急性脑梗死患者脑微出血的危险因素及其对心脑血管事件发生率影响的研究

Study on risk factors of cerebral microbleeds and its effect on incidence of cardiovascular and cerebrovascular events in patients with acute cerebral infarction

摘要:

目的??研究急性脑梗死（ACI）患者脑微出血（CMBs）的影响因素，以及 CMBs 对 ACI 患者再发心 脑血管事件发生率的影响。 方法??选取2014年3月—2017年4月武汉市第一医院神经内科住院的ACI患者131例， 分为无 CMBs 组（85 例）和 CMBs 组（46 例） 。根据两组患者的吸烟、 饮酒、 糖尿病、 高血压、 脑出血等既往史， 探讨引起 ACI 患者 CMBs 的危险因素，并分析 CMBs 对两组患者心脑血管事件发生情况的影响。结果??脑梗死、 脑出血既往史是引起 CMBs 的危险因素，年龄、性别、抽烟、高血压、冠状动脉粥样硬化性心脏病（以下简称 冠心病） 等一般资料不是 CMBs 的危险因素。131 例患者中 46 例?CMBs， 共查出脑微出血 183 个； 46 例 CMBs 中， 重度 17 例， 中度 13 例， 轻度 16 例。心脑血管事件主要为再发脑卒中、 脑梗死、 脑出血、 缺血性心脏病以及死亡。 CMBs 组患者的再发脑卒中和脑出血发生率与无 CMBs 组比较，差异有统计学意义（ P <0.05） ； CMBs 组患者 的脑梗死、缺血性心脏病及病死率与无 CMBs 组比较，差异无统计学意义（ P >0.05） ； CMBs 严重程度与再 发脑卒中发生率差异有统计学意义（ P <0.05） ，重度 CMBs 组的发生率最高 ； 脑梗死、脑出血、缺血性心脏 病及病死率与 CMBs 严重程度差异无统计学意义（ P >0.05） 。结论??脑梗死、脑出血既往史是脑微出血的危 险因素，而脑微出血也可一定程度增加 ACI 患者再发心脑血管事件发生率，脑微出血严重程度与脑出血发生 率呈正相关。

Abstract:

Objective To investigate the influencing factors of brain microbleeds (CMBs) in patients with acute cerebral infarction (ACI) and the effect of CMBs on the incidence of recurrent cardiovascular and cerebrovascular events in patients with ACI. Methods A total of 131 ACI patients admitted to the Department of Neurology, Wuhan NO. 1 Hospital from March 2014 to April 2017 were enrolled. The patients were divided into non-CMBs group (85 cases) and CMBs group (46 cases). According to the previous history of smoking, drinking, diabetes, hypertension, cerebral hemorrhage, the risk factors of CMBs in patients with ACI were discussed, and the effect of CMBs on the occurrence of cardiovascular and cerebrovascular events were analyzed. Results The past history of cerebral infarction and cerebral hemorrhage was a risk factor for CMBs. The general data such as age, gender, smoking, hypertension, coronary atherosclerotic heart disease (hereinafter referred to as coronary heart disease) were not risk factors for CMBs. Of the 131 patients, 46 were CMBs, and 183 brain microbleeds were detected. Of the 46 CMBs, 17 were severe, 13 were moderate, and 16 were mild. Cardiovascular and cerebrovascular events were mainly recurrent stroke, cerebral infarction, cerebral hemorrhage, ischemic heart disease and death. The incidence of recurrent stroke and cerebral hemorrhage in the CMBs group was significantly lower than that in the non-CMBs group (P < 0.05). The cerebral infarction, ischemic heart disease and mortality in the CMBs group were compared with those without CMBs. The difference was not statistically significant (P > 0.05); the difference between the severity of CMBs and the incidence of recurrent stroke was statistically significant (P < 0.05), and the incidence of severe CMBs was the highest. There was no significant difference between the severity of CMBs and the incidence of cerebral infarction, cerebral hemorrhage, ischemic heart disease and death (P > 0.05). Conclusions The past history of cerebral infarction and cerebral hemorrhage is a risk factor for CMBs, and CMBs can also increase the incidence of recurrent cardiovascular and cerebrovascular events in ACI patients. The severity of CMBs is positively correlated with the incidence of cerebral hemorrhage.