脑微出血与冠心病抗栓治疗患者主要不良心血管事件发生风险的相关性研究

Correlation between cerebral microbleeds and major adverse cardiovascular events in patients with coronary heart disease undergoing antithrombotic therapy

目的:观察冠心病抗栓治疗患者脑微出血(CMBs)分布及数目与主要不良心血管事件发生风险的关系。方法:本研究入选2015年5月—2020年1月我院老年内科住院的已诊断冠心病、服用至少一种抗栓药物且完成头颅MRI的患者。根据是否存在CMBs分为CMBs组和非CMBs组,比较2组临床资料、主要不良心血管事件发生情况,发生主要不良心血管事件的危险因素及CMBs分布、数目对预后的影响。结果:共162例患者纳入研究,47例(29.0%)存在CMBs。与非CMBs组比较,CMBs组白蛋白更低,超敏C反应蛋白更高,阿司匹林与替格瑞洛联用及单用抗凝药比例更高(P<0.05)。CMBs组出血性和缺血性卒中发生率明显高于非CMBs组(P<0.001)。多因素Cox回归分析显示CMBs是冠心病抗栓治疗患者发生主要不良心血管事件的独立危险因素(HR=4.01,95%CI:1.67~9.62,P=0.002)。随着CMBs数目增多,出血性和缺血性卒中风险明显升高。结论:CMBs是冠心病抗栓治疗患者发生主要不良心血管事件的独立危险因素;随着CMBs数目增多,出血性和缺血性卒中风险明显升高。

Objective:To investigate the correlation between cerebral microbleeds(CMBs)and major adverse cardiovascular events(MACE)in patients with coronary heart disease(CHD)undergoing antithrombotic therapy.Methods:This is a single-center retrospective study.CHD patients taking at least one thrombotic agent who underwent brain MRI from May 2015 to January 2020 were included.The patients were divided into two groups:the CMBs group and the non-CMBs group.The clinical data and incidence of MACE were compared between the two groups.The independent predictors of MACE were determined by the Cox regression model and the distribution and quantity of CMBs were also analyzed.Results:A total of 162 patients were enrolled in this study,CMBs were identified in 47(29.0%)patients.The patients with CMBs had lower albumin levels,higher c-reactive protein levels,a higher percentage of taking aspirin and ticagrelor or only anticoagulant(P<0.05).The rates of ischemic and hemorrhagic stroke were significantly higher in patients with CMBs than those without(P<0.001).A multivariate cox regression analysis revealed that the presence of CMBs was independently correlated with the occurrence of MACE after adjusting for major confounding factors(hazard ratio 4.01,95%CI:1.67~9.62,P=0.002).Increasing CMBs burden category was associated with the risk of ischemic and hemorrhagic stroke.Conclusion:CMBs was independently correlated with the occurrence of MACE in CHD patients receiving antithrombotic therapy.Thw risk of ischemic and hemorrhagic stroke increased with the quantity of CMBs.