高血压性脑出血患者伴新发无症状性脑梗死的相关危险因素分析及预后的探讨

doi:10.16150/j.1671-2870.2016.05.012

摘要/Abstract

摘要： 目的: 探讨急性高血压性脑出血患者的新发无症状性脑梗死（silent brain infarction,SBI）的发生率及相关危险因素,同时探讨伴发新发SBI的脑出血患者发生临床脑血管事件或血管相关性死亡的情况。方法: 采用前瞻性研究,观察100例在发病3 d内经CT诊断为高血压性脑出血的患者,所有患者在发病第5天行MRI检查以明确新发SBI及脑微出血（cerebral microbleeds,CMBs）病灶,并在1年内定期随访后续的临床脑血管事件或血管相关性死亡。结果: 100例患者中,观察到11例（11%）共有14个新发SBI病灶。经单因素分析发现,基线水平中伴有CMBs和脑白质疏松是新发SBI的危险因素。在随访的1年内,14例患者发生了临床脑血管事件或血管相关性死亡,其中9例发生脑梗死,1例再发脑出血,4例发生血管相关性死亡。Cox比例风险模型显示,高龄、房颤和伴有新发SBI为发生临床脑血管事件或血管相关性死亡的独立预测因素。结论: 新发SBI在脑出血的急性期阶段常见,与CMBs及脑白质疏松相关。伴有新发SBI的高血压性脑出血患者未来1年内发生临床脑血管事件或血管相关性死亡的风险增加。

关键词: 无症状性脑梗死, 高血压性脑出血, 脑小血管病, 核磁共振

Abstract: Objective: To investigate the frequency and risk factors of new silent brain infarction (SBI) in patients with acute hypertensive intracerebral hemorrhage(ICH) and to analyze the association of new SBI with subsequent clinical cerebrovascular events and vascular related deaths. Methods: This prospective study was performed on 100 patients diagnosed as hypertensive ICH within 3 days after onset and MRI was performed on the fifth day after onset to detect new SBI and lesions of cerebral microbleeds(CMBs). Patients were regularly followed up one year for subsequent clinical cerebrovascular events and vascular related death. Results: Fourteen new SBI were observed in 11(11%) patients. Univariate analysis showed that baseline cerebral microbleeds (CMBs) and white matter leukoaraiosis were associated with new SBI. During 1 year of follow-up, 14 patients experienced clinical cerebrovascular events or vascular related deaths, including 9 cases of cerebral infarction, 1 case of recurrent cerebral hemorrhage and 4 cases of vascular related death. Cox proportional hazards models showed that age, atrial fibrillation and new SBI were independently associated with clinical cerebrovascular events or vascular related death. Conclusions: New SBI frequently occurs during the acute phase of ICH and is mainly associated with CMBs and white matter leukoaraiosis. The risk of subsequent clinical cerebrovascular events and vascular related death is increased in hypertensive ICH patients with new SBI.

Key words: Silent brain infarction, Hypertensive intracerebral hemorrhage, Cerebral small vessel diseases, Magnetic resonance imaging

中图分类号:

R743.3

慕瑾瑾, 杨康, 冯玉兰, 傅毅. 高血压性脑出血患者伴新发无症状性脑梗死的相关危险因素分析及预后的探讨[J]. 诊断学理论与实践, 2016, 15(05): 492-497.

MU Jinjin, YANG Kang, FENG Yulan, FU Yi. New silent cerebral infarction in patients with hypertensive intracerebral hemorrhage: related risk factors and prognosis[J]. Journal of Diagnostics Concepts & Practice, 2016, 15(05): 492-497.

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