急性腔隙性脑梗死病人脑微出血的观察

CEREBRAL MICROBLEEDS IN PATIENTS WITH ACUTE LACUNAR INFARCTION

目的了解急性腔隙性脑梗死病人脑微出血发生率、分布特点和危险因素。方法对82例急性腔隙性脑梗死病人的临床资料和影像学特点进行分析,以同期无脑血管病住院病人96例作为对照组。结果老龄、卒中史、高血压、糖尿病是急性腔隙性脑梗死的危险因素,陈旧性腔隙性脑梗死灶、较严重的脑白质病变（Fazekas3、4级改变）对急性腔隙性脑梗死具有提示意义。35例（42.7%）病人存在脑微出血,以脑深部最多见,高血压和Fazekas 3、4级脑白质病变是其独立危险因素。4~10个陈旧性腔隙性脑梗死灶、Fazekas 3、4级脑白质病变在脑微出血者中更常见。脑深部和幕下区域微出血的数目与脑白质病变的程度呈正相关（r=0.399、0.404,P〈0.05）,脑深部区域微出血的数目与陈旧性腔隙性脑梗死灶的数目呈正相关（r=0.552,P〈0.01）。结论急性腔隙性脑梗死病人脑微出血较常见,可能是高血压性脑小血管病严重程度的重要标志。

Objective To explore the incidence, distribution and risk factors of cerebral microbleeds （CMBs） in patients with acute lacunar infarction （ALI）. Methods Clinical data and imaging characteristics of 82 patients with ALI were analyzed, and 96 patients with non-eerebrovascular diseases hospitalized in the same period served as controls. Results Advanced age, his- tory of stroke, hypertension and diabetes were risk factors of ALL Old lacunar infarction focus and serious leukodystrophy （Fazek- as grade 3 and 4） had a denotative meaning for ALL CMBs were found in 35 （42.7%） patients, mostly located in deep part. Hyper- tension and alba lesions （Fazekas grade 3 and 4） were the independent risk factors of CMBs. Four to 10 obsolete lacunar infarction lesions, and white matter changes of Fazekas grades 3 and 4, were more frequently seen in ALI patients with CMBs. There was a significant correlation between the numbers of CMBs and the severity of white matter changes in the deep and infratentorial struc- tures （r = 0.399,0.404~P ~0.05）, and between the numbers of CMBs and the numbers of obsolete lacunar infarcts in the deep area （r=0.552,P%0.01）. Conclusion Cerebral microhemorrhage is commonly seen in patients with acute lacunar infarction, which might be a significant marker of the severity of hypertensive cerebral small vascular disease.