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目的探讨脑内微出血(MB)在老年性脑梗死患者中的发生、危险因素及各TOAST亚型间的发生率的差异。方法连续收集老年性脑梗死的住院病例,详细记录临床资料,观察脑内微出血及白质病变(WMC)的严重程度。对所有入组病例行TOAST分型,观察各亚型间MB发现率的异同。结果694例老年性脑梗死患者进入本研究。217例患者(31.3%),其中26例小动脉闭塞型患者(55.3%)脑内存在MB。单因素分析显示年龄(P=0.021),高血压病(P=0.024),入院时收缩压(P<0.001)、舒张压水平(P<0.001),既往脑梗死病史(P<0.001)及口服抗血小板聚集药物史(P=0.002)与MB的发生有关。Logistic回归分析显示WMC分值(OR1.157,95%CI1.112￣1.203,P<0.001)、既往脑梗死病史(OR1.587,95%CI1.013￣2.486,P=0.044)及舒张压水平(OR1.019,95%CI1.007￣1.032,P=0.003)为MB的独立危险因素。结论老年性脑梗死患者,特别是小动脉闭塞型的患者,MB的发生率增高,提示更为严重的脑内微血管病变及可能的出血倾向。脑白质病变的严重程度、既往脑梗死病史、舒张压水平是老年性脑梗死患者脑内MB发生的独立危险因素。
Objective To investigate the occurrence of intracerebral hemorrhage (MB) in elderly patients with cerebral infarction, risk factors and the incidence of each subtype of TOAST. Methods The hospitalized cases of senile cerebral infarction were collected continuously, and the clinical data were recorded in detail to observe the severity of microbleeds and white matter lesions (WMC) in the brain. All the patients were enrolled in TOAST classification and observed the similarities and differences in the detection rate of MB between different subtypes. Results 694 cases of senile cerebral infarction patients entered the study. There were 217 patients (31.3%), of which 26 had arteriolar occlusion (55.3%) in the brain. Univariate analysis showed that age (P = 0.021), hypertension (P = 0.024), systolic blood pressure at admission (P <0.001), diastolic blood pressure (P <0.001), past history of cerebral infarction Anti-platelet aggregation drug history (P = 0.002) and the occurrence of MB. Logistic regression analysis showed that the WMC scores (OR1.157,95% CI1.112-1.203, P <0.001), past history of cerebral infarction (OR 1.587, 95% CI1.013-2.486, P = 0.044) and diastolic blood pressure (OR1.019, 95% CI 1.007 ~ 1.032, P = 0.003) were independent risk factors for MB. Conclusions Patients with senile cerebral infarction, especially those with arteriolar occlusion, have a higher incidence of MB, suggesting more severe intracranial microangiopathy and possible bleeding tendency. The severity of white matter lesions, past history of cerebral infarction, diastolic blood pressure level is an independent risk factor for brain MB in patients with senile cerebral infarction.