急性脑梗死伴脑微出血患者的抗血小板治疗

Therapy of anti-platelet in acute cerebral infarction with cerebral microbleeds

目的探讨抗血小板聚集治疗对急性脑梗死合并脑微出血(cerebral microbleeds,CMB)患者的临床意义。方法选择铜陵市人民医院神经内科2011年2～12月收治的急性脑梗死患者107例。入院时均常规行MRI加梯度回波T2加权成像(grandient-echo T2weighted MRI,GRE)检查。根据是否存在CMB分为有CMB组,无CMB组。记录CMB组的CMB发生例数、CMB病灶部位、数目、记录两组患者腔隙性脑梗死、脑白质疏松等情况,记录两组患者的血压、血脂、血糖、既往卒中病史。107例患者均接受抗血小板聚集治疗。治疗后2周复查MRI加GRE。观察两组患者CMB的总数、部位有无变化,有无梗死后出血转化,并探讨CMB的危险因素。结果 CMB在脑部各个区域均有分布,以基底节区最多;高血压(OR=4.004,95%CI=1.483～10.814,P<0.05)、腔隙性脑梗死(OR=10.727,95%CI=3.646～31.563,P<0.05)是CMB发生的危险因素;高血脂、糖尿病、脑白质疏松、抗血小板聚集治疗与CMB发生无明显相关(OR=0.887,95%CI=0.631～1.248,P>0.05)。无CMB组治疗两周后无新发CMB;有CMB组CMB的总数、部位均无明显变化(P>0.05);两组患者均无出血转化的发生。结论 CMB在急性脑梗死患者中有较高的发生率,高血压、腔隙性脑梗死是急性脑梗死发生CMB的危险因素。急性脑梗死合并CMB患者在2周内行抗血小板聚集治疗不增加CMB发生率,不增加出血转化的危险。

Objective To investigate the clinical significance of anti-platelet therapy to acute cerebral infarction with cerebral microbleeds （CMB）. Methods 107 patients with acute cerebral infarction had been admitted in the Neurological Department of Tongling People Hospital from February 2011 to December 2011, all patients had been scanned with MRI and GRE series. According to the existence of CMB, the patients fell into two groups, CMB group and non-CMB group. CMB group was recorded in items： CMB occurrence cases, CMB focus number, CMB location, lacunar infarction number, leukoaraiosis situation, and others. Blood pressure, blood lipids, blood glucose, past history of stroke were recorded in two groups of patients. All patients were treated with anti-platelet aggregation medicine. After treatment for two weeks, the patients were rescanned with MRI and GRE to observe and compare the total number and location of CMB,the incidence of hemorrhagic transformation and to explore the risk factor for CMB in acute cerebral infarction. All data were analyzed using SPSS 17.0 software. Results CMB distributed in various regions,most often in the basal ganglia. CMB occurrence significantly associated with hypertension（ OR =4. 004,95 % CI = 1. 483-10. 814, P 〈0.05） and lacunar infarction（ OR =10. 727,95% CI =3. 646-31. 563, P 〈0.05） ,but did not relate with high blood lipids, diabetes, white matter lesions and anti-platelet aggregating treatment （ P 〉0.05）. The non-CMB group had none new occurrence in CMB after two weeks of treatment. In CMB group, there was no significant difference in the total number and location before and after treatment （P 〉 0.05 ）; Two groups of patients had no hemorrhagic transformation. Conclusion CMB has a higher incidence in acute cerebral infarction patients. CMB is associated closely with hypertension and lacunar infarction. Within 2 weeks, the therapy of anti-platelet in acute cerebral infarction patients with CMB does not augment the incidence of CMB and CMB does not augment the hemorrhagic risk of anti- platelet aggregation treatment.