缺血性脑血管病患者脑微出血相关因素及其对抗血小板单药治疗的影响分析

Cerebral microbleeds in patients with ischemic cerebrovascular disease:risk factors and effects on antiplatelet monotherapy

目的研究缺血性脑血管病患者脑微出血(CMB)危险因素及其对抗血小板单药治疗的影响。方法选取2018年1月至2018年6月该院神经内科接受抗血小板单药治疗的急性缺血性脑血管病患者300例为样本,入院后采集基本资料并完善相关检查,根据梯度回波T2*加权成像(GRE-T2*WI)检查结果将患者分为CMB组(176例)和非CMB组(124例),均给予抗血小板聚集治疗,比较两组临床资料及治疗1年内再发梗死、脑出血和病死率,分析影响CMB发病的危险因素以及CMB对抗血小板单药治疗的影响。结果高龄、高血压、肥胖、脑卒中病史、ACI和脑白质疏松为CMB发生的危险因素(P<0.05)。CMB组和非CMB组抗血小板单药治疗期间脑出血率分别为14.20%和6.45%,差异有统计学意义(P<0.05)。轻度组、中度组和重度组脑出血率分别为9.18%、10.64%和35.48%,差异有统计学意义(P<0.05)。不同部位CMB患者抗血小板单药治疗期间再发脑梗死、脑出血及病死率比较,差异无统计学意义(P>0.05)。结论高龄、高血压、肥胖、脑卒中病史、ACI及脑白质疏松为缺血性脑血管疾病合并CMB的危险因素。CMB可导致抗血小板单药治疗期间脑出血风险增加,重度CMB者更甚。

Objective To study risk factors for cerebral microbleeds(CMBs)in patients with ischemic cerebrovascular disease and the effects of CMBs on antiplatelet monotherapy.Methods We selected 300 patients with acute ischemic cerebrovascular disease who received antiplatelet monotherapy in the department of neurology of our hospital from January to June,2018.The basic information and results of relevant examinations were collected.The patients were divided into CMB group(176 cases)and non-CMB group(124 cases)according to the results of gradient recalled echo T2*-weighted imaging.All the patients were given antiplatelet monotherapy.We compared the clinical data and the incidence rates of reinfarction,cerebral hemorrhage,and death within 1 year after treatment between the two groups,and analyzed the risk factors for CMBs and the influence of CMBs on antiplatelet monotherapy.Results Advanced age,hypertension,obesity,a history of stroke,acute cerebral infarction(ACI),and leukoaraiosis were risk factors for CMBs in the patients with ischemic cerebrovascular disease(P<0.05).The incidence of cerebral hemorrhage during antiplatelet monotherapy showed a significant difference between the CMB group and the non-CMB group(14.20%vs 6.45%,P<0.05).The incidence rates of cerebral hemorrhage were 9.18%,10.64%,and 35.48%for the mild CMB group,moderate CMB group,and severe CMB group,respectively,with a significant difference(P<0.05).There were no significant differences in the incidence rates of recurrent cerebral infarction,cerebral hemorrhage,and death during antiplatelet monotherapy between patients with CMBs at different sites(P>0.05).Conclusions Advanced age,hypertension,obesity,a history of stroke,ACI,and leukoaraiosis are risk factors for the incidence of CMBs in patients with ischemic cerebrovascular disease.CMBs,especially severe CMBs,can increase the risk of cerebral hemorrhage during antiplatelet monotherapy.