脑淀粉样血管病与高血压引起脑出血的临床特点和CT表现

Clinical features and CT findings of cerebral hemorrhage due to cerebral amyloid angiopathy and hypertension

目的探讨脑淀粉样血管病相关性脑出血(CAAH)与高血压脑出血(hypertensive cerebral hemorrhage,HICH)的临床特点和CT表现,旨在提高CAAH的临床诊断水平。方法选择CAAH患者49例(CAAH组),HICH患者53例(HICH组),所有患者均行头颅CT检查,对2组患者一般临床资料及影像学结果进行比较。结果 2组男女性别比例差异无统计学意义(P>0.05);与HICH组比较,CAAH组年龄、脑卒中家族史、抗凝或溶栓治疗史、发病前痴呆、癫(疒间)发生率明显增高,高血压、活动或情绪激动中发病、偏瘫发生率明显降低(P<0.05,P<0.01)。与HICH组比较,CAAH组大脑浅表部位出血、出血量>60 ml、多发性出血率明显增高,丘脑基底节出血、出血量<30 ml、再次出血发生率明显降低,差异有统计学意义(P<0.05,P<0.01)。结论 CAAH患者以70岁以上老年人多见,发病前痴呆、脑卒中家族史及使用抗凝或溶栓药可能增加患者出血的危险。CAAH临床及CT表现具有一定的特点,CT有助于临床诊断。

Objective To improve the clinical diagnosis of cerebral amyloid angiopathy hemorrhage （CAAH） and hypertensive cerebral hemorrhage（HCH） by studying their clinical features and CT findings. Methods One hundred and two patients were divided into CAAH group （n = 49） and HCH group（n=53）. All patients underwent cranial CT examination and their clinical data and CT imaging were compared. Results No significant difference was found in male and female ratio between the two groups（P〉0.05）. The patients in CAAH group were older than those in HCH group（P〈0. 05）. The proportion of patients with family history of cerebral stroke and history of anticoagulant or thrombolytic therapy,the incidence of dementia and apoplexy, the superficial cerebral bleeding volume（〉60 ml） and multiple bleeding rate were higher in CAAH group than in HCH group（P〈0.05）. However,the incidence of hypertension due to physical activity and agitation, hemiplegia, subthalamus bleeding, bleeding volumed30 ml and rebleeding was significantly lower in CAAH group than in HCH group（P〈0.05）. Conclusion CAAH patients are usually over the age of 70 years. Family history of dementia and apoplexy and anticoagulant or thrombolytic therapy can increase the risk of bleeding in CAAH patients. CAAH patients are characterized by their clinical features and CT findings. CT contributes to the diagnosis of CAAH.