脑微出血对轻型急性期脑梗死强化双抗后出血陛转化的风险探讨

Risk of hemorrhagic transformation in light acute cerebral ischemic infarction patients with cerebral microbleeds and combined clopidogrel-aspirin treatment

目的 探究轻型急性期脑梗死患者伴发脑微出血（CMBs）能否升高经强化双抗后出血性转化（HT）发生风险.方法 选择2015年1月至2017年1月收治的128例轻型急性期脑梗死患者,根据脑MRI结果分为无CMBs组和有CMBs组;有CMBs组按CMBs解剖部位再分为脑叶亚组、深部亚组及混合亚组,比较各亚组HT发生率;采用Logistic回归法分析影响轻型急性期脑梗死患者HT的相关危险因素.结果 CMBs检出率为54.7％（70/128）.有CMBs组和无CMBs组HT发生率比较差异无统计学意义（P〉0.05）.有CMBs组中,脑叶亚组13例患者中5例发生HT,深部亚组43例患者中5例发生HT,混合亚组14例患者中3例发生HT,三组比较差异有统计意义（χ^2=7.465,P=0.036）.多因素Logistic回归分析结果显示,心房颤动（OR=6.590,95％CI 2.561～17.282,P=0.000）和空腹血糖（OR=1.132,95％CI 1.544～2.953,P=0.025）是轻型急性期脑梗死患者发生HT的独立危险因素.结论 轻型急性期脑梗死患者伴发CMBs时并不升高强化双抗之后发生HT风险,但如患者伴发脑叶部CMBs则应谨慎给予强化双抗治疗.

Objective To investigate the risk of hemorrhagic transformation （HT） in light acute cerebral ischemic infarction patients with cerebral microbleeds （CMBs） and combined clopidogrel-aspirin treatment. Methods One hundred and twenty- eight patients with light acute cerebral ischemic infarction were selected from January 2015 to January 2017. The patients were divided into non-CMBs group and CMBs group according to the cerebral MRI result; the patients in CMBs group were subdivided into brain lobe subgroup, deep subgroup and mixed subgroup according to the anatomic site of CMBs, and the incidence of HT was compared among the subgroups. Risk factors related to HT in patients with light acute cerebral ischemic infarction were analyzed by Logistic regression. Results The incidence of CMBs was 54.7% （70/128）. There was no statistical difference in the incidence of HT between CMBs group and non-CMBs group （P〉0.05）. In CMBs group, the number of patients with HT in lobe of brain subgroup （13 cases） was 5, in deep subgroup （43 cases） was 5, in mixed subgroup （14 cases） was 3, and there was statistical difference （χ2 = 7.465, P = 0.036）. Multifactor Logistic regression analysis result showed that atrial fibrillation （OR = 6.590, 95% CI 2.561 to 17.282, P = 0.000） and fasting blood glucose （OR = 1.132, 95% CI 1.544 to 2.953, P = 0.025） were the independent risk factors of HT in patients with light acute cerebral ischemic infarction. Conclusions The combined clopidogrel-aspirin treatment does not increase the risk of HT in patients with light acute cerebral ischemic infarction combined CMBs, but the combined clopidogrel-aspirin treatment in patients with brain lobe CMBs should be careful.