脑微出血与急性缺血性卒中溶栓后出血转化的相关性研究

Study on Correlation between Cerebral Microbleeds and Hemorrhagic Transformation after Thrombolytic Therapy in Acute Ischemic Stroke

目的分析脑微出血(cerebral microbleeds,CMBs)与急性缺血性卒中溶栓治疗后出血转化(hemorrhage transformation,HT)的相关性。方法连续纳入80例发病6 h内急性缺血性卒中患者,根据磁敏感加权成像(susceptibility weighted imaging,SWI)图像上有无CMBs,将患者分为两组:CMBs阳性组和CMBs阴性组;同时根据CMBs病灶的发生部位和数量对患者进行分组和分级。参照欧洲协作性急性卒中研究Ⅱ(European Cooperative Acute Stroke StudyⅡ,ECASSⅡ),对梗死溶栓后HT分类进行改良分组,分为HT阴性、HT-1型和HT-2型。应用χ~2检验对CMBs阳性组和阴性组中的HT分型情况、CMBs阳性患者中不同发生部位的HT分型情况、CMBs不同数目分级的HT分型情况进行统计学分析,P<0.05为差异有显著性。结果 CMBs在缺血性卒中患者中占31.3%,CMBs阳性组、CMBs阴性组之间年龄差异有显著性(P<0.05);CMBs发生率、发生部位、数目差异在HT阴性组、HT-1型、HT-2型之间均无显著性(P>0.05),但CMBs阳性患者发生HT-2型比率高于CMBs阴性患者。结论 CMBs阳性、CMBs部位及数目与梗死后HT无明确相关性,CMBs不应作为急性缺血性卒中溶栓治疗的绝对溶栓禁忌,但可增加溶栓后HT的危险。

Objective To analyze the correlation between cerebral microbleeds （CMBs） and hemorrhagic transformation （HT） after thrombolytic therapy in acute ischemic stroke. Methods A total of 80 acute ischemic stroke patients were consecutively enrolled. According to the SWI with and without CMBs, the patients were divided into CMBs positive group and CMBs negative group. CMBs positive patients were grouped and classified according to the lesion location and number. According to the experimental study of European Cooperative Acute Study （ECASS II）, the modified classification of hemorrhagic transformation after thrombolysis was divided into HT negative group, HT-1 type and HT-2 type. Chi-square test were used to compare the statistical difference of the modified classification of HT in CMBs positive and negative groups, in different sites and different numbers of CMBs positive patients, respectively, which had significant difference （P〈0.05）. Results CMBs accounted for 31.3% in patients with ischemic stroke, and there was significant difference in age between CMBs positive group and CMBs negative group （P〈0.05）. The incidence, location and number of CMBs showed no significant difference between HT negative group, HTol type, and HT-2 type （P〉0.05）. However, the incidence of type HT-2 was higher in patients with CMBs positive than that in negative patients. Conclusion There was no correlation between the incidence, location and number of CMBs in the brain and post-thrombolysis intracerebral hemorrhage, and CMBs in the brain was not an absolute contraindication of thrombolytic therapy in acute ischemic stroke, although it can increase the risk of HT after thrombolysis.