脑微出血与脑卒中

Association between cerebral microbleeds and stroke

目的探讨脑微出血与脑卒中发生、发展的联系。方法卒中患者83例,分为脑缺血组(43例)和脑出血组(40例),以同期住院的50岁以上非脑卒中患者设立对照组(32例)。采用T2加权梯度回波MRI观察各病例脑微出血、卒中病灶、腔隙性梗塞以及白质疏松情况,同时记录卒中患者的高血压、糖尿病、高脂血症、卒中病史以及阿司匹林使用史。结果微出血在缺血组和出血组的发生率分别为34.9%、75.0%,对照组9.4%。各组微出血均最常见于基底节区。微出血与高血压、卒中病史相关(P<0.01),与高脂血症、糖尿病病史及使用阿司匹林无关(P>0.05)。微出血的严重程度与腔隙性梗塞、白质疏松的严重程度相关(P<0.01)。微出血在卒中病灶区域同侧或对侧分布无显著性差异(P>0.05)。出血组微出血在卒中病灶区域的分布率明显高于缺血组。结论微出血与脑卒中,特别是与出血性脑卒中有密切关系,对卒中患者出血性转化具有预测意义。

Objective To investigate the influence ofmicrobleeds on the onset and development of stroke. Methods Eighty-three patients with acute stroke were divided into 2 groups： ischemic group （n=43） or hemorrhagic group （n=40）, and compared with a cohort of non-stroke individuals who were older than 50 years （n=32）. The number, location and frequency of microbleeds were examined using T2^＊ -weighted gradient-echo MRI, and stroke foci, lacunar infarction and leukoaraiosis were also evaluated. Meanwhile, hypertension, diabetes mellitus, hyperlipemia, stroke history and use of aspirin were recorded for stroke patients. Results The frequency of microbleeds were 34.9% in ischemic group, 75.0% in hemorrhagic group and 9.4% in control group. The occurrence index of microbleeds was significantly highest in the basal ganglia including the thalami in all groups. Microbleeds were relatively mild or moderate in ischemic group compared with hemorrhagic group. Microbleeds were more prevalent in patients with hypertension and previous stroke history （P 〈0.01）. There were no significant relationships between microbleeds and diabetes mellitus, hyperlipemia and use of aspirin （P〉0.05）. The degree ofmicrobleeds was positively correlated with the severity of lacunar infarction, and was closely correlated with the degree of leukoaraiosis （P〈0.01）. There was no significant difference whether the location of microbleeds were ipsilateral or contralateral to stroke location （P〉0.05）. The correspondence between stroke location and microbleeds topography in hemorrhagic group is significantly greater than that in ischemic group. Conclusion Microbleeds were closely associated with stroke, especially with intracerebral hemorrhage, and play a predictive role for stroke patients in the hemorrhagic transformation.