摘要目的 探讨脑微出血(CMBs)与短暂性脑缺血发作(TIA)后脑卒中发生的相关性,以指导临床早期判断患者预后及预防. 方法 对自2015年1月至2017年6月在淮南东方医院集团总院神经内科就诊的147例TIA患者,均在人院时及不同方案治疗(他汀治疗基础上给予单抗治疗29例、双抗治疗103例、抗凝治疗15例)1周后行头颅影像学检查评估CMBs情况,同时收集患者的一般资料、既往史、生化指标及影像学结果等,及随访观察患者治疗后90 d内脑卒中发生情况,采用单因素分析及多因素Logistic回归分析筛选影响TIA后脑卒中发生的危险因素. 结果 首次头颅影像学检查示存在CMBs患者共30例,治疗1周后复查示新增CMBs患者2例(单抗治疗1例,双抗治疗1例),不同治疗方案间新增CMBs比例差异无统计学意义(P＞0.05).在治疗后90 d随访中,147例TIA患者中发生脑卒中9例,未发生脑卒中138例.单因素分析显示,脑卒中发生组在心房颤动、ABCD2评分、颈动脉狭窄≥50％、CMBs、脑白质高信号比例方面与脑卒中未发生组比较差异均有统计学意义(P＜0.05);多因素Logistic回归分析表明,CMBs是TIA后脑卒中发生的独立危险因素(OR=4.126,P=0.003,95％CI:0.320～2.390). 结论 CMBs可以预测评估TIA后脑卒中的发生风险.

abstractsObjective To explore the relationship between cerebral micro-bleeds (CMBs) and recurrent stroke after transient ischemic attack (TIA),and to guide early diagnosis of prognoses.Methods A total of 147 patients with TIA,admitted to our hospital from January 2015 to June 2017,were enrolled;29 patients (19.73％) were given anti-platelet therapy,double-antibody treatment was performed in 103 patients (70.07％),15 patients (10.20％) were given anticoagulation,and 108 patients (73.47％) took statins.Intracranial imaging was performed on these patients on admission and one week after different treatments.The general data and biochemical markers were collected;the recurrent stroke after TIA within 90 d was followed up.Univariate analysis and multivariate Logistic regression were used to screen the risk factors for stroke after TIA.Results CMBs were noted in 30 patients (20.41％) at first intracranial imaging;another 2 patients with CMBs were noted at one week after treatments,and there were no significant differences in newly-detected CMBs among different treatment methods (P＞0.05).Nine patients (6.12％) had stroke recurrence.Univariate analysis indicated that the percentages of patients with atrial fibrillation,symptomatic carotid artery stenosis≥ 50％,CMBs and white matter high signal (WMH) and high ABCD2 scores between TIA patients with/without stroke were significantly different (P＜0.05).Multivariate Logistic regression showed that CMBs were the independent risk factors of recurrent stroke after TIA (OR=4.126,P=0.003,95％CI:0.320-2.390).Conclusion CMBs canpredict the risk of stroke recurrence after TIA.