摘要目的 探讨伴脑微出血(CMBs)的急性缺血性脑卒中患者预后不良的影响因素.方法 采用前瞻性研究设计,以自2016年10月至2017年12月在徐州医科大学第二附属医院神经内科住院治疗的急性缺血性脑卒中患者为研究对象,收集整理患者的人口统计学、血管危险因素、影像学检查、 实验室检查及治疗方式等临床资料,并根据是否伴CMBs将患者分为CMBs组和无CMBs组.随访至发病后6个月时,依据改良Rankin量表(mRS)评分将CMBs组和无CMBs组患者分别分为预后不良(mRS评分>2分)亚组和预后良好(mRS评分0～2分)亚组.应用单因素分析及多因素Logistic回归分析筛选出患者预后不良的影响因素.结果 (1)共纳入274例急性缺血性脑卒中患者,其中CMBs组148例(54.01％),无CMBs组126例(45.99％).随访至发病后6个月时,241例患者完成随访,其中CMBs组131例(54.36％),包括预后不良62例(47.33％)、预后良好69例(52.67％);无CMBs组110例(45.64％),包括预后不良38例(34.55％)、预后良好72例(65.45％).CMBs组和无CMBs组间预后不良率比较差异有统计学意义(P<0.05).(2)单因素分析显示,CMBs组中预后不良亚组和预后良好亚组在年龄段分布、既往脑卒中或短暂性脑缺血发作史比例、脑卒中发病时间、TOAST病因学分型、脑卒中严重程度、脑卒中病灶数、治疗方式、出血转化、CMBs病灶数分级方面差异均有统计学意义(P<0.05).多因素Logistic回归分析显示,大动脉粥样硬化性脑卒中(OR=2.239,95％CI:1.432～2.947,P=0.044)、中重度脑卒中(OR=3.887,95％CI:2.403～4.643,P=0.021)、重度CMBs(OR=4.491,95％CI:2.879～6.802,P=0.017)、 出血转化(OR=2.411,95％CI:1.347～3.232,P=0.040)是预后不良的独立危险因素,静脉溶栓(OR=0.676,95％CI:0.324～0.865,P=0.039)是预后良好的独立保护因素.结论 CMBs在急性缺血性脑卒中患者中普遍存在,且伴CMBs者预后不良更常见.早期评估CMBs病灶数对预测急性缺血性脑卒中患者预后不良的发生有重要参考价值.

abstractsObjective To explore the influencing factors of poor outcome in acute ischemic stroke patients with cerebral microbleeds (CMBs). Methods In prospective study, patients with acute ischemic stroke, admitted to our hospital from October 2016 to December 2017, were divided into CMBs group and non CMBs group. The clinical data of demographics, vascular risk factors, imaging examination, laboratory examination and treatment were collected. Follow up was performed till 6 months of onset, the patients were divided into poor outcome group (modified Rankin scale [mRS] scores>2) and good outcome group (mRS scores 0-2). Univariate analysis and multivariate Logistic regression analysis were used to determine the factors of poor outcome in acute ischemic stroke patients with CMBs. Results (1) A total of 274 patients with acute ischemic stroke were enrolled in the study, including 148 patients (54.01％) of CMBs group and 126 patients (45.99％) of non CMBs group. At the 6 months of follow up, 241 patients finished follow up, and there were 131 patients (54.36％) from CMBs group, 62 patients (47.33％) with poor outcome and 69 patients (52.67％) with good outcome;there were 110 patients (45.64％) from non CMBs group, 38 patients (34.55％) with poor outcome and 72 patients (65.45％) with good outcome; the difference of poor outcome rate in the two groups was statistically significant (P<0.05). (2) Univariate analysis showed that the differences of age distribution, percentage of having history of previous stroke or transient ischemic attack, stroke onset time, TOAST etiology type, stroke severity, number of stroke lesions, treatment methods, hemorrhagic transformation, number of CMBs lesions for grading in CMBs patients from poor and good outcome subgroups had statistical significance (P<0.05). Multivariable Logistic regression analysis showed that large atherosclerotic (odds ratio [OR]=2.239, 95％ confidence interval [CI]: 1.432-2.947, P=0.044), moderate and severe stroke (OR=3.887, 95％CI: 2.403-4.643, P=0.021), severe CMBs (OR=4.491, 95％CI:2.879-6.802, P=0.017), hemorrhagic transformation (OR=2.411, 95％CI: 1.347-3.232, P=0.040) were independent risk factors for poor outcome, and intravenous thrombolysis (OR=0.676, 95％ CI:0.324-0.865, P=0.039) was independent protective factor for good outcome. Conclusions CMBs is prevalent and poor outcome is more common in acute ischemic stroke patients with CMBs. Early evaluating the number of CMBs lesions has important reference value in predicting the occurrence of poor outcome in patients with acute ischemic stroke.