血的数量>4个,其出血转化明显高于对照组,按微出血部分进行分层分析,脑叶多发微出血>2个,其出血转化明显高于对照组.结论 CMB>4个,抗凝治疗更易出血;脑叶CMB>2个,抗凝治疗更易出血.

Objective To investigate the correlation between anticoagulant therapy and symptomatic hemorrhage(ICH)in patients with nonvalvular atrial fibrillation and cerebral microbleeds(CMB).Methods A total of 198 patients with atrial fibrillation were divided into CMB group(n=88)and non-CMB group(control group),110 patients with CHA2DS2-VASc score>2,and warfarin anticoagulant therapy,CHA2DS2-VASc score 1 point according to the benefit and risk,warfarin anticoagulation or aspirin antithrombotic therapy were performed.All patients underwent 1 year follow-up.Symptomatic hemorrhage(ICH)was the end point event and confirmed by head CT.Results The bleeding in the CMB group was higher than that in the CMB-free group after anticoagulant therapy,but the difference was not statistically significant.However,after further stratification analysis by quantity,when the number of microbleeds was>4,the hemorrhagic transformation was significantly higher than that of the control group.After stratified analysis according to the microbleeds,the cerebral had multiple microbleeds>2,the Bleeding transformation was significantly higher than the control group.Conclusion When CMB>4,anticoagulant therapy is more likely to bleed;when brain lobe CMB>2,anticoagulant therapy is more likely to bleed.