卒中合并脑微出血的影像学研究
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摘要
目的探讨ICH和脑梗死患者合并脑微出血(cerebral microbleeds,CMBs)数量分级及部位分布差异。方法连续选取2017年8月-2018年12月在北京市大兴区人民医院神经内科病房住院且资料完整的卒中患者,分为ICH和脑梗死两组。收集患者发病2周内头颅MRI磁敏感加权成像影像,统计ICH与脑梗死患者中CMBs数量分级及部位分布特点。结果共入组患者234例,其中ICH组79例,脑梗死组155例。ICH组合并CMBs65例(82.3%),其中CMBs>5个的患者41例(51.9%);脑梗死组合并CMBs73例(47.1%),其中CMBs>5个的患者21例(13.6%),两组差异有统计学意义(P<0.001)。ICH组中,CMBs同时累及脑叶和深部脑组织的患者40例(50.6%);脑梗死组中,CMBs同时累及脑叶和深部脑组织的患者25例(16.1%),两组差异有统计学意义(P<0.001)。结论 CMBs病灶>5个多见于ICH患者;CMBs同时累及脑叶及深部脑组织多见于ICH患者。
Objective To compare the incidence, amounts and distribution of cerebral microbleeds(CMBs) in cerebral hemorrhage patients and cerebral infarction patients.Methods Stroke patients with complete data from Department of Neurology of People Hospital of Beijing Daxing District from August 2017 to December 2018 were consecutively enrolled in this study. All subjects were divided into cerebral hemorrhage and cerebral infarction groups. The image data of MRI SWI of all the patients within two weeks of onset were collected, to analyze the incidence, amounts and distribution of CMBs of the two groups.Results A total of 234 patients were selected, including 79 cases of cerebral hemorrhage and 155 cases of cerebral infarction. 65(82.3%) cerebral hemorrhage patients had CMBs, and 41/65(51.9%) patients had the amount of CMBs >5; 73(47.1%) cerebral infarction patients had CMBs, 21/73(13.6%) patients had the amount of CMBs >5. and the difference between the two groups was statistically significant(P<0.001). In cerebral hemorrhage group, CMBs involved both lobes and deep brain tissue in 40 patients(50.6%); in cerebral infarction group, CMBs involved both lobes and deep brain tissue in 25 cases(16.1%), and the difference between the two groups was statistically significant(P<0.001).Conclusions The amount of CMBs >5 were more common in cerebral hemorrhage patients than in cerebral infarction patients. CMBs involving both cerebral lobe and deep brain tissue were also more common in cerebral hemorrhage patients than in cerebral infarction patients.
Objective To compare the incidence, amounts and distribution of cerebral microbleeds(CMBs) in cerebral hemorrhage patients and cerebral infarction patients.Methods Stroke patients with complete data from Department of Neurology of People Hospital of Beijing Daxing District from August 2017 to December 2018 were consecutively enrolled in this study. All subjects were divided into cerebral hemorrhage and cerebral infarction groups. The image data of MRI SWI of all the patients within two weeks of onset were collected, to analyze the incidence, amounts and distribution of CMBs of the two groups.Results A total of 234 patients were selected, including 79 cases of cerebral hemorrhage and 155 cases of cerebral infarction. 65(82.3%) cerebral hemorrhage patients had CMBs, and 41/65(51.9%) patients had the amount of CMBs >5; 73(47.1%) cerebral infarction patients had CMBs, 21/73(13.6%) patients had the amount of CMBs >5. and the difference between the two groups was statistically significant(P<0.001). In cerebral hemorrhage group, CMBs involved both lobes and deep brain tissue in 40 patients(50.6%); in cerebral infarction group, CMBs involved both lobes and deep brain tissue in 25 cases(16.1%), and the difference between the two groups was statistically significant(P<0.001).Conclusions The amount of CMBs >5 were more common in cerebral hemorrhage patients than in cerebral infarction patients. CMBs involving both cerebral lobe and deep brain tissue were also more common in cerebral hemorrhage patients than in cerebral infarction patients.
引文
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[13]SOO Y O,YANG S R,LAM W W,et al.Risk vs benefit of anti-thrombotic therapy in ischaemic stroke patients with cerebral microbleeds[J].J Neurol,2008,255(11):1679-1686.
[14]ROMERO J R,PREIS S R,BEISER A S,et al.Lipoprotein phospholipase A2 and cerebral microbleeds in the Framingham Heart study[J].Stroke,2012,43(11):3091-3094.
[15]THIJS V,LEMMENS R,SCHOOFS C,et al.Microbleeds and the risk of recurrent stroke[J].Stroke,2010,41(9):2005-2009.--
[2]GREGOIRE S M,BROWN M M,KALLIS C,et al.MRI detection of new micro-bleeds in patients with ischemic stroke five year cohort follow-up study[J].Stroke,2010,41(1):184-186.
[3]杨松,周志明,张志强,等.缺血性卒中患者脑微出血的相关因素分析[J].中华神经医学杂志,2010,9(1):64-67.
[4]徐金法,布青春,谢国华,等.高血压脑内微出血的3.0T MR诊断研究[J].影像诊断与介入放射学,2011,20(6):407-410.
[5]ZIEGLER D,MOVSESYAN L,MANKOVSKY B,et a1.Treatment of symptomatic polyneumpathy with actovegin in type 2 diabetic patients[J].Diabetes Care,2009,32(8):1479-1484.
[6]贾建平,苏川.神经病学[M].9版.北京:人民卫生出版社,2018:210.
[7]贾建平,苏川.神经病学[M].9版.北京:人民卫生出版社,2018:194.、
[8]GREENBERG S M,VERNOOIJ M W,CORDONNIER C,et al.Cerebral microbleeds:a guide to detection and interpretation[J].Lancet Neurol,2009,8(2):165-174.
[9]郭爱华,潘小平,程秋生,等.脑出血并脑微出血的临床与影像学特征[J].中华脑血管病杂志(电子版),2012,6(3):21-23.
[10]LAM C K,YOO T,HINER B,et a1.Embolus extravasation is an alternative mechanism for cerebral mierovaseular recanalization[J].Nature,2010,465(7297):478-482.
[11]SUN S,GAO P,SUI B,et al.Association between cerebral microbleeds and the first onset of intracerebral hemorrhage-a 3.0T MR study[J].Acta Radiol,2012,53(2):203-207.
[12]CORDONNIER C,AL-SHAHI SALMAN R,WARDLAW J,et a1.Spontaneous brain microbleeds:systematic review,subgroup analyses and standards for study design and reporting[J].Brain,2007,130(Pt 8):1988-2003.
[13]SOO Y O,YANG S R,LAM W W,et al.Risk vs benefit of anti-thrombotic therapy in ischaemic stroke patients with cerebral microbleeds[J].J Neurol,2008,255(11):1679-1686.
[14]ROMERO J R,PREIS S R,BEISER A S,et al.Lipoprotein phospholipase A2 and cerebral microbleeds in the Framingham Heart study[J].Stroke,2012,43(11):3091-3094.
[15]THIJS V,LEMMENS R,SCHOOFS C,et al.Microbleeds and the risk of recurrent stroke[J].Stroke,2010,41(9):2005-2009.--