脑微出血对非腔隙性梗死抗栓治疗后早期出血转化的预测价值的初步研究

摘要/Abstract

摘要：

【摘要】目的评估脑微出血（cerebral microbleed，CMB）对采用抗栓治疗的非腔隙性梗死患者早期脑出血转化的预测价值。方法本研究为前瞻性研究，入选2011年6月～2012年10月广东省人民医院神经科发病后24 h内住院的心源性脑栓塞及大动脉粥样硬化性梗死患者。根据临床情况对所有患者予以抗血小板或抗凝治疗。采用颅脑磁共振成像（magnetic resonance imaging，MRI）检测CMB数目及分布情况，用颅脑计算机断层扫描（computed tomography，CT）判断发病后1周内出血转化（hemorrhagic transformation，HT）情况。根据有无HT将患者分为有HT组和无HT组，比较两组间一般临床资料、病因、美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分及CMB是否存在，并采用多因素逐步Logistic回归模型分析HT的独立危险因素。结果 167例患者中18例发生HT（11%），57例检出CMB（34%），CMB检出率在是否合并HT的患者之间差异无显著性（分别为22%和36%，P＞0.05）。抗血小板治疗患者是否存在CMB，早期HT差异无显著性（分别为12%和9%，P＞0.05）；抗凝治疗患者差异无显著性（分别为17%和12%，P＞0.05）。Logistic回归分析显NIHSS（≥8）和心源性脑栓塞与HT有关，其比值比（odds ratio，OR）值分别为3.65［95%可信区间（confidence interval，CI）1.47～8.26］和5.82（95%CI 1.89～15.38）；高血压、大动脉粥样硬化以及CMB并不增加HT风险，其OR和95%CI值分别为1.05（0.97～1.12），2.31（0.91～3.45）以及0.35（0.09～1.41）。结论 CMB对非腔隙性脑梗死患者抗栓治疗后早期HT缺乏预测价值，疾病严重程度以及病因类型有助于估计HT风险。

文章导读： 脑微出血对非腔隙性梗死患者抗栓治疗后的早期出血转化缺乏预测价值。

关键词: 脑微出血; 脑梗死; 抗栓治疗; 出血转化

Abstract:

【Abstract】 Objective To assess the predictive value of cerebral microbleeds (CMB) for early hemorrhagic transformation (HT) in non-lacunar infarction patients with antithrombotic therapy. Methods The patients with cardiogenic cerebral embolism or artery atherosclerotic infarction were prospectively enrolled within 24 hours after symptom onset from June 2011 to October 2012 in Department of Neurology of Guangdong General Hospital. All patients took antiplatelet or anticoagulant therapy according to the clinical situation. CMB were detected with magnetic resonance imaging and HT was determined with head CT within one week after onset. The patients were divided into HT group and non-HT group; the differences of the clinical data, etiology, National Institutes of Health Stroke Scale (NIHSS), and CMB between the two groups were compared, and independent risk factors for HT were determined with multivariate stepwise Logistic regression analysis. Results Among 167 patients enrolled, HT occurred in 18 cases (11%), CMB were detected in 57 cases (34%). There was no significant difference of CMB between the patients with and without HT (22% vs 36%, P>0.05). The prevalence of early HT was not significantly different regardless of CMB status in patients with antiplatelet (12% vs 9%, P>0.05), and in patients with anticoagulants (17% vs 12%, P>0.05). Logistic regression analysis showed NIHSS≥8 and cardiogenic embolism associated with the increased risk of HT (odds ratio [OR]3.65, 95% confidence interval [CI]1.47~8.26; OR 5.82, 95%CI 1.89~15.38); There was no relationship between hypertension, large artery atherosclerosis, CMB with HT, their OR and 95%CI values were 1.05 (0.97~1.12), 2.31 (0.91~3.45) and 0.35 (0.09~1.41), respectively. Conclusion CMBs may not be a predictor of early HT in non-lacunar patients with antithrombotic therapy, stroke severity and etiology of type help to estimate HT risk.

Key words: Microbleeds; Ischemic stroke; Antithrombotic therapy; Hemorrhagic transformation

代成波，王硕，段振鹏，曹裕民，张雄，王丽娟. 脑微出血对非腔隙性梗死抗栓治疗后早期出血转化的预测价值的初步研究[J]. 中国卒中杂志, 2013, 8(09): 712-717.

DAI Cheng-Bo, WANG Shuo, DUAN Zhen-Peng, CAO Yu-Min, ZHANG Xiong, WANG Li-Juan.. Predictive Value of Cerebral Microbleeds for Early Hemorrhagic Transformation in Non-lacunar Infarction Patients with Antithrombotic Therapy[J]. Chinese Journal of Stroke, 2013, 8(09): 712-717.

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