CAJ | 학술논문

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。
목적평고뇌미출혈（cerebral microbleed，CMB）대채용항전치료적비강극성경사환자조기뇌출혈전화적예측개치。 　　방법본연구위전첨성연구，입선2011년6월～2012년10월광동성인민의원신경과발병후24 h내주원적심원성뇌전새급대동맥죽양경화성경사환자。근거림상정황대소유환자여이항혈소판혹항응치료。채용로뇌자공진성상（magnetic resonance imaging，MRI）검측CMB수목급분포정황，용로뇌계산궤단층소묘（computed tomography，CT）판단발병후1주내출혈전화（hemorrhagic transformation，HT）정황。근거유무HT장환자분위유HT조화무HT조，비교량조간일반림상자료、병인、미국국립위생연구원졸중량표（National Institutes of Health Stroke Scale，NIHSS）평분급CMB시부존재，병채용다인소축보Logistic회귀모형분석HT적독립위험인소。 　　결과167례환자중18례발생HT（11%），57례검출CMB（34%），CMB검출솔재시부합병HT적환자지간차이무현저성（분별위22%화36%，P＞0.05）。항혈소판치료환자시부존재CMB，조기HT차이무현저성（분별위12%화9%，P＞0.05）；항응치료환자차이무현저성（분별위17%화12%，P＞0.05）。Logistic회귀분석현NIHSS（≥8）화심원성뇌전새여HT유관，기비치비（odds ratio，OR）치분별위3.65[95%가신구간（confidence interval，CI）1.47～8.26]화5.82（95%CI 1.89～15.38）；고혈압、대동맥죽양경화이급CMB병불증가HT풍험，기OR화95%CI치분별위1.05（0.97～1.12），2.31（0.91～3.45）이급0.35（0.09～1.41）。 　　결론 CMB대비강극성뇌경사환자항전치료후조기HT결핍예측개치，질병엄중정도이급병인류형유조우고계HT풍험。
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 signiifcant difference of CMB between the patients with and without HT (22%vs 36%, P>0.05). The prevalence of early HT was not signiifcantly 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.