【摘要】：目的:利用磁敏感加權(quán)成像技術(shù)(SWI)檢測缺血性卒中患者腦微出血(CMBs)的數(shù)目和部位,探討二級預(yù)防中腦微出的部位和數(shù)目對未來發(fā)生腦出血風險的預(yù)測價值。方法:本前瞻性病例對照研究,納入2015年5月至2016年4月期間,因急性腦梗死就診于新疆維吾爾自治區(qū)人民醫(yī)院神經(jīng)內(nèi)科的患者,將所有納入的患者行SWI檢查,記錄CMBs數(shù)目和部位。根據(jù)發(fā)病機制均口服單一抗血小板聚集藥物(阿司匹林腸溶片100mg或氯吡格雷片75mg),6個月后電話或門診隨訪。終點事件是發(fā)生了腦出血(ICH)、復(fù)發(fā)腦梗死和其他。結(jié)果:共納入了94例患者,其中發(fā)現(xiàn)伴CMBs患者50(53.2%)例,平均隨訪6.23±0.7月,發(fā)現(xiàn)發(fā)生腦出血的風險與CMBs的數(shù)目明顯相關(guān):0%(沒有CMBs),6.7%(1個CMBs),9.1%(2-4個CMBs),15.4%(≥5個CMBs)(P=0.015)。復(fù)發(fā)腦梗死的風險分別是9.1%,6.7%,22.1%,7.7%(P=0.327)。結(jié)論:未來腦出血(ICH)的發(fā)病率與CMBs的數(shù)目明顯相關(guān),當患者CMBs數(shù)目≥5個時,發(fā)生腦出血的風險高于服用抗血小板聚集藥物帶來的益處。并且從總體上來看,未來腦梗死的復(fù)發(fā)率仍高于腦出血,所以,抗血小板聚集藥物作為缺血性卒中患者二級預(yù)防的基石之一,繼續(xù)服用抗血小板聚集藥物仍然是必要的。作為臨床醫(yī)生應(yīng)對CMBs有足夠的重視,應(yīng)積極采取干預(yù)措施,以平衡未來發(fā)生抗血小板聚集藥物相關(guān)性腦出血和復(fù)發(fā)腦梗死的風險。
[Abstract]:Objective: to detect the number and location of cerebral microhemorrhage (CMBs) in ischemic stroke patients by magnetic sensitivity weighted imaging (SWI), and to explore the predictive value of the number and number of secondary prevention sites and numbers for the risk of intracerebral hemorrhage (ICH) in the future. Methods: this prospective case-control study included patients with acute cerebral infarction who were admitted to the Department of Neurology of the people's Hospital of Xinjiang Uygur Autonomous region from May 2015 to April 2016. All patients were examined by SWI. The number and location of CMBs were recorded. All patients were treated with single antiplatelet aggregation drugs (aspirin enteric-coated tablets 100mg or clopidogrel 75mg) according to the pathogenesis and followed up 6 months later by telephone or outpatient. The endpoint event is the occurrence of intracerebral hemorrhage, (ICH), recurrence, cerebral infarction and other. Results: a total of 94 patients were included, of whom 50 (53.2%) were found to be with CMBs, with an average follow-up of 6.23 鹵0.7 months. It was found that the risk of intracerebral hemorrhage was significantly correlated with the number of CMBs: 0% (without CMBs), 6.7% (1 CMBs) or 9.1% (2-4 CMBs) (鈮，

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