应用新型抗凝药物预防脑梗死患者的脑微出血进展情况及影响因素研究

Progression of cerebral microbleeds and influencing factors in cerebral infarction patients treated with new oral anticoagulant

目的 探索新型抗凝药物预防脑梗死患者脑微出血进展情况及其影响因素。方法 前瞻性选取2019年1月至2020年1月我院住院的新发脑梗死合并心房颤动患者126例,收集基线临床资料,所有患者出院后均行利伐沙班抗凝预防脑梗死并随访2年。对基线及2年后磁敏感序列微出血进行计数,根据脑微出血数有无增多分为进展组(39例)及非进展组(68例),比较2组基线资料;采用logistic回归模型分析引起微出血进展的危险因素。结果进展组患者年龄、高血压及基线脑微出血数≥5个比例明显高于非进展组(P<0.05,P<0.01)。调整混杂因素后,年龄(OR=1.058,95%CI:1.002~1.118)、高血压(OR=4.113,95%CI:1.074~15.744)及脑微出血数≥5个(OR=6.461,95%CI:1.766~23.641)为脑微出血进展的独立危险因素(P<0.05,P<0.01);年龄、高血压及脑微出血数联合预测脑微出血进展风险曲线下面积为0.732(P<0.01)。结论 基线年龄、高血压及脑微出血数与应用新型抗凝药物预防脑梗死患者的脑微出血进展风险显著相关,对脑微出血进展具有重要的预测价值。

Objective To explore the progression and influencing factors of cerebral microbleeds in cerebral infarction patients with a new oral anticoagulant, rivaroxaban.Methods A total of 126 patients with atrial fibrillation and newly occurred cerebral infarction admitted in our hospital from January 2019 to January 2020 were prospectively enrolled in this study.Their baseline clinical data were collected.After discharge, all patients were given rivaroxaban for anticoagulation to prevent stroke and followed up for 2 years.According to the counts of microbleeds at baseline and the end of follow-up on blood-sensitive magnetic resonance imaging sequences, the patients were divided into progression group(n=39) and non-progression group(n=68).The clinic data were compared between the 2 groups.Logistic regression analysis was conducted to find the risk factors for cerebral microbleeds.Results The patients of the progression group were older, and had larger proportions of hypertension and microbleeds ≥5 at baseline in comparison with those of the non-progression group(P<0.001).The baseline age(OR=1.058,95%CI:1.002-1.118),hypertension(OR=4.113,95%CI:1.074-15.744),and microbleeds ≥5(OR=6.461,95%CI:1.766-23.641) were independent risk factors for the progression of cerebral microbleeds(P<0.05,P<0.01).The area under curve(AUC) of the 3 indicators combined together was 0.732(P<0.001).Conclusion Baseline age, hypertension, and microbleeds ≥5 are greatly correlated with progression of cerebral microbleeds in cerebral infarction patients after rivaroxaban treatment, and they show important predictive value for the progression.