脑梗死患者脑微出血程度及位置对早期复发的影响

Effect of degree and location of cerebral microbleeds on early recurrence in patients with cerebral infraction

目的观察急性缺血性脑卒中患者脑微出血程度及位置以及其对早期复发影响,为预防急性缺血性脑卒中复发提供依据。方法选取沭阳县人民医院2017年4月30日至2018年12月30日收治的60例急性缺血性脑卒中患者,根据头颅MRI(SWI)提示是否脑微出血将患者分为脑微出血及无脑微出血组,比较两组临床资料,观察患者90天内缺血性脑卒中复发情况,分析患者临床资料及脑微出血情况对复发的影响。使用Cox回归分析观察患者早期复发的影响因素。结果随访90天,无患者失访,共10例患者复发(16.67%)。无脑微出血组25例,复发1例;脑微出血组35例,复发9例。两组间合并高血压比例、既往脑卒中史、复发率差异有统计学意义(χ2=4.000~4.951,P <0.05)。在脑微出血组,脑微出血轻度、中度和重度患者复发率差异有统计学意义(χ2=9.588,P <0.05),重度患者复发率(5例,55.56%)高于轻度患者(2例,22.22%)及中度患者(2例,22.22%)。Cox回归模型单因素分析结果显示,是否存在脑微出血、合并高血压、既往脑卒中史、低密度脂蛋白胆固醇与急性缺血性脑卒中患者再发脑卒中相关(OR=1.097~2.014,P <0.05)。多因素分析显示,是否存在脑微出血(OR:1.238,95%CI:1.094~2.687)、既往脑卒中史(OR:2.614,95%CI:1.654~6.214)、低密度脂蛋白胆固醇(OR:1.520,95%CI:1.157~4.105)是急性缺血性脑卒中患者再发脑梗死的影响因素(P <0.05)。结论存在脑微出血的急性缺血性脑卒中患者早期复发率较高,且重度脑微出血患者复发率高于轻度和中度患者。

Objective To evaluate the effect of brain microbleeding degree and location on early recurrence in patients with acute ischemic stroke, and to provide a basis for preventing recurrence of stroke. Methods Sixty patients with acute ischemic stroke admitted to the people’s hospital of Shuyang country from April 30, 2017 to December 30, 2018 were enrolled. According to whether the patient had cerebral microbleeds tested by SWI, the patients were divided into cerebral microbleeds group and no cerebral microbleeds group. The clinical data of two groups were compared, and their recurrence within 90 days was observed, and the influence of clinical data and brain microbleeds on ischemic stroke were analyzed. Cox regression analysis was used to observe the influencing factors of early recurrence in patients with acute ischemic stroke. Results After 90 days of follow-up, no patients were lost to follow-up. A total of 10 patients had recurrent ischemic stroke(16.67%). There was 1 case recurred in cerebral microbleeds group(n=25), 9 cases recurred in non cerebral microbleeds group(n=35). The proportion of hypertension, previous stroke and recurrence rate were statistically significant different in the two groups(χ~2=4.000~4.951, P < 0.05). In the cerebral microbleeds group, recurrence rates among mild, moderate and severe cerebral hemorrhage patients were statistically significant different(χ~2=9.588, P < 0.05), and the recurrence rate of severe patients(5 cases, 55.56%) was higher than that in mild patients(2 cases, 22.22%) and moderate patients(2 cases, 22.22%). COX univariate analysis showed that there was a correlation between cerebral microbleeds, hypertension, previous stroke, lowdensity lipoprotein cholesterol and recurrent cerebral infarction in patients with acute ischemic stroke(OR=1.097~2.014, P < 0.05). Multivariate analysis showed presence of cerebral microbleeds(OR:1.238, 95%CI:1.994~2.687), previous stroke(OR:2.614, 95%CI:1.654~6.214), low-density lipoprotein cholesterol(OR:1.520, 95%CI:1.157~4.105) were independent influencing factors for recurrent stroke in patients with acute ischemic stroke(P < 0.05). Conclusion The early recurrence rate of patients with acute ischemic stroke combined with cerebral microbleeds is relatively high, and the recurrence rate of patients with severe cerebral microbleeds is higher than that of mild and severe patients.