脑微出血分布模式与缺血性卒中的关联研究进展

doi:10.3969/j.issn.1673-5765.2025.08.015

摘要/Abstract

摘要： 脑微出血（cerebral microbleeds，CMBs）是一种亚临床的脑实质病变，也是脑小血管病（cerebral small vessel disease，CSVD）的重要影像学标志。根据分布模式，CMBs可分为脑叶皮质型、脑深部型和混合型。CMBs常伴发于缺血性卒中（ischemic stroke，IS）。其中，脑叶皮质型CMBs与脑淀粉样血管病相关，易引起IS患者的皮质下认知障碍；脑深部型CMBs与高血压相关小动脉硬化有关，更易引起IS患者的皮质下认知障碍与运动障碍，且与IS的发病风险和死亡率密切相关；混合型CMBs的病理机制更为复杂，常伴随更严重的认知障碍、运动障碍及不良预后。不同分布模式的CMBs对IS患者抗血栓和再灌注治疗预后的影响存在差异，但是否应将CMBs及其分布模式作为治疗禁忌证仍存在争议，未来仍需更多研究进一步明确CMBs对抗血栓和再灌注治疗的具体作用机制，推动个体化治疗策略的优化。

文章导读： 本文围绕脑微出血的分布模式，探讨其对缺血性卒中临床表现、发病风险和预后评估，以及抗血栓和再灌注治疗决策的影响，以期为精准卒中管理与个体化治疗提供新的思路与参考。

关键词: 脑叶皮质型脑微出血; 脑深部型脑微出血; 混合型脑微出血; 缺血性卒中

Abstract: Cerebral microbleeds (CMBs) are subclinical parenchymal lesions and serve as an important imaging marker of cerebral small vessel disease (CSVD). Based on their distribution patterns, CMBs can be classified into lobar-cortical type, deep-type, and mixed-type. CMBs frequently coexist with ischemic stroke (IS). Among them, lobar-cortical type CMBs are associated with cerebral amyloid angiopathy and predispose IS patients to subcortical cognitive impairment. Deep-type CMBs are linked to hypertensive arteriopathy, more commonly inducing subcortical cognitive impairment and dyskinesia in IS patients, and are closely related to the risk and mortality of IS. Mixed-type CMBs exhibit more complex pathological mechanisms, typically accompanied by more severe cognitive impairment, dyskinesia, and poorer prognosis. Different distribution patterns of CMBs may influence the outcomes of antithrombotic and reperfusion therapy in IS patients. However, whether the presence and distribution patterns of CMBs should be considered as contraindications for these treatments remains controversial. Further research is needed to clarify the specific mechanisms by which CMBs affect antithrombotic and reperfusion therapy, in order to optimize individualized treatment strategies.

Key words: Lobar-cortical type cerebral microbleed; Deep-type cerebral microbleed; Mixed-type cerebral microbleed; Ischemic stroke

中图分类号:

朱霄宇, 周凡敬, 徐运, 张梅娟. 脑微出血分布模式与缺血性卒中的关联研究进展[J]. 中国卒中杂志, 2025, 20(8): 1051-1057.

ZHU Xiaoyu, ZHOU Fanjing, XU Yun, ZHANG Meijuan. Research Progress on the Association between Cerebral Microbleeds Distribution Patterns and Ischemic Stroke[J]. Chinese Journal of Stroke, 2025, 20(8): 1051-1057.

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