缺血性脑卒中颈动脉狭窄与脑微出血关系的研究

Study on the correlation between carotid artery stenosis and cerebral microbleeds in ischemic stroke

目的探讨缺血性脑卒中患者颈动脉狭窄与脑微出血(cerebral microbleeds,CMBs)的关系。方法缺血性脑卒中患者268例根据血管狭窄程度分为4组:轻度组(血管狭窄程度0%~49%)96例,中度组(血管狭窄程度50%~69%)87例,重度组(血管狭窄程度70%~99%)53例,闭塞组(血管完全闭塞)32例。应用3.0TPhilips磁共振成像行磁敏感加权成像扫描的方法,检查6个月和12个月后各组新增CMBs。结果在皮层及皮层下区、基底节区,6个月和12个月时,均有随着颈动脉狭窄程度增加CMBs也逐渐增加的趋势,尤其是在12个月时皮层及皮层下区,组间总的差异有统计学意义(P<0.05),但各组两两之间比较差异无统计学意义(P>0.05)。在6个月和12个月,各组所有部位新增加的CMBs有随着颈动脉狭窄程度增加而逐渐增加的趋势,但6个月时组间比较差异无统计学意义(P>0.05),12个月时组间总的差异有统计学意义(P<0.05),但各组两两之间比较差异无统计学意义(P>0.05)。结论缺血性脑卒中患者,有随着颈动脉狭窄程度增加CMBs逐渐增加的趋势,且随着时间延长,CMBs的发生概率增大。

Objective To discuss the correlation between carotid artery stenosis（CAS）and cerebral microbleeds（CMBs） in patients with ischemic stroke.Methods Two hundred and sixty-eight patients with ischemic stroke were divided into four groups according to the degree of CAS： the slight stenosis group（ninety-six cases, the degree of CAS was zero to fourty-nine percent）, moderate stenosis group（eighty-seven cases, the degree of CAS was fifth to sixty-nine percent）, severe stenosis group （fifty-three cases,the degree of CAS was seventy to ninety-nine percent） and total occlusion group （thirty-two cases, carotid artery was completely blocked）. All patients were examined with susceptibility weighted imaging by 3.0T magnetic resonance imaging. New CMBs were counted after six months and twelve months.Results In the cortex, subcortical area and basal ganglia, new CMBs were increased gradually with the increasing degree of CAS at the sixth month and the twelfth month. Especially in the cortex and the subcortical area at the twelfth month, the difference of total comparison was significantly statistical between the groups（ P 〈 0.05）, but there were no statistical differences between every two groups（ P 〉 0.05）. At the sixth month and the twelfth month,the new CMBs in all parts of each group showed a trend of gradual increasewith the increasing degree of CAS. At the sixth month, there were no significantdifferences between the groups（ P 〉 0.05）. At the twelfth month, there was statistical difference of total comparison between the groups（ P 〈 0.05）, but the differences were no statistical between every two groups（ P 〉 0.05）.Conclusion The CMBs tends to increase gradually with the increasing degree of CAS in ischemic stroke and the probability of occurrence of CMBs is increased with the extension of time.