急性脑梗死患者合并脑微出血的静脉溶栓治疗

Intravenous thrombolysis in acute cerebral infarction with cerebral microbleeds

目的:探讨急性脑梗死合并脑微出血(CMB)的患者在静脉溶栓后脑微出血的变化。方法:收集2011年1月1日至2012年12月31日在广州医学院第二附属医院神经内科住院的89例急性脑梗死患者,入院时均行常规MRI加梯度回波序列T2加权检查,根据是否存在CMB分为有CMB组、无CMB组。记录两组患者的吸烟、饮酒、高血压、腔隙性脑梗死、糖尿病、白质疏松等既往史,并探讨CMB的危险因素。患者经溶栓治疗后,观察CMB数目的变化。结果:经溶栓治疗后24 h复查,有CMB组的CMB个数与治疗前相比,轻度CMB患者减少,重度CMB患者增多;性别、年龄、高血压病、腔梗、白质疏松与CMB有显著相关性。结论:性别、年龄、高血压病、腔隙性脑梗死、白质疏松是急性脑梗死发生CMB的危险因素。急性脑梗死合并CMB患者溶栓治疗增加重度CMB的发生率,增加出血转化危险。

Objective To investigate the influence of intravenous thrombolysis to acute cerebral infarction with cerebral microbleeds （CMB）. Methods Eight-nine patients with cerebral infarction in the Neurological Department of the Second Affiliated Hospital of Guangzhou Medical College from January 1st, 2011 to December 31st, 2012 were enrolled in this study. All patients were scanned with MRI and GRE. According to the presence of CMB, the patients were classified into two groups, including CMB group and non-CMB group. Past history of smoking, drinking, hypertension, lacunar infarction, diabetes and leukoaraiosis situation were recorded and risk factors of CMB were explored. All patients were treated with intravenous thrombolysis and rescanned with MRI to compare the total number of CMB 24 hours after thrombolysis. Results In the CMB group, the number of patients with mild CMB decreased and the number of patients with serious CMB increased after thrombolysis. CMB was associated with sex, age, hypertension, lacunar infarction and leukoaraiosis. Conclusions Sex, age, hypertension, lacunar infarction and leukoaraiosis were the risk factors of CMB in acute cerebral infarction. Thrombolysis in acute cerebral infarction augments the incidence of CMB and promotes the hemorrhagic transformation.