缺血性脑卒中大血管病变不同治疗方法脑微出血的比较

Comparison of Cerebral Microbleeds with Different Tre atments for Macrovascular Disease in Ischemic Stroke

目的 比较两种方法治疗缺血性脑卒中大血管病变发生脑微出血有无差异。方法 入组78例缺血性脑卒中合并大血管病变患者,分为双联抗血小板药物保守治疗组和支架植入+双联抗血小板药物治疗组,进行临床队列研究。收集患者的一般资料,年龄、性别、吸烟饮酒史,相关高血压病、糖尿病病史;测身高体重计算体重指数;动态监测患者血压;分别于入组时以及治疗3月后记录血常规、血生化指标:血小板计数、空腹血糖、血尿酸、同型半胱氨酸、低密度脂蛋白;同样于入组时以及治疗3月后完善头颅CT、头颅核磁平扫+磁敏感加权成像(MRI+SWI),明确是否发生脑出血,记录脑微出血数目。应用SPSS 25.0软件进行统计学分析,比较入组时以及治疗3月后上述指标有无统计学差异。结果 双联抗血小板药物治疗组入组38人,平均年龄:64.87±6.29岁,女性患者15人,男性患23人。支架植入+双联抗血小板药物治疗组入组40人,平均年龄:64.28±6.82岁,两组间年龄无统计学差异。治疗前两组间年龄、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、血尿酸(UA)、同型半胱氨酸(Hcy)、血小板计数(Plt)以及脑微出血(CBMs)数量比较,差异均无统计学意义(P≥0.05)。两组间低密度脂蛋白比较,差异有统计学意义(P<0.05)。双联抗血小板药物治疗组治疗3月后血压、空腹血糖、同型半胱氨酸、血小板计数、低密度脂蛋白水平下降,脑微出血数量增加(P<0.05)。血尿酸水平与治疗前比较,差异无统计学意义(P≥0.05)。支架植入+双联抗血小板治疗3月后血压、空腹血糖、同型半胱氨酸、血小板计数、低密度脂蛋白水平下降,脑微出血数量增加(P<0.05)。血尿酸水平与治疗前比较,差异无统计学意义(P≥0.05)。治疗后两组间收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、血尿酸(UA)、同型半胱氨酸(Hcy)、血小板计数(Plt)以及脑微出血(CBMs)数量比较,差异均无统计学意义(P≥0.05)。两组间低密度脂蛋白比较,差异有统计学意义(P<0.05)。结论 缺血性脑卒中大血管病变两种治疗方法脑微出血比较差异无统计学意义。两种治疗方法治疗3月后脑微出血数量均有所增加。

Objective To compare the difference between two methods in the treatment of ischemic stroke with Great vessels disease and cerebral micro hemorrhage.Methods 78 patients with ischemic stroke complicated with Great vessels disease were divided into two groups:the dual antiplatelet drug Conservative management group and the stent implantation+dual antiplatelet drug treatment group.The clinical Cohort study was conducted.Collect the general information of patients,age,sex,smoking and drinking history,related hypertension,diabetes history;Measure height and weight to calculate body mass index;Dynamic monitoring of patient blood pressure;Blood routine examination and blood biochemical indexes were recorded at the time of enrollment and after 3 months of treatment:platelet count,Glucose test#Fasting blood sugar,blood uric acid,homocysteine,low-density lipoprotein;At the time of enrollment and after 3 months of treatment,complete head CT,head magnetic resonance imaging+magnetic sensitivity weighted imaging(MRI+SWi)to determine whether cerebral hemorrhage has occurred and record the number of cerebral microbleeds.SPSS 25.0 software was used for statistical analysis to compare whether there were any statistical differences in the above indicators at the time of enrollment and after 3 months of treatment.Results The results showed that 38 patients were enrolled in the dual antiplatelet drug treatment group,with an average age of 64.87±6.29 years.There were 15 female patients and 23 male patients.40 people were enrolled in the stent implantation+dual antiplatelet drug treatment group,with an average age of 64.28±6.82 years.There was no statistically significant difference in age between the two groups.There was no significant difference in age,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),Glucose test#Fasting blood sugar(FPG),blood uric acid(UA),homocysteine(Hcy),platelet count(Plt)and the number of cerebral microbleeds(CBM)between the two groups before treatment(P≥0.05).There was a statistically significant difference in low-density lipoprotein between the two groups(P<0.05).The blood pressure,Glucose test#Fasting blood sugar,homocysteine,platelet count and low density lipoprotein levels in the dual antiplatelet drug treatment group decreased after 3 months of treatment,and the number of cerebral microbleeds increased(P<0.05).There was no statistically significant difference in blood uric acid levels compared to before treatment(P≥0.05).Three months after stent implantation and dual antiplatelet therapy,blood pressure,Glucose test#Fasting blood sugar,homocysteine,platelet count,and low-density lipoprotein levels decreased,and the number of cerebral microbleeds increased(P<0.05).There was no statistically significant difference in blood uric acid levels compared to before treatment(P≥0.05).After treatment,there was no significant difference in the number of systolic blood pressure(SBP),diastolic blood pressure(DBP),Glucose test#Fasting blood sugar(FPG),blood uric acid(UA),homocysteine(Hcy),platelet count(Plt),and cerebral microbleeds(CBM)between the two groups(P≥0.05).There was a statistically significant difference in low-density lipoprotein between the two groups(P<0.05).Conclusions There is no significant difference between the two treatment methods for cerebral micro hemorrhage in ischemic stroke with Great vessels disease.Both treatment methods increased the number of cerebral microbleeds after 3 months of treatment.